TEENAGE GYNECOLGICAL PROBLEMS. PROF. MAHMOUD YOUSSEF ABDALLA FACLTY OF MEDECINE,AIN SHAMS UNIVERSITY.

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1 TEENAGE GYNECOLGICAL PROBLEMS PROF. MAHMOUD YOUSSEF ABDALLA FACLTY OF MEDECINE,AIN SHAMS UNIVERSITY.

2 TEENAGE GYNECOLOGICAL PROBLEMS امراض الجهاز التناسلى للفتيات Teenage gynecological problems. Delayed puberty. البلوغ تاخر عدم قدوم الطمث Amenorrhea. Dysmenorrhea. ا لام اثناء الطمث ا لالم Pain الافرازات. Discharge Bleeding. النزف تورم Swelling Breast problems. الثدى امراض الثقافة الجنسية knowledge. Sex

3 AMENORRHEA False amenorrhea (cryptmenorrhea). Imperforate hymen. Transverse vaginal septum Transverse vaginal septum in one side in case of uterus didelphys bicollis Investigation. Ultrasonography,transabdominal or transrectal. CAT scan

4 One side vaginal obstruction in case of uterus didelphys

5 AMENORRHEA. Ultrasound. It is of value to asses for anomaly of uterus,ovary and congenital obstruction as imperforate hymen, transverse vaginal septum,cervical agenesis or partial vaginal agenesis. Hormonal assay,it may diagnose hyper prolactinaemia, Hypothyroidism. congenital adrenal hyperplasia, adrenal tumor.

6 1ry amenorrhea. Mullerian agenesis. Hymen is seen but there is small vaginal pouch.

7 تكيسات المبيض

8 Chromosomal analysis is of value to know the sex, turner syndrome, mosaic turner..

9 AMENORRHEA Hyperprolactinemia. CAT scan or MRI. It is diagnostic for pituitary tumor.

10 Pituitary adenoma ورم الغدة النخامية

11 PAIN Ultrasound. It is of value to diagnose. Congenital obstructive lesions. Ovarian endometriosis. Ovarian tumor. Complicated ovarian cyst. Fibroid, complicated fibroid.

12 Neglected ovarian torsion

13 Menorrhagia Ultrasound is of value for: Evaluation of endometrial thickness. Fibroid,especially submucous fibroid. Ovarian cyst. Ovarian tumor,espcially juvenile Granuolosa cell tumor. Evaluation of inhibin level is of great value in case of granulosa cell tumor.

15 VAGINALDISCHARGE Recurrent vaginal discharge. Sero sanguinous vaginal discharge. It is mandatory to put in consideration the presence of foreign body or polyp or tumor so diagnostic Hysteroscopy is essential

It may be used as a vaginoscope in case of intractable vaginal

16 HYSTEROSCOPY Rarely,hysteroscope is used when there is suspicious of the presence of cervical polyp. It may be used as a vaginoscope in case of intractable vaginal discharge or in the presence of serosanguinous discharge as may be a foreign body or tumor.

17 Foreign body was removed by hystroscope. Recurrent Vaginal Discharge.

18 OVARIAN SWELLINGS Ultrasound. It is useful to determine the type of ovarian swelling. Follicular cyst. Dermoid. Ovarian tumor. Sex cord tumor. Juvenile Granuolosa cell tumor. CAT scan. MRI.

19 Young female & ovarian malignancy. Diagnosis of malignancy is almost delayed Malignancy sometimes is diagnosed d after obtaining i the result of the histopathological examination of the ovarian tissue removed Sometimes, there is delay on the start of adjuvant chemotherapy. Preservation (of fertility) of one ovary is a problem.

20 TUMOR MARKER alpha fetprotein,it is of great diagnostic value in case of endodermal sinus tumor. Serum Inhibin is of value in Granuolosa cell tumor. CA 125 may be of value in some cases of endometriosis or epithelial ovarian tumor.

21 Ultrasound

22 OVARIAN TUMOR. ورم بالمبيض CAT SCAN Ovarian tumor.

24 The trend of ovarian tumor to the period Germ cell tumor 20 Stromal cell tumor 15 Epithelial cell tumor Krukenberg tumor total

25 Ovarian tumor in relation to age total >20years <20years Germ cell tumor Stromal cell tumor Epithelial tumor Krukenburg tumor

26 Ovarian tumor below 30 years in relation to the period Germ cell tumor 20 Stromal cell tumor 15 Epithelial cell tumor Krukenberg tumor Total (,20) (,20)

27 Staging of Ovarian tumors Germ cell tumor Stromal cell tumor 10 Epithelial cell tumor Krkenberg tumor 5 0 Stage I II Stage III IV unstaged

28 Pain and abdominal swelling were the presenting symptom in all cases. Ultrasound reveled heterogonous ovarian swellings. Alpha fetoprotein was markedly elevated in all endodermal sinus tumor and mixed germ cell tumor.it was helpful marker to determine curability. CA125 was elevated in 3/6 border line tumor and in 2o/38 ovarian carcinoma and 2/ 5 krukenberg tumor.

29 Surgical procedure for germ cell tumors and stomal cell tumors 6 Endodermal sinus tumor 5 Dysgerminoma 4 Mixed Germ cell tumor 3 Immature teratoma 2 Youlk sac tumor 1 Granulosa tumor 0 Radical staged Oophorectomy,unstaged Sertoli lydig

30 Surgical procedures for epithelial cell tumors 25 Serous cystadenocarcinoma Mucinous 20 cystadenocarcinoma Endmetroid 15 adenocarcinoma Clear cell adenocarcinoma 10 Border line malignancy 5 Krukenberg tumor 0 total Radical Staged Oophorectomy,unstaged

31 Adjuvant chemotherapy and the prognosis Germ cell tumor Stromal cell tumor 15 Epithelial cell tumor 10 Krukenberg tumor 5 0 Adjuvant Recurrent chemotherapy disease Persistatant disease Reported death

32 Pregnancy after treatment of ovarian tumor Pregnancy is possible after complete cure of ovarian malignancy in cases had conservative surgery (preserved one healthy ovary). Reported pregnancy after treatment: 2 pregnancy after germ cell tumor 1 pregnancy after border line serous cyst adenocarcinoma.

33 Conclusions. It is important to concentrate in proper evaluation by ultrasound of any young female having abdominal pain or change in the shape of the abdomen. Once there solid area inside the ovarian swelling by ultrasound.doppler study for the ovarian swelling and evaluation of the tumor marker (alpha fetoprotein, t CA125,BhCG,CA19-9) 9) should be considered. Colonoscopy and gastroscopy are mandatory whenever there are bilateral l ovarian swellings.

34 Proper staging of ovarian malignancy The surgeons should consider proper staging for the ovarian disease whenever oophorectomy or total hysterectomy is performed (peritoneal fluid sampling, omental biopsy and lymph node sampling). Also,it is important to avoid rupture of intact capsule.

35 One ovary can be left! There is tendency for conservation of the apparent normal ovary and to remove the affected ovary in case of germ cell tumor and stromal cell tumor.but in case of epithelial l cell tumor,conservation of the apparent normal ovary is acceptable in stage IA.In IC,it is controversial.

36 انقلاب حاد بالرحم لبكر

37 انقلاب حاد بالرحم لبكر

38 انقلاب حاد بالرحم لبكر

39 Breast problems Small breast. Unequal breast size. Retracted nipple. Breast discharge. Breast lump. Breast pain ( mastalgia).

40 SEX KNOWLEDGE Hymen. Sex practice. Sexual excitation. Sexually transmitted disease.

41 C0NCLUSIONS. Teen age Gynecological problems are in need for special care and the medical physician should be aware of these problems in order to guide them properly for the proper treatment. Improper diagnosis and wrong treatment may endanger their reproductive capability.

42 Advanced technology provides a way to approach the proper diagnosis of teenage gynecolgical problems without affecting their virginity. It is essential to discuss how to protect them from sexually transmitted disease. It is essential to have a study to know what is the effect of media upon teenage behavior.

43 Media & teenage knowledge. TV satellites. Internet. These provide a source of knowledge,so it is essential to be ready to answer or correct their informations. It is essential to have an Egyptian web site to provide a way to answer teen age needs.

Gynaecological Malignancies

Gynaecological Malignancies Dr Rodney Itaki Lecturer Anatomical Pathology Discipline University of Papua New Guinea Division of Pathology School of Medicine & Health Sciences Overview Genital tract tumors