BMC Pediatrics

Influence of uterine fibroid size on perinatal and neonatal outcomes: a single-centre cohort of 651 pregnancies

To evaluate the impact of fibroid size on maternal and neonatal outcomes, determine whether a dose-response pattern exists across size categories ( 10 cm), and identify a threshold at which pregnancy risk increases significantly. This retrospective cohort study included 651 pregnant women with sonographically confirmed uterine fibroids. Participants were stratified into three groups based on the maximum diameter of the largest fibroid:  10 cm. Outcomes assessed included preterm birth, PPROM, malpresentation, caesarean delivery, postpartum haemorrhage (PPH), fetal growth restriction (FGR), NICU admission, miscarriage, surgical outcomes such as operative time and blood loss, and a composite adverse perinatal outcome (CAPO). Logistic regression analysis was performed to identify variables independently associated with CAPO. Adverse events rose stepwise with fibroid size. Preterm birth occurred in 12.3%, 24.1% and 36.1% of the size groups (p  5 cm independently predicted CAPO (aOR: 1.84 for 5-10 cm; 3.78 for > 10 cm), while maternal age, parity, IVF were not significant. Descriptive subgroup analysis revealed longer operative times and greater blood loss in women with multiple, cervical, or combined-type fibroids. Fibroid diameter emerged as a key determinant of obstetric and neonatal risk. Lesions > 5 cm, particularly > 10 cm, were associated with markedly increased rates of maternal haemorrhage, preterm birth, and neonatal morbidity. Such pregnancies should be managed as high-risk, with enhanced antenatal surveillance and individualized delivery planning.

Primary vaginal endodermal sinus tumor in infants and children: experience from a tertiary center

Abstract Background The objective of the study was to analyze the clinical features, treatment, and outcomes of primary vaginal endodermal sinus tumor (EST) in infants and children treated in a tertiary center. Methods Clinical data of patients with pathologically confirmed primary vaginal EST in our hospital from January 1997 to December 2017 were retrospectively reviewed and analyzed. Results A total of 21 patients were included in this study. The median age at diagnosis was 11 months (range, 4–44 months). The most common manifestations were abnormal vaginal bleeding, and a polypoid mass protruding from the vagina. Chemotherapy based on PEB (cisplatin, etoposide, bleomycin) regimen was given, and serum alpha-fetoprotein (AFP) levels dropped to normal levels after 2 to 4 cycles of chemotherapy (median, 2 cycles). After 3 to 13 cycles of chemotherapy, with a median of 5 cycles, 20 patients achieved complete remission (95.2%). The median follow-up time was 80 months (range, 4-281months). At the time of the last follow-up, 19 cases were alive without disease, and the survival rate was 90.5%. Conclusion Vaginal EST is a very rare malignant germ cell tumor and is sensitive to chemotherapy. Conservative surgery combined with PEB chemotherapy is an effective way of treatment. Serum AFP and imaging examinations can monitor the treatment response and recurrence.

Coexistence of giant serous cystadenoma and hemorrhagic corpus luteal cyst in a 12-year-old: diagnostic and fertility-sparing surgical approach

Ovarian cystic lesions are typically slow-growing neoplasms, but giant ovarian tumors with dual histological types are rare, particularly in pediatric populations. They pose significant diagnostic and therapeutic challenges due to the potential for rapid enlargement and surgical complexity. A 12-year-old female presented with progressive abdominal pain, early satiety, and a two-month history of abdominal distension. Imaging revealed a 30 × 22 × 12 cm intraperitoneal cystic mass with negative tumor markers. She underwent mini-laparotomy and tumor enucleation, during which 4400 cc of serous fluid was aspirated. Histopathology revealed a serous cystadenoma alongside a hemorrhagic corpus luteal cyst. Fertility was successfully preserved. Despite their rarity, large benign ovarian cysts with differing histology should be considered in young patients presenting with abdominal symptoms suggestive of malignancy. Early imaging, tumor marker evaluation, and fertility-preserving surgical strategies are crucial for optimal outcomes. Benign giant ovarian cysts with concurrent histological types may mimic malignancy. Thorough preoperative evaluation and conservative surgical management are essential to balance oncological safety with fertility preservation in pediatric patients.

Rare presentations of Swyer syndrome in a 13.5-year-old female; a case report and literature review

Swyer syndrome (SS), or 46, XY pure gonadal dysgenesis, is a rare disorder of sex development. It typically presents with primary amenorrhea and an absence of secondary sexual characteristics. However, in rare cases, patients may exhibit atypical features such as spontaneous breast development and menstruation. This report details the case of a 13.5-year-old female with a 46, XY karyotype, fully developed secondary sexual characteristics, and unilateral gonadoblastoma. The primary clinical symptoms included generalized hirsutism and secondary amenorrhea, occurring ten months after experiencing two menstrual periods. Physical examination revealed a phenotypic female of normal height with apparently normal external genitalia but clitoromegaly. Breast and pubic hair development were at Tanner stage five. Noteworthy features included generalized hirsutism and a deep voice. Initial laboratory investigations showed follicle-stimulating hormone (FSH) at 0.39 mIU/mL, luteinizing hormone (LH) at 0.43 mIU/mL, testosterone at 1.96 ng/mL, and estradiol at 79.54 pg/mL. An abdominal computed tomography (CT) scan detected a 12 × 10 × 10.5 cm calcified mass on the left side of the pelvis, originating from the ovaries. Surgical excision of the mass, along with a left salpingo-oophorectomy, was performed. Histopathology confirmed the mass as a gonadoblastoma. Chromosomal analysis confirmed the diagnosis of XY pure gonadal dysgenesis (Swyer syndrome). This case highlights the importance of comprehensive genetic testing in females presenting with amenorrhea despite fully developed secondary sexual characteristics.