Skene's gland adenocarcinoma resembling prostatic adenocarcinoma.

An 88-year-old woman presented with gross hematuria and a 3-cm periurethral mass. Biopsy revealed an adenocarcinoma resembling prostatic adenocarcinoma; the tumor cells were positive for keratin and prostate-specific antigen. The serum level of prostate-specific antigen was elevated; the carcinoembryonic antigen and CA-125 serum levels were normal. One year after external beam radiotherapy, the patient is without evidence of disease. This is the sixth case of a urethral prostatic-type adenocarcinoma, tumors that are most likely of Skene's gland origin.     

Adenocarcinoma of Skene's duct associated with a systemic coagulopathy

Adenocarcinoma of the urethra is a rare neoplasm which is believed to arise from the periurethral ducts. Four such cases have been diagnosed at our institution during the past 25 years and their clinical courses are summarized in this report. In one patient, a disseminated coagulopathy with a predominantly fibrinolytic component developed. The pathologic mechanism of fibrinolysis is addressed and a successful approach to the medical management of this confusing coagulopathy is outlined.     

Prepubertal vulvovaginopathies.

The vast majority of prepubertal gynecologic problems fall into three categories. The most serious category includes those "things that bleed": sarcoma botryoides, trauma (including sexual abuse), vaginal foreign objects, condylomata, urethral prolapse, and single organism vaginitis. Very rarely, the clinician will see precocious menarche, metastatic Crohn's disease, vascular vulvar lesions, and factitious cases. The next category contains entities that have an abnormal appearance: ambiguous genitalia, periurethral cysts of the newborn, hymenal variants, and agglutination of the labia and vulva. Rarely, an underlying skin disorder such as lichen sclerosus, seborrhea, or atopic vulvitis will be seen. The last and most bothersome category, distinguished by its symptoms of pruritus and discharge, includes the most common types of vulvovaginitis.     

Prepubertal menarche: a defined clinical entity

Prepubertal vaginal bleeding is considered as isolated menarche when, in the absence of detectable abnormality, it is not accompanied by any evidence of sexual development. The etiology remains unclear and various hypotheses have been put forward. This is the first time that a series of ultrasound patients with prepubertal menarche whose investigation has included imaging with ultrasound has been described. This paper illustrates isolated prepubertal menarche without the presence of an endometrial echo.     

Personal Hygiene and Vulvovaginitis in Prepubertal Children

Study ObjectiveTo determine and compare clinical and microbiological features of vulvovaginitis in prepubertal girls. Vulvovaginitis is the most common gynecological problem of childhood.Design, Setting, Participants, Interventions, and Main Outcome MeasuresThis study involved 45 girls from 2-12 (5.38 ± 2.9) years old; and 26 girls from 3-12 (5.72 ± 3.1) years old as a control group. Anamnesis and physical examination were followed by vaginal smear, urine culture, and stool analyses from both groups, and the personal hygiene status and education level of the mother were determined.ResultsThe most common symptoms among the patients were vaginal discharge (44.4%, vulvar erythema (37.8%), and vaginal itch (24.4%). Microorganisms, isolated from vaginal smears, were detected in 48.9% of the patients. Escherichia coli was shown in the urine culture of 3 patients with vulvovaginitis (6.70%). In microscopic stool analysis parasites were detected (45.9%). We found some relevant personal hygiene factors, such as wiping back to front (42.9%), cleaning by herself after defecation (89.3%), using toilet paper (60.7%) and wet wipes (21.4%), and bathing standing (14.3%) and sitting (46.4%) among patients. The questionnaire also showed that the children wore tight clothing (35.7%).ConclusionOur findings suggest that vulvovaginitis in prepubertal girls is related not only to microorganisms but also poor personal hygiene, the educational status of mothers, and specific irritants.     

Breast Abscess in Lactation

A.B. is a 29‐year‐old gravida 1 para 1001 who experienced recurrent lactational breast abscess requiring surgical treatment. Her obstetric, medical, surgical, family, and social histories are unremarkable. She takes no medications and does not use alcohol, tobacco, or drugs. She gave birth at 41 weeks'gestation to a female infant, weighing 8 pounds 5 ounces. Her intrapartum course and immediate postpartum course were within normal limits. Breastfeeding was initiated within 40 minutes of birth and was successful. Her infant nursed on demand approximately every 2 to 4 hours while in the hospital. A.B. was discharged home with her baby at 28 hours postpartum. On day 3 postpartum, A.B.'s left nipple became cracked and bleeding. This was self‐treated with lanolin ointment and correction of latch‐on technique. Ten days postpartum, A.B. was diagnosed with mastitis and treated with dicloxacillin for 10 days. After 8 days of antibiotic treatment, she reported continued breast pain with a firm area of exquisite pain and redness in the upper outer quadrant of her left breast. The midwife ordered a breast ultrasound which revealed a 4‐cm abscess in the left breast. A.B. was referred to a therapeutic radiologist who performed an ultrasound‐guided needle aspiration of the abscess and obtained 15 mL of fluid. The fluid culture was positive for Staphylococcus aureus. She was treated postprocedure with doxycycline, and the breast pain, firmness and redness resolved within 36 hours. The rationale for treatment with doxycycline is unknown and subject to inquiry because S aureus is not sensitive to doxycycline. 1 Two weeks after the procedure, the abscess returned, and she was again treated with ultrasound‐guided needle aspiration and a regimen of amoxicillin with clavulanate. The abscess partially resolved, but worsened 6 days later. At that time, A.B. was referred to a breast surgeon who surgically incised and drained this 6‐cm abscess under general anesthesia. She was discharged home the same day with an indwelling Penrose drain. Two days later, the drain was removed and the wound was healing normally. A.B. continued breastfeeding exclusively throughout all of these events and was completely healed by 3 weeks after the incision and drainage. At 5 months postpartum, she had not experienced further breast infections and was continuing to breastfeed her baby.     

Innervation of the Labia Minora of Prepubertal Girls

IntroductionSurgical and histologic sources of information give little reference to innervation, vascular, and epithelial details of the labia minora. Little is known about areas of nerve density, epithelial qualities, and vascular compartments of the labial minora that contribute to sexual arousal and orgasm. Surgical procedure development and counsel about surgical risks related to labioplasty and surgical flaps created from labial tissue may be based on inadequate information.MethodsLabial samples from 10 normal girls (aged 2–9 years) who underwent surgery for labial fusion utilized waste tissue strips for immunohistochemical identification of S-100 and neuronal nitric oxide synthase (nNOS) in the labia minora.ResultsVascular and lymphatic plexus lie within the reticular dermis, which contains a dense mesh of nerve fibers with a higher concentration of nerve fiber at the level of the subepithelial plexus. Dense innervations are located at the epidermis, extending along the basal and spinous layers of the epithelium of labia minora. Nerve bundles in the papillary dermis are associated with sebaceous and eccrine glands and nerve terminals located throughout the epithelium. The introital epithelium of the labia minora is highly innervated with widespread and intense staining, detected in the introital border of the labia minora versus the external one. The dermis appeared to display S-100 and nNOS immunolabelling. S-100 was also immunopositive in the epidermis.ConclusionLabia minora is highly innervated along its entire edge. Related vascular compartment tissue involved in engorgement during sexual arousal makes this tissue important for sexual response. Labioplasty risks removal of tissue with an important contribution to sensory sexual arousal. Movement of labial tissue during genitoplasty may have different sensory outcomes dependent on which labial surface is used.     

Literature Review of Periclitoral Cysts in the Prepubertal Population

Study ObjectiveClitoral cysts in the pediatric population are rare conditions that require careful evaluation. In this review of the literature we discuss the evaluation of clitoral abnormalities in the pediatric population, the development of clitoral cysts, and how to differentiate benign from malignant tumors. In addition, a summary of relevant cases of clitoral tumors in the literature are discussed.DesignLiterature review.Data SourceA MedLine and advanced PubMed search was conducted of all English language articles published using the search terms “clitoris” and “cyst” until February 2015. Reference tracing was completed for all articles for completeness.Main OutcomeLiterature review of clitoral cysts in the prepubertal population.ResultsIn total, we found 15 cases of benign, spontaneously forming clitoral cysts reported. Eleven of those cases document symptom onset before puberty. Reports of other benign clitoral lesions in the pediatric population include 1 angiokeratoma, 1 hemangiopericytoma, 1 granular cell tumor, 6 hemangiomas, and approximately 30 neurofibromas. Clitoral malignancies in the pediatric population are even more rare with only 3 cases of clitoral schwannomas, 2 rhabdomyosarcomas, 1 lymphoma, and 1 endodermal sinus tumor documented in the literature.ConclusionClitoral cysts must be considered as a possible cause of clitoral enlargement in the prepubertal population. Clitoral tumors are distinguished clinically from hormonal abnormalities and intersex disorders by their hormonal profile, and the presence of an underlying mass. Ultrasound and magnetic resonance imaging might be useful imaging modalities to further characterize the clitoral enlargement. When confirmed as the most likely diagnosis, surgical resection is the mainstay of treatment for clitoral cysts.     

Microbiological Findings of Symptomatic Vulvovaginitis in Chinese Prepubertal Girls

Study objectiveTo study the bacteria and fungi causing vulvovaginitis in prepubertal girls.DesignSwabs from vaginal introitus were collected from patients with vulvovaginitis in 2018, and cultured for the identification of microorganisms with standard microbiological techniques.SettingA children's hospital in Hangzhou, East China.ParticipantsA total of 1235 Chinese prepubertal girls diagnosed with vulvovaginitis.Main Outcome MeasureBacteria or fungi in pure cultures or as the predominant organism were defined as pathogens.ResultsA total of 1235 cases were diagnosed as vulvovaginitis, and 515 isolates were identified from 494 patients (40%, 494/1235). The most common pathogen was Streptococcus pyogenes (27.6%,142/515), followed by Haemophilus influenzae (27.2%,140/515), Candida albicans (22.3%,115/515), Staphylococcus aureus (5.8%, 30/515) and Escherichia coli (4.7%,24/515). All S pyogenes isolates were sensitive to penicillin, whereas 53.7% (73/136) of H influenzae isolates were sensitive to ampicillin, and 70.4% (19/27) of S aureus isolates were sensitive to oxacillin.ConclusionS pyogenes and H influenzae were the 2 most commonly identified pathogenic bacteria found in prepubertal girls with vulvovaginitis. Vulvovaginitis in prepubertal girls caused by C albicans may be more common in older children.