The management of an ectopic ovary in the inguinal canal: literature review and discussion.

We report the case of a female adolescent who had an ectopic ovary in the inguinal canal without an associated hernia, a unicornuate uterus, and ipsilateral renal agenesis. The incidental discovery of the ectopic ovary and other Mullerian anomalies, as well as the surgical correction that followed, highlights important fertility considerations in children and available treatment algorithms for these rare cases.

A large pelvic mass in an adolescent patient with granulomatous nephritis: case report and discussion of treatment challenges.

BACKGROUND: An adolescent patient with granulomatous nephritis presents with a large, solid pelvic mass. Pertinent differential diagnosis for this solid ovarian mass as well as discussion regarding treatment challenges for this patient is delineated. CASE: A 15-year-old female presented to her primary care doctor with fatigue and syncope. Initial laboratory workup revealed a hemoglobin of 7.9 g/dL, an elevated creatinine of 3.5 mmol/L, and an elevated ionized calcium of 13.1 mg/dL. Renal biopsy revealed diffuse non-caseating granulomatous nephritis with rare acid-fast bacilli. Renal ultrasound first noted a pelvic mass. Pelvic ultrasound revealed a 15.0 x 8.4 x 12.2 cm mass, characterized as mostly solid with diffuse spaces, in the location of the right ovary. CA-125 and the lactate dehydrogenase (LDH) tumor markers were elevated. The patient underwent a left salpingo-oophorectomy and pelvic staging. Intra-operative frozen section revealed a dysgerminoma. Final pathology report revealed extensive non-caseating granulomatous inflammation within the ovarian tumor. Special stains showed no evidence of acid-fast organisms. CONCLUSION: Dysgerminoma is the most likely solid ovarian tumor in a patient of this age. In light of her initial renal biopsy with acid-fast bacilli, pelvic tuberculosis needs to be considered. Due to its extreme rarity, sarcoidosis of her genital tract should be lower on the differential, yet this patient presented with pathology consistent with non-caseating granulomas suggesting this diagnosis. Once ovarian dysgerminoma was diagnosed, the possibility that this patient's renal findings may represent paraneoplastic syndrome also becomes important for her treatment.

Van Wyk and Grumbach syndrome revisited: imaging and clinical findings in pre- and postpubertal girls.

BACKGROUND: In 1960 Van Wyk and Grumbach described a syndrome of juvenile hypothyroidism, precocious puberty and ovarian enlargement. These findings undergo complete regression with thyroid hormone replacement therapy. This diagnosis can be made on the basis of imaging findings and thyroid function analysis, avoiding surgery. OBJECTIVE: To relate the distinctive clinical and imaging features and putative pathophysiological mechanism of a series of patients with Van Wyk and Grumbach syndrome (VWGS). MATERIALS AND METHODS: Patients with VWGS diagnosed at two large children's hospitals over a 6-year period beginning in 1999 were retrospectively reviewed. A literature review was also conducted. RESULTS: Five female patients were diagnosed with cystic ovarian enlargement and hypothyroidism at ages ranging from 9 to 17 years. Isosexual precocious puberty was found in prepubescent patients. Associated findings included delayed bone age, ascites, and pleural and pericardial effusions. Ovarian cyst involution occurred following treatment of the hypothyroidism. CONCLUSION: The association of primary hypothyroidism with cystic ovarian enlargement and precocious puberty is important to recognize. In the absence of suspected ovarian torsion, surgery is unnecessary, as cyst regression occurs after appropriate thyroid hormone replacement. Noncompliance with hormone replacement therapy should be considered when cystic ovarian enlargement is noted in patients with a history of hypothyroidism.