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The Resection of A Large Cervical Mass in an Eleven Year Old Girl
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Poster Abstracts
Comments: This is an interesting and unique case of a disorder of sexual development.
when a pelvic ultrasound is reported as unremarkable.(Figures 1 and 2)
doi:10.1016/j.jpag.2010.01.033
The Resection of A Large Cervical Mass in an Eleven Year Old Girl Kerry Rut, DO, and Elana Kastner, MD Winthrop University Hospital - Mineola, New York
Background: Immaturity of the hypothalamicpituitary-ovarian axis accounts for a large majority of abnormal uterine bleeding in adolescents. Other causes include infections, coagulopathies, endocrinopathies, systemic diseases, medications, and complications of pregnancy. Tumors are a rare cause of abnormal uterine bleeding in this age group. Case: This is an unusual case of an eleven year old who presented to her pediatrician with daily vaginal bleeding of four months duration. Bloodwork and a transabdominal pelvic ultrasound were unremarkable. The patient was started on oral contraceptives by her pediatric endocrinologist with no change in her bleeding. The patient was sent to us for gynecologic evaluation. Vaginal examination revealed a large, bulbous mass with irregular borders filling the vagina. The mass was firm in texture and friable to the touch. No normal cervical tissue was palpable. Rectal examination confirmed the presence of a uterus and adnexa that were free of masses. A pelvic MRI demonstrated a 7.9 x 5.6 x 6.6 cm mass arising from the cervix and lower uterine segment. The patient was taken to the operating room for a resection of the mass. Electrocautery and sharp dissection were utilized during the resection. The base of the polyp was noted to be large and broad, spanning the left lower uterine segment and the length of the cervix. It was difficult to delineate a plane between the mass and normal cervical tissue. The bulk of the mass was removed. A small portion of the mass in the endocervical wall was left in situ to avoid damaging normal tissue. The frozen section and final pathology showed a benign endometrial polyp. The patient is scheduled to follow up as an outpatient. Comments: Although a benign polyp was included in our differential diagnosis, the gross appearance and the characteristics of the mass did not coincide with the final pathology. Our initial clinical impression favored a mass of malignant origin. Of clinical importance, this case emphasizes the need for vaginal examinations in selected adolescent patients. In addition, we as physicians must not be complacent
Figure 1
Figure 2
doi:10.1016/j.jpag.2010.01.034
Poster Abstracts
Comments: This is an interesting and unique case of a disorder of sexual development.
when a pelvic ultrasound is reported as unremarkable.(Figures 1 and 2)
doi:10.1016/j.jpag.2010.01.033
The Resection of A Large Cervical Mass in an Eleven Year Old Girl Kerry Rut, DO, and Elana Kastner, MD Winthrop University Hospital - Mineola, New York
Background: Immaturity of the hypothalamicpituitary-ovarian axis accounts for a large majority of abnormal uterine bleeding in adolescents. Other causes include infections, coagulopathies, endocrinopathies, systemic diseases, medications, and complications of pregnancy. Tumors are a rare cause of abnormal uterine bleeding in this age group. Case: This is an unusual case of an eleven year old who presented to her pediatrician with daily vaginal bleeding of four months duration. Bloodwork and a transabdominal pelvic ultrasound were unremarkable. The patient was started on oral contraceptives by her pediatric endocrinologist with no change in her bleeding. The patient was sent to us for gynecologic evaluation. Vaginal examination revealed a large, bulbous mass with irregular borders filling the vagina. The mass was firm in texture and friable to the touch. No normal cervical tissue was palpable. Rectal examination confirmed the presence of a uterus and adnexa that were free of masses. A pelvic MRI demonstrated a 7.9 x 5.6 x 6.6 cm mass arising from the cervix and lower uterine segment. The patient was taken to the operating room for a resection of the mass. Electrocautery and sharp dissection were utilized during the resection. The base of the polyp was noted to be large and broad, spanning the left lower uterine segment and the length of the cervix. It was difficult to delineate a plane between the mass and normal cervical tissue. The bulk of the mass was removed. A small portion of the mass in the endocervical wall was left in situ to avoid damaging normal tissue. The frozen section and final pathology showed a benign endometrial polyp. The patient is scheduled to follow up as an outpatient. Comments: Although a benign polyp was included in our differential diagnosis, the gross appearance and the characteristics of the mass did not coincide with the final pathology. Our initial clinical impression favored a mass of malignant origin. Of clinical importance, this case emphasizes the need for vaginal examinations in selected adolescent patients. In addition, we as physicians must not be complacent
Figure 1
Figure 2
doi:10.1016/j.jpag.2010.01.034