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Homa LD, Smorgick-Rosenbaum N, Smith YR, Gemmete JJ, Quint EH. Congenital Venous Lymphatic Malformation as an Unusual Source of Premenarchal Vaginal Bleeding. J Pediatr Adolesc Gynecol 2017; 30:367-369. [PMID: 26880044 DOI: 10.1016/j.jpag.2016.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 02/03/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Premenarchal vaginal bleeding can present a diagnostic challenge and has not been previously reported in association with congenital venous lymphatic malformation. CASE A 3-year-old girl presented with intermittent vaginal bleeding since birth. Evaluation showed premenarchal estradiol and gonadotropin hormones, a normal pelvic ultrasound and normal colonoscopy. Examination under anesthesia and vaginoscopy showed a congested appearance of the hymen and vaginal petechiae. Sudden development of a vulvar cyst led to a pelvic magnetic resonance imaging scan, which revealed a venous malformation of the pelvis and vulvar lymphatic cyst. Vaginal bleeding stopped for approximately 6 months after sclerotherapy with doxycycline and ethanol, however recurred and required repeat sclerotherapy. SUMMARY AND CONCLUSION Congenital venous lymphatic malformations can rarely be associated with premenarchal vaginal bleeding and should be considered when all more common etiologies have been ruled out. Diagnosis is made using magnetic resonance imaging, and treatment might include doxycycline and ethanol sclerotherapy.
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Affiliation(s)
- Lori D Homa
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan.
| | | | - Yolanda R Smith
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Joseph J Gemmete
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
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Homa LD, Burger LL, Cuttitta AJ, Michele DE, Moenter SM. Voluntary Exercise Improves Estrous Cyclicity in Prenatally Androgenized Female Mice Despite Programming Decreased Voluntary Exercise: Implications for Polycystic Ovary Syndrome (PCOS). Endocrinology 2015; 156:4618-28. [PMID: 26360506 PMCID: PMC4655213 DOI: 10.1210/en.2015-1593] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prenatal androgen (PNA) exposure in mice produces a phenotype resembling lean polycystic ovary syndrome. We studied effects of voluntary exercise on metabolic and reproductive parameters in PNA vs vehicle (VEH)-treated mice. Mice (8 wk of age) were housed individually and estrous cycles monitored. At 10 weeks of age, mice were divided into groups (PNA, PNA-run, VEH, VEH-run, n = 8-9/group); those in the running groups received wheels allowing voluntary running. Unexpectedly, PNA mice ran less distance than VEH mice; ovariectomy eliminated this difference. In ovary-intact mice, there was no difference in glucose tolerance, lower limb muscle fiber types, weight, or body composition among groups after 16 weeks of running, although some mitochondrial proteins were mildly up-regulated by exercise in PNA mice. Before running, estrous cycles in PNA mice were disrupted with most days in diestrus. There was no change in cycles during weeks 1-6 of running (10-15 wk of age). In contrast, from weeks 11 to 16 of running, cycles in PNA mice improved with more days in proestrus and estrus and fewer in diestrus. PNA programs reduced voluntary exercise, perhaps mediated in part by ovarian secretions. Exercise without weight loss improved estrous cycles, which if translated could be important for fertility in and counseling of lean women with polycystic ovary syndrome.
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Affiliation(s)
- Lori D Homa
- Departments of Obstetrics and Gynecology (L.D.H., S.M.M.), Molecular and Integrative Physiology (L.L.B., A.J.C., D.E.M., S.M.M.), and Internal Medicine (D.E.M., S.M.M.), University of Michigan, Ann Arbor, Michigan 48109-5622
| | - Laura L Burger
- Departments of Obstetrics and Gynecology (L.D.H., S.M.M.), Molecular and Integrative Physiology (L.L.B., A.J.C., D.E.M., S.M.M.), and Internal Medicine (D.E.M., S.M.M.), University of Michigan, Ann Arbor, Michigan 48109-5622
| | - Ashley J Cuttitta
- Departments of Obstetrics and Gynecology (L.D.H., S.M.M.), Molecular and Integrative Physiology (L.L.B., A.J.C., D.E.M., S.M.M.), and Internal Medicine (D.E.M., S.M.M.), University of Michigan, Ann Arbor, Michigan 48109-5622
| | - Daniel E Michele
- Departments of Obstetrics and Gynecology (L.D.H., S.M.M.), Molecular and Integrative Physiology (L.L.B., A.J.C., D.E.M., S.M.M.), and Internal Medicine (D.E.M., S.M.M.), University of Michigan, Ann Arbor, Michigan 48109-5622
| | - Suzanne M Moenter
- Departments of Obstetrics and Gynecology (L.D.H., S.M.M.), Molecular and Integrative Physiology (L.L.B., A.J.C., D.E.M., S.M.M.), and Internal Medicine (D.E.M., S.M.M.), University of Michigan, Ann Arbor, Michigan 48109-5622
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