Diffuse leiomyomatosis in a child
- Authors: Khashchenko E.P.1, Silenok E.R.2, Uvarova E.V.1,3, Chuprynin V.D.1, Kyurdzidi S.O.3, Kulabukhova E.A.1, Uchevatkina P.V.1, Mamedova F.S.1,4, Asaturova A.V.1, Tregubova A.V.1, Badlaeva A.S.1
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Affiliations:
- Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
- N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
- I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
- Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
- Issue: No 7 (2023)
- Pages: 162-170
- Section: Clinical Notes
- URL: https://journals.eco-vector.com/0300-9092/article/view/568747
- DOI: https://doi.org/10.18565/aig.2023.75
- ID: 568747
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Abstract
Background: Uterine leiomyomas are not uncommon in adolescence; however, an unusual growth model, such as diffuse uterine leiomyomatosis (DUL), has been registered in single cases. The differential diagnosis of DUL is made with common multiple uterine leiomyomas and nodular adenomyosis. In view of the fact that the early diagnosis is difficult and there is no universal approach to the tactics of patient management, uterine masses frequently reach large sizes and motivate organ-removing operations.
Case report: The paper presents a review of literature data and an extremely rare clinical case of DUL in a 14-year-old girl. The patient visited a gynecologist with complaints of severe lower abdominal pain increasing in the last days of menstruation, which has been bothering her for the past year. She was suspected of diffuse nodular adenomyosis or multiple uterine myoma and was referred to be admitted to Gynecology Department Two, V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation. The Department made an instrumental and laboratory additional study, diagnosed uterine leiomyomatosis and external genital endometriosis of the pelvic peritoneum, ruled out other sites of possible leiomyomatosis; oncomarkers were obtained within the reference values. The girl received surgical treatment (laparoscopy, adhesiolysis, removal of a subserous leiomyomatous node, corpus uteri biopsy, coagulation of the foci of external genital endometriosis, and diagnostic hysteroscopy. Morphological examination confirmed uterine leiomyomatosis with hyalinosis. Immunohistochemical study of a myometrial biopsy sample revealed that the expression of estrogen receptors was 3 scores and that of progesterone receptors was 4 scores (according to the Allred scale; that of the proliferation marker Ki-67 was 20%. The patient was discharged home; after 3 months during therapy with gestagens (norethisterone), pelvic organ ultrasound indicated no substantial changes in the uterine sizes. Therapy and a follow-up were continued.
Conclusion: DUL is extremely rare in pediatric practice and is frequently detected late, which determines the relevance of timely preventive examinations and early diagnosis in order to maximize the organ-sparing tactics of management.
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About the authors
Elena P. Khashchenko
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Author for correspondence.
Email: khashchenko_elena@mail.ru
ORCID iD: 0000-0002-3195-307X
PhD, obstetrician-gynecologist, Senior Researcher at the 2nd Gynecological (Children and Adolescents) Department
Russian Federation, 117997, Moscow, Academician Oparin str., 4Elena R. Silenok
N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia
Email: khashchenko_elena@mail.ru
4th year student, Faculty of General Medicine
Russian Federation, 117321, Moscow, Ostrovityanova str., 1Elena V. Uvarova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Email: elena-uvarova@yandex.ru
ORCID iD: 0000-0002-3105-5640
Dr. Med. Sci., Professor, Corresponding Members of the RAS, Head of the 2nd Gynecological (Children and Adolescents) Department, Professor of the Department of Obstetrics, Gynecology, Perinatology and Reproductology of the Institute of Professional Education
Russian Federation, 117997, Moscow, Academician Oparin str., 4; 119991, Moscow, Trubetskaya str., 8-2Vladimir D. Chuprynin
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: v_chuprynin@oparina4.ru
PhD, Head of the Surgery Department
Russian Federation, 117997, Moscow, Academician Oparin str., 4Stanislav O. Kyurdzidi
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Email: dr.kyurdzidis@gmail.com
ORCID iD: 0000-0002-6316-1325
PhD student at the Department of Obstetrics, Gynaecology and Perinatology, Institute of Professional Education
Russian Federation, 119991, Moscow, Trubetskaya str., 8-2Elena A. Kulabukhova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: e_kulabukhova@oparina4.ru
PhD, Radiologist at the Department of Radiation Diagnostics
Russian Federation, 117997, Moscow, Ac. Oparina str., 4Polina V. Uchevatkina
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: p_uchevatkina@oparina4.ru
Radiologist at the Department of Radiation Diagnostics
Russian Federation, 117997, Moscow, Ac. Oparina str., 4Fatima Sh. Mamedova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Email: f_mamedova@oparina4.ru
ORCID iD: 0000-0003-1136-7222
PhD, Physician at the Department of Ultrasound Diagnostics in Neonatology and Pediatrics, assistant at the Department of Radiation Diagnostics of Pediatric Age
Russian Federation, 117997, Moscow, Oparina str., 4; MoscowAleksandra V. Asaturova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: a_asaturova@oparina4.ru
ORCID iD: 0000-0001-8739-5209
PhD, Head of the 1th Pathology Department
Russian Federation, 117997, Moscow, Academician Oparin str., 4Anna V. Tregubova
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: a_tregubova@oparina4.ru
ORCID iD: 0000-0003-4601-1330
Junior Researcher, 1st Pathology Department
Russian Federation, 117997, Moscow, Oparina str., 4Alina S. Badlaeva
Academician V.I. Kulakov National Medical Research Center for Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia
Email: khashchenko_elena@mail.ru
ORCID iD: 0000-0001-5223-9767
Junior Researcher at the 1st Pathology and Anatomical Department
Russian Federation, 117997, Moscow, Oparina str., 4References
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