Clinical Characterization of Patients with Ovarian Mass Combined with Dysplasia of Secondary Sexual Characteristics / 中国医学科学院学报

Objective To investigate the clinical characteristics of preadolescent and adolescent female patients with ovarian mass combined with dysplasia of secondary sexual characteristics. Methods This study retrospectively analyzed 18 cases of ovarian mass combined with dysplasia of secondary sexual characteristics aged 0-19 years admitted to Peking Union Medical College Hospital from January 2012 to November 2019.By analyzing the clinical manifestations,surgical methods,postoperative pathology,therapies and prognosis of the cases,we summarized the diagnosis and treatment ideas. Results Among the 18 cases,7(7/18,38.9%)developed secondary sex signs before puberty,including 5 cases showing precocity(including 2 cases of juvenile granulosa cell tumor,1 case of gonadoblastoma,1 case of ovarian follicular cyst,and 1 case of 46,XY simple gonadal dysplasia combined with dysgerminoma)and 2 cases presenting masculine manifestations(1 case of steroid cell tumor and 1 case of sclerosing stromal tumor).The rest 11(11/18,61.1%)cases showed abnormal development of secondary sexual characteristics during puberty,including 8 cases with masculine manifestations or abnormal menstruation after menarche(7 cases with sex cord stromal cell tumor and 1 case with cystic granulosa cell tumor),2 cases with primary amenorrhea(1 case with androgen insensitivity syndrome combined with testicular sertoli cell tumor and 1 case with endometriosis cyst combined with reproductive tract malformation),and 1 case diagnosed as 46,XX gonadal dysplasia with serous cystadenoma and no secondary sexual development during puberty. Conclusions Sex hormone levels should be actively tested in the case of prepubertal secondary sexual characteristics appearing early,pubertal secondary sexual characteristics being abnormal(underdevelopment),and/or menstrual abnormalities.Imaging examination should be performed to exclude ovarian organic lesions,and chromosome karyotype analysis should be performed if necessary.The diagnosis of ovarian mass in preadolescent and adolescent females with related symptoms should first be alerted to cord stromal cell tumor.It is recommended to rule out the possibility of combined reproductive tract malformation in the adolescent patients with primary amenorrhea.Chromosome examination should be conducted to rule out the possibility of gonadal dysplasia in the adolescent patients with primary amenorrhea and/or no development of secondary sexual characteristics.

Cambios en los caracteres sexuales secundarios del paciente con disforia de género a consecuencia del tratamiento endocrino en Cuba / Changes in the secondary sexual characteristics of the patient with gender dysphoria as a result of endocrine therapy in Cuba

RESUMEN Introducción: La transexualidad es una incongruencia entre el sexo con el que se nace y el sexo al que se siente pertenecer, por tanto, estas personas desean cambios en su apariencia física que se logran mediante el tratamiento hormonal. Objetivo: Describir los cambios en los caracteres sexuales secundarios en pacientes con disforia de género en Cuba como consecuencia del tratamiento endocrino. Métodos: Se realizó un estudio de revisión de las historias clínicas en 76 pacientes atendidas por disforia de género en los últimos 15 años. Se extrajo la información relacionada con datos sociodemográficos y algunos cambios físicos, como resultado del traamiento hormonal. Para el análisis de los datos se obtuvieron distribuciones de frecuencia de las variables cualitativas, media y desviación estándar de las cuantitativas. Resultados: La mayoría de los pacientes corresponde a transexuales de hombre a mujer (THM). Al año, la mayoría de las personas ya tenían un estadio III o IV de desarrollo mamario (45,3 por ciento de estos tenían estadio III y el 32,3 por ciento estadio IV). Al año de iniciada la atención de los 58 pacientes, 41,4 por ciento tenían un patrón de vello triangular típico del sexo femenino con el que se identifican y a los 2 años ascendió al 80,5 por ciento. Al año se evaluaron 50 por ciento de todos los casos y en ese momento solo 5,1 por ciento mantenían un vello facial intenso y más de la mitad (56,8 por ciento), ya no tenían. Al inicio, la media del volumen testicular fue de 17,4 ml, a los 3 meses fue de 15,7 ml, a los 6 meses 14,3 ml y 9,7 ml al año. Conclusiones: Los pacientes con disforia de género en la mayoría de los casos logran cambios en los caracteres sexuales secundarios acordes al sexo con que se identifican(AU)

ABSTRACT Introduction: Transsexualism is an inconsistency between the sex with which someone was born and the sex he or she feels belong to; therefore, these subjects want to do changes in their physical appearance that are achieved through hormonal treatment. Objective: To describe changes in the secondary sexual characteristics in patients with gender dysphoria in Cuba as a result of endocrine therapy. Methods: A study was conducted to review the clinical records in 76 patients treated by gender dysphoria in the past 15 years. It was collected the information related to socio-demographic data and some physical changes as a result of the hormonal therapy. For data analysis were obtained frequency distributions of the qualitative variables, the mean and the standard deviation of the quantitative ones. Results: The majority of patients correspond to male to female transsexuals (THM, by its acronym in Spanish). A year after, the majority of the patients already studied had a stage III or stage IV of breast development (45.3 percent) of these had stage III and 32.3 percent had stage IV). A year after the start of the attention of the 58 patients, 41.4 percent had a pattern of triangular hair typical of the female sex which they feel identified with and after 2 years it increased to 80.5 percent. After a year, there were evaluated 50 percent of all cases and at that time only 5.1 percent maintained intense facial hair, and more than half (56.8 percent) had no facial hair. At the beginning, the mean of testicular volume was 17.4 mL, after 3 months it was 15.7 mL, after 6 months was 14.3 mL and 9.7 mL after a year. Conclusions: Patients with gender dysphoria in most cases achieve changes in the secondary sexual characteristics in accordance with the sex which they feel identified with(AU)

Color pattern variation in Cichla temensis (Perciformes: Cichlidae): resolution based on morphological, molecular, and reproductive data

Morphological variants of Cichla temensis, readily differentiated by their striking color pattern differences, are found in several Amazon basin flood pulse river systems. The adult variants have at times been thought to represent different species or sexual dimorphism. A three part study was performed in two regions in Brazil (rio Igapó Açú and rio Caures) to elucidate the nature of the variants. In part one; selected diagnostic morphometric characters were compared intraspecifically among the variants and interspecifically with C. monoculus and C. orinocensis. All of the C. temensis variants were found to differ significantly from their sympatric congeners while not differing among each other. In part two, mitochondrial DNA samples were compared intraspecifically among the variants and interspecifically with their sympatric congeners. There were no diagnostic molecular synapomorphies that would unambiguously distinguish the variants and all C. temensis variants were clearly diagnosable and divergent from their sympatric congeners. In part three, color pattern variation in both sexes was compared to a gonadosomatic index (GSI). A significant correlation between color pattern variation and gonadosomatic index was found. The results of this study demonstrate that Cichla temensis variants are confirmed to be members of a single species and that the variation does not represent a sexual dimorphism. The color pattern variation is a cyclically occurring secondary sexual characteristic and is indicative of the specific degree of an individual's seasonal sexual maturation.

Variantes morfológicas de Cichla temensis, facilmente diferenciados por seus padrões de coloração marcantes, são encontrados em vários rios do sistema de inundação da várzea da bacia Amazônica. Variantes dos indivíduos adultos têm sido cogitados como pertencerem a uma diferente espécie ou apresentarem dimorfismo sexual. Um estudo em três etapas foi realizado em duas regiões no Brasil (rio Igapó Açú e rio Caures) para elucidar a natureza desta variação. Na primeira parte, caracteres morfométricos diagnósticos foram comparados intraespecificamente entre os variantes e interespecificamente com C. monoculus e C. orinocensis. Todos os variantes de C. temensis apresentaram diferenças significativas quando comparados com seus congêneres simpátricos enquanto não diferiram entre si. Na segunda parte, sequências de DNA mitocondrial foram comparadas intraespecificamente entre os variantes e interespeficamente com seus congêneres simpátricos. Não houve sinapomorfias moleculares diagnósticas para diferenciar inequivocamente os variantes e todos os variantes de C. temensis foram claramente divergentes de seus congêneres simpátricos. Na terceira parte, a variação no padrão de cor em ambos os sexos foi comparado ao índice gonadossomático (GSI). Foi encontrada uma correlação significativa entre a variação na coloração e o índice gonadossomático. Os resultados deste estudo demonstram que os variantes em Cichla temensis são membros de uma única espécie e que a variação não representa um dimorfismo sexual. A variação no padrão de cor é uma característica sexual secundária que ocorre em ciclos, sendo um indicativo do grau de maturação sexual sazonal dos indivíduos.

The Delinquency, Depression, and Anxiety Level on Timing on Expression of Secondary Sex Characteristics in Adolescents / 신경정신의학

OBJECTIVES: This survey was attempted to examine the psychological significance, such as depression, anxiety and delinquent, of pubertal changes(expressions of secondary sexual characteristics) between student and delinqent group. METHOD: Data were collected through self-report questionnaire survey over a period 12 months. Subjects served for this study consisted of 248 adolescents including 90 delinquent adolescents and 158 student adolescents in Korea, sampled from Korean middle school population and delinquent adolescent population confined in juvenile corrective institutions. The SDS & SAS were used to evaluate the state of depression & anxiety in adolescents, respectively. RESULT: 1) The early-bloomer outnumbered late-bloomer in male delinquent adolescent. 2) There were the significant differences in first experiences of masturbation, expression of pubic hair, expression of axillary hair, expression of facial hair among secondary sexual characteristics between both groups. 3) In student adolescent, there was no significant difference in anxiety, depression level between early-bloomer and late-bloomer. 4) In male delinquent adolescent, late-bloomer was significantly more anxious, depressive than early-bloomer. CONCLUSION: These findings suggest the rapid pubertal changes during adolescence have effect on delinquency, depression, anxiety, especially male. Furthermore we may assume that this preliminary results will provide useful information in understanding the psychological aspect of adolescents.