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46,XY pure gonadal dysgenesis: clinical presentations and management of the tumor risk. J Pediatr Urol 2011; 7:72-5. [PMID: 20153258 DOI: 10.1016/j.jpurol.2010.01.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2009] [Accepted: 01/18/2010] [Indexed: 11/22/2022]
Abstract
PATIENTS Eleven patients with 46,XY PGD were divided into two groups. Six symptomatic girls (group 1) were referred for amenorrhea (n = 3), gonadal tumor (n = 2) or campomelic dysplasia (n = 1). Five asymptomatic screened patients (group 2) were diagnosed as 46,XY PGD after familial investigation of the two probands with gonadal tumor. Bilateral gonadectomy was performed in all patients. RESULTS In group 1, pathologic examination revealed an association of dysgerminoma with gonadoblastoma (n = 2), bilateral gonadoblastoma (n = 2) and streak gonads (n = 2). Prophylactic gonadectomy in asymptomatic patients (group 2) also showed asymptomatic dysgerminoma with gonadoblastoma (n = 1), bilateral gonadoblastoma (n = 2) and streak gonads (n = 2). CONCLUSIONS A gonadal tumor arising in a girl with pubertal delay may be related to dysgenesis of the gonad. Primary amenorrhea or diagnosis of dysgerminoma should warrant karyotype, and familial study if 46,XY PGD is found. Considering the high incidence of gonadoblastoma and the early occurrence of dysgerminoma, early bilateral gonadectomy is recommended.
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Cheikhelard A, Thibaud E, Morel Y, Jaubert F, Lortat-Jacob S, Polak M, Nihoul-Fekete C. Complete androgen insensitivity syndrome: diagnosis and management. Expert Rev Endocrinol Metab 2009; 4:565-573. [PMID: 30780790 DOI: 10.1586/eem.09.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Complete androgen insensitivity syndrome (CAIS) is an X-linked genetic disorder affecting 46,XY individuals, characterized by the loss of function of the androgen receptor gene resulting in complete peripheral androgen resistance. Patients have a nonambiguous female phenotype with normal female external genitalia. Gonads are undescended testes (either intra-abdominal or inguinal), there is no uterus and the length of the vagina is usually very short. Gender identity is always female. This review focuses on the importance of accurate diagnosis of CAIS versus partial androgen insensitivity syndrome and other disorders of sex development by genotyping the androgen receptor, and raises issues of the optimal management of these patients. In the era of the Consensus Statement on Management of Intersex Disorders, we provide new insights into CAIS screening, surgical management of the gonads (balancing between hormonal production and malignancy risk) and of vaginal adequacy, and the ethics concerned with the disclosure to patients and their families.
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Affiliation(s)
- Alaa Cheikhelard
- a Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France.
| | - Elisabeth Thibaud
- b Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, Paris, France
| | - Yves Morel
- c Department of Molecular Biology and Hormonology, Université Claude Bernard Lyon 1, Lyon, France
| | - Francis Jaubert
- d Department of Cytology and Pathology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, Paris, France and Université Paris Descartes, Paris, France
| | - Stephen Lortat-Jacob
- e Department of Pediatric Surgery and Urology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France
| | - Michel Polak
- f Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Department of Pediatric Endocrinology and Gynaecology, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
| | - Claire Nihoul-Fekete
- g Department of Pediatric Surgery and Urology and Centre de Référence des Pathologies Gynécologiques Rares, AP-HP Hôpital Necker Enfants-malades, 149, rue de Sèvres, 75743, Paris Cedex 15, France and Université Paris Descartes, Paris, France
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A rare case of large epididymal cyst in androgen insensitivity syndrome removed laparoscopically. J Minim Invasive Gynecol 2009; 16:504-6. [PMID: 19573832 DOI: 10.1016/j.jmig.2009.04.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 04/21/2009] [Accepted: 04/26/2009] [Indexed: 11/23/2022]
Abstract
Androgen insensitivity syndrome is a disorder of sexual differentiation with 46XY karyotype. The gonad is at risk (33% by 50 years of age) for development of malignant tumors. Hence, gonadectomy is warranted. We present a case of a 22-year-old woman diagnosed with androgen insensitivity syndrome during investigation of primary amenorrhea. Ultrasonography showed intraabdominally-located gonads, with a large, nontender cyst of 9.2 x 5.6 x 5.4 cm size, with limited mobility, to the right of the midline. There was also a partial septum, with a wall thickness of 1 to 2 mm and containing clear fluid. Because of suspicion of malignancy, complete surgery including laparoscopic peritoneal cytologic study, gonadectomy, lymphadenectomy, and omentectomy were performed. Histopathologic study showed testis with an epididymal cyst. Formation of epididymal cyst is rare in these cases. The patient did well in the postoperative period. She was put on hormone replacement therapy and is doing well.
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Parker JL, Ekman DL, Hayden LJ. Hysterectomy in a phenotypic male with advanced gonadal malignancy and intersex. Med J Aust 2009; 190:644-6. [DOI: 10.5694/j.1326-5377.2009.tb02595.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 12/16/2008] [Indexed: 11/17/2022]
Affiliation(s)
- Jim L Parker
- School of Medicine, University of Western Sydney, Sydney, NSW
- Department of Obstetrics and Gynaecology, Campbelltown Hospital, Sydney, NSW
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Stewart CJR, Baker E, Beaton C, Crook M, Peverall J, Wallace S. Detection of Y-chromosome in gonadal tumours using fluorescence in situ hybridization: diagnostic value in intersex conditions including older patients with clinically unsuspected androgen insensitivity syndrome. Histopathology 2007; 52:175-82. [DOI: 10.1111/j.1365-2559.2007.02927.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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