Squamous Carcinoma of the Cervix in a 15-Year-Old with Congenital HIV: A Case Report.

BACKGROUND: Human papillomavirus (HPV) is the most prevalent sexually transmitted infection (STI) worldwide. Immunocompetent hosts have intact defense mechanisms to prevent HPV infection, but immunocompromised patients are at higher risk for complications, including HPV-related cancers. Most of these cancers originate from high-risk HPV strains in sexually active patients. CASE: Here we present a case of an immunocompromised adolescent who developed cervical cancer despite no prior sexual activity and only ever having had low-risk type HPV on biopsy. SUMMARY AND CONCLUSIONS: To our knowledge, this is the first case report of a cervical cancer arising from a low-risk HPV strain in an immunocompromised, non-sexually active adolescent. This case highlights the importance of preventive and screening mechanisms in immunocompromised populations, as they are have a higher probability of HPV-related complications, even in the absence of traditional risk factors.

Therapy for anogenital verrucae in preadolescent children with topical and systemic treatment.

BACKGROUND/OBJECTIVES: Anogenital verrucae (AV) are benign, human papillomavirus (HPV)-induced tumors of the anogenital skin and mucosa. Medical therapy for AV in preadolescents has not been well studied. We explore the efficacy and safety profile of sinecatechins 15% ointment and imiquimod 5% cream in the treatment of AV, alone and in combination therapy with other commonly used medications. METHODS: A single-institution, retrospective review of children under 12 years of age with AV treated with imiquimod 5% cream and sinecatechins 15% ointment was performed. Demographic data, side effects, and outcomes of therapy were recorded for each patient, and overall efficacy was determined. RESULTS: A total of 37 patients met inclusion criteria. Responses were seen in 8 out of 9 patients treated with sinecatechins 15% ointment (5 full, 3 partial, and 1 no response) and 9 out of 17 patients treated with imiquimod 5% cream (4 full, 5 partial, and 8 no response). Combination therapy with one or more of the following treatments (podophyllin, cimetidine, candida antigen injection, and HPV vaccine) were evaluated, but no combination was objectively superior to the others. No significant difference was found in overall efficacy between sinecatechins and imiquimod. Side effects were mild and limited to irritation and erythema. CONCLUSIONS: Both imiquimod 5% cream and sinecatechins 15% ointment are moderately effective in the treatment of AV in preadolescent children, with a trend toward greater effectiveness of sinecatechins. Combination therapy with other treatments did not significantly increase the effectiveness of topical therapies. Each modality has a tolerable side effect profile with a low risk of serious complications.

Female reproductive structures found in inguinal hernia sacs: A retrospective review.

BACKGROUND: In female infants undergoing herniorrhaphy, there is a reported incidence of 15%-20% of prolapsed adnexal structures. Our primary aim is to confirm the incidence of adnexal tissue in hernia sacs at the time of repair and to further delineate the clinical characteristics of this population at a major pediatric institution. METHODS: Retrospective chart review of all cases of herniorrhaphy in female patients less than the age of 18 from June 2009 to December 2015 in a large tertiary referral children's hospital. RESULTS: The overall incidence of patients with gynecological findings during herniorrhaphy was 11.2%. For patients with positive findings, the average gestational age at birth was 34.07 weeks, the age at surgery was 0.99 years, and the rate of right-sided hernias was 43.2%. For patients with negative findings, the average gestational age at birth was 38.23 weeks, the age at surgery was 5.14 years, and the rate of right-sided hernias was 23.2%. CONCLUSIONS: Incidence of adnexal structures found in hernia sacs is comparable to previously reported figures. These patients had a significantly lower gestational age at birth, lower age at surgery, and lower rate of right-sided hernias from the general population and from those without gynecological findings during herniorrhaphy. LEVEL OF EVIDENCE: Level II.

Vulvar Nodules: A Rare Presentation of Mastocytosis.

BACKGROUND: Mastocytosis is a rare benign disorder characterized by the finding of mast cells in the skin and other organs, occurring in adult as well as pediatric age groups. The cutaneous form is the most common presentation in childhood and is rarely located on the vulva. CASE: A 9-year-old prepubertal girl presented with bilateral vulvar nodules found incidentally by her pediatrician. Biopsy and histopathologic review confirmed mastocytosis. Her lesions significantly diminished over the following year. SUMMARY AND CONCLUSION: Mastocytosis should be on the differential for lesions on the vulva in children, in addition to the more common disorders such as condyloma acuminata and molluscum contagiosum. It is a benign condition in children, and conservative, symptomatic management is recommended.

Bilateral mucinous cystadenomas and massive edema of the ovaries in a virilized adolescent girl.

BACKGROUND: Ovarian pathology, including nonfunctional tumors and massive edema of the ovary, has been associated with stromal luteinization and clinical endocrinopathies. CASE: An adolescent girl presented with primary amenorrhea, clitoromegaly, and large abdominopelvic mass. Laboratory evaluation revealed an elevated serum total testosterone level of 241 ng/dL. Magnetic resonance imaging confirmed three cystic adnexal structures, with the largest measuring 16 × 8 × 18 cm. Surgery with pelvic washings, bilateral ovarian cystectomies, unilateral paratubal cystectomy, and bilateral ovarian biopsies were performed. Pathology confirmed bilateral mucinous cystadenomas and massive edema of the ovaries. Postoperatively, the serum total testosterone level normalized. CONCLUSION: Nonfunctional ovarian tumors and massive edema of the ovaries should be considered in the differential diagnosis for a patient presenting with signs of hyperandrogenism.

Assisted reproductive technologies and multiple gestations.

Since the first in vitro fertilization infant was born in England in 1978, the practice of assisted reproductive technology (ART) has steadily increased as the technology and success rates have improved. The incidence of multiple gestations has also increased, primarily owing to the practice of transferring multiple embryos during an ART cycle. Guidelines for infertility clinics have been outlined, along with strategies to limit the number of embryos transferred (depending on the age of the patient) to achieve a lower risk of multiple births. Since 1997, a decrease has occurred in the number of embryos transferred and the percentage of gestations with three or more fetuses, accompanied by a steady increase in the percentage of live births per cycle.

Pediatric gynecology: assessment strategies and common problems.

Pediatric gynecology is an emerging subspecialty involving the collaborative efforts of health professionals from gynecology, pediatrics, and urology. The gynecologic problems encountered in the pediatric population are unique to this age group and involve physician skills differing from those utilized with an adult population. The purpose of this manuscript is to describe the normal anatomy and physiology of the reproductive tract and genitalia and common problems seen in the prepubertal female. Common anatomic variations are considered. Suggestions on assessment techniques for evaluation of the young child are discussed. Presentation of common gynecologic problems in the prepubertal child will include common symptoms, evaluation and testing, and management to enable the practicing gynecology health professional to provide compassionate and quality care to the young female.