Journal of pediatric and adolescent gynecology · 2009
Ovarian tissue autologous transplantation to the upper extremity for girls receiving abdominal/pelvic radiation: 20-year follow-up of reproductive endocrine function.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Laufer Marc R, Upton Joseph, Schuster Samuel R, Grier Holcombe, Emans S Jean, Diller Lisa
Аннотация
OBJECTIVE: Upper-extremity ovarian autologous transplantation was first used for girls undergoing abdominal/pelvic radiation therapy; long-term follow-up is provided.
DESIGN: A case series.
SETTING: Tertiary pediatric medical center.
PATIENTS: Girls with Wilms tumor with planned abdominal/pelvic radiation therapy.
INTERVENTIONS: Subjects 1, 2, and 3 (ages 5, 2, and 1 year) presented with a Wilms tumor and underwent surgical resection. Each patient underwent ovarian autotransplantation to move ovarian tissue out of the radiation field. Subjects 1 and 2 had thin slices from 1 ovary placed in the arm. Subject 3 had a free transfer of the entire ovary into an axilla. Follow-up was obtained for the subsequent 20-25 years for all 3 subjects.
OUTCOME MEASURES: Pubertal, menarcheal, and menstrual history, and hormonal serum levels.
RESULTS: All subjects survived and experienced spontaneous pubertal development and menarche. Data were available for follow-up for 20-25 years. Subjects 1 and 2 showed spontaneous follicular development of the autotransplanted ovarian tissue. They had fluctuating gonadotropin and estradiol levels until age 29 and 26, respectively; spontaneous menses until age 29 and 26; and cessation of spontaneous menses with elevated gonadotropins and low estradiol levels at age 30 and 26. Subject 3 had severe monthly axillary pain, and the ovary was transferred back to the pelvis. She then had ovarian dysfunction with intermittent spontaneous ovarian activity until age 25.
CONCLUSIONS: Ovarian autotransplantation to the upper extremity resulted in long-term sex steroid production for spontaneous puberty, menarche, follicular development, and menses with fluctuating gonadotropin and ovarian sex steroid levels and follicular activity that lasted for 13-15 years.
DESIGN: A case series.
SETTING: Tertiary pediatric medical center.
PATIENTS: Girls with Wilms tumor with planned abdominal/pelvic radiation therapy.
INTERVENTIONS: Subjects 1, 2, and 3 (ages 5, 2, and 1 year) presented with a Wilms tumor and underwent surgical resection. Each patient underwent ovarian autotransplantation to move ovarian tissue out of the radiation field. Subjects 1 and 2 had thin slices from 1 ovary placed in the arm. Subject 3 had a free transfer of the entire ovary into an axilla. Follow-up was obtained for the subsequent 20-25 years for all 3 subjects.
OUTCOME MEASURES: Pubertal, menarcheal, and menstrual history, and hormonal serum levels.
RESULTS: All subjects survived and experienced spontaneous pubertal development and menarche. Data were available for follow-up for 20-25 years. Subjects 1 and 2 showed spontaneous follicular development of the autotransplanted ovarian tissue. They had fluctuating gonadotropin and estradiol levels until age 29 and 26, respectively; spontaneous menses until age 29 and 26; and cessation of spontaneous menses with elevated gonadotropins and low estradiol levels at age 30 and 26. Subject 3 had severe monthly axillary pain, and the ovary was transferred back to the pelvis. She then had ovarian dysfunction with intermittent spontaneous ovarian activity until age 25.
CONCLUSIONS: Ovarian autotransplantation to the upper extremity resulted in long-term sex steroid production for spontaneous puberty, menarche, follicular development, and menses with fluctuating gonadotropin and ovarian sex steroid levels and follicular activity that lasted for 13-15 years.