Pediatric primary extra-ovarian Sertoli Leydig cell tumor of the retroperitoneum

Ovarian Sertoli Leydig cell tumors (SLCT) accounts for less than 0.5% of all ovarian malignancies. The incidence of primary extra-ovarian SLCT is extremely rare with reported cases occurring in young adult women till now. We report case of primary retroperitoneal extra-ovarian SLCT in a seven-year girl child without any hormonal manifestation. She presented with complaint of left side abdominal swelling associated with intermittent pain for a duration of six months. CT scan revealed a huge retroperitoneal space-occupying lesion abutting the dorsal vertebrae and present posterior to pancreas, spleen and left kidney. The tumor was diagnosed as extraovarian Sertoli Leydig cell tumor with intermediate differentiation on histopathology and immunohistochemistry.

Leydig and Sertoli cell function in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion: a case-control study

Abstract BACKGROUND: Because normal male sexual differentiation is more complex than normal female sexual differentiation, there are more cases of disorders of sex development (DSDs) with 46,XY karyotype that have unclear etiology. However, Leydig and Sertoli cell markers are rarely used in distinguishing such individuals. OBJECTIVES: To evaluate the function of Leydig and Sertoli cells in individuals with genital ambiguity, 46,XY karyotype, palpable gonads and normal testosterone secretion. STUDY DESIGN AND SETTING: Case-control study with 77 patients, including eight with partial androgen insensitivity syndrome, eight with 5α-reductase deficiency type 2 (5ARD2) and 19 with idiopathic 46,XY DSD, and 42 healthy controls, from the Interdisciplinary Study Group for Sex Determination and Differentiation (GIEDDS), at the State University of Campinas (UNICAMP), Campinas, Brazil. METHODS: Baseline levels of gonadotropins, anti-Müllerian hormone (AMH), inhibin B, insulin-like 3 (INSL3), testosterone and dihydrotestosterone in cases, and AMH, inhibin B, and INSL3 levels in controls, were assessed. RESULTS: There was no significant difference in age between cases and controls (P = 0.595). AMH and inhibin B levels were significantly lower in cases than in controls (P = 0.031 and P < 0.001, respectively). INSL3 levels were significantly higher in cases than in controls (P = 0.003). Inhibin B levels were lower in 5ARD2 patients (P = 0.045) and idiopathic patients (P = 0.001), in separate comparisons with the controls. CONCLUSION: According to our findings, we can speculate that inhibin B levels may be used to differentiate among DSD cases.

Clinical significance and expression of inhibin βB in nasopharyngeal carcinoma and lung adenocarcinoma / 中国医师杂志

Objective:To investigate the expression of inhibin β B (INHBB) in nasopharyngeal carcinoma (NPC) and lung adenocarcinoma (LUAD) and its relationship with clinicopathological features.Methods:Paraffin-embedded tissue specimens of 39 patients with NPC and 16 patients with chronic nasopharyngitis diagnosed by biopsy, and 30 patients with LUAD after surgical resection collected in Brain Hospital of Hunan Province (the Second People′s Hospital of Hunan Province) were analyzed retrospectively. The expression of INHBB in NPC and LUAD was detected by immunohistochemical streptavidin-perosidase (SP) method and the relationship of INHBB expression level with clinicopathological indicators was analyzed.Results:The expression of INHBB in NPC was lower than that in chronic nasopharyngitis (51.28% vs 81.25%, P=0.039), and the expression of INHBB was related to lymph node metastasis ( P=0.026) and clinical stage ( P=0.039); On the contrary, the expression level of INHBB in LUAD was significantly higher than that in adjacent tissues (86.67% vs 23.33%, P<0.001). The expression level of INHBB in patients with LUAD was only related to clinical stage ( P=0.048). Conclusions:The expression of INHBB might play an important role in the development and progression of NPC and LUAD, and it was expected to be a novel diagnostic biomarker.

Endocrine aberrations of human nonobstructive azoospermia / 亚洲男科学杂志(英文版)

Nonobstructive azoospermia (NOA) refers to the failure of spermatogenesis, which affects approximately 1% of the male population and contributes to 10% of male infertility. NOA has an underlying basis of endocrine imbalances since proper human spermatogenesis relies on complex regulation and cooperation of multiple hormones. A better understanding of subtle hormonal disturbances in NOA would help design and improve hormone therapies with reduced risk in human fertility clinics. The purpose of this review is to summarize the research on the endocrinological aspects of NOA, especially the hormones involved in hypothalamic-pituitary-testis axis (HPTA), including gonadotropin-releasing hormone, follicle-stimulating hormone, luteinizing hormone, prolactin, testosterone, estradiol, sex hormone binding globulin, inhibin B, anti-Müllerian hormone, and leptin. For the NOA men associated with primary testicular failure, the quality of currently available evidence has not been sufficient enough to recommend any general hormone optimization therapy. Some other NOA patients, especially those with hypogonadotropic hypogonadism, could be treated with hormonal replacement. Although these approaches have succeeded in resuming the fertility in many NOA patients, the prudent strategies should be applied in individuals according to specific NOA etiology by balancing fertility benefits and potential risks. This review also discusses how NOA can be induced by immunization against hormones.

Comparison of age-related anti Müllerian hormone, inhibin-b levels and follicle reserve in rat ovarium / Comparación de la hormona anti-mülleriana relacionada con la edad, los niveles de inhibina-b y la reserva folicular en el ovario de rata

SUMMARY: Anti-Müllerian hormone (AMH) and Inhibin B (INHB) in the glycoprotein structure are members of the transforming growth factor β family and expressed by granulosa cells from puberty. AMH is a factor that increases the life span of small developing follicles. For this reason, it is widely used to determine the ovarian reserve and age. Inhibin-B secreted from granulosa cells plays a role in regulation of the Follicle Stimulating Factor (FSH) and determination of the follicle diameter. There are few studies on the effect of these two age-related hormones on ovarian histology in rats. In this study, AMH and INHB expression in ovarian tissues of female rats of different age groups, their relationship with ovarian structure and folliculogenesis were examined histologically and biochemically. Wistar Albino rats were used in the study and a total of 3 groups were formed. The ovaries of rats in the pre-oestrous period were collected, and follicle count was performed on tissue sections in batches. Expression of AMH in the follicles was identified immunohistochemically. In serum, AMH and INHB levels were assessed by ELISA method and their significance was evaluated statistically. Results from light microscopic examination determined that AMH was expressed from the granulosa cells of developing follicles. INHB expression during the prepubertal period and AMH had a protective effect on the ovarian reserve and the number of developing follicles, respectively.

RESUMEN: La hormona antimülleriana (AMH) y la inhibina B (INHB) en la estructura de la glicoproteína son miembros de la familia del factor de crecimiento transformante β y se expresan en las células de la granulosa desde la pubertad. La AMH es un factor que aumenta la vida útil de los pequeños folículos en desarrollo. Por este motivo, se utiliza frecuentemente para determinar la reserva ovárica y la edad. La inhibina B secretada por las células de la granulosa tiene un rol en la regulación del factor estimulante de (FSH) y en la determinación del diámetro del folículo. Hay pocos estudios sobre el efecto de estas dos hormonas relacionadas con la edad en la histología ovárica en ratas. Se examinaron histológica y bioquímicamente la expresión de AMH e INHB en tejidos ováricos de ratas hembras de diferentes grupos de edad, su relación con la estructura ovárica y la foliculogénesis. Se utilizaron ratas Wistar Albino en el estudio y se formaron 3 grupos. En los ovarios de ratas en el período preestro se realizó el recuento de folículos en secciones de tejido. La expresión de AMH en los folículos se identificó inmunohistoquímicamente. En suero, los niveles de AMH e INHB se evaluaron mediante el método ELISA y su importancia se evaluó estadísticamente. Los resultados del examen con microscopio óptico determinaron que la AMH se expresaba a partir de las células de la granulosa de los folículos en desarrollo. La expresión de INHB durante el período prepuberal y AMH tuvo un efecto protector sobre la reserva ovárica y el número de folículos en desarrollo, respectivamente.

A case of postmenopausal bleeding with an unusual finding

Authors report the case of a 55-year-old patient who presented with postmenopausal bleeding. On clinical evaluation uterus was 12 weeks size with a left sided adnexal cystic mass of 8 × 6 cm size. Further imaging studies revealed uterus size of 11.5 × 6.7 × 6.3 cm, left ovarian mass of size 8.4 × 6.7 × 6 cm and endometrial thickness of 17 mm on ultrasonography. She underwent endometrial biopsy to exclude endometrial cancer. The report of which came to be endometrial hyperplasia without atypia. Further MRI study confirmed the findings of USG of a complex cystic lesion of left adnexa 75 × 57 × 60 mm. Tumor marker for ovarian tumors were sent and inhibin B was found to be markedly raised. A provisional diagnosis of GCT (Granulosa cell tumour) was made and staging laparotomy was done. The uterus was found to be 12 × 8 cm size and a left sided ovarian cyst of 8-9 cm size with smooth wall and intact capsule was found. Patient had an uneventful postoperative recovery.

Sporadic ovarian sex cord-stromal tumor with annular tubules: a rare case report

Ovarian sex cord stromal tumor with annular tubules (SCTAT) is a distinctive, rare subtype of sex cord stromal tumor of the ovary, predominant component of which has morphological features intermediate between that of granulosa cell and sertoli cell. The majority of ovarian SCTAT are benign. So far, malignant behavior in SCTAT has been reported only in sporadic cases. We have presented a case of SCTAT in a 40 year old lady with no association of Peutz-Jegher (P-J) syndrome. The patient’s chief complaints were post-menopausal bleeding for 1 year on and off along with menorrhagia. MRI abdomen was suggestive of intensely enhancing solid tissue mass lesion in the right  adnexa, features suggestive of ovarian mass. Panhysterectomy was done. Grossly uterus and left adnexa appeared to be normal. Right ovary showed mass measuring 17x11x9cm3 in size, on cut section, solid, homogenous lobulated, yellowish areas identified. Microscopic and Immunohistochemistry findings confirmed the diagnosis of sex cord stromal tumor with annular tubules of granulosa cell type. PAS stain supported the diagnosis.

Inhibin B: are modified ranges needed for orchiectomised testicular cancer patients? / 亚洲男科学杂志(英文版)

Inhibin B is a gonadal hormone that downregulates the pituitary production of follicle-stimulating hormone (FSH). In recent years, inhibin B has proved to be an excellent marker of spermatogenesis and even a predictive factor for the recovery of fertility in patients undergoing orchiectomy and antineoplastic treatments. We propose to study inhibin B levels in orchiectomised testicular cancer patients, in order to identify a minimum value representative of normal semen quality. This retrospective study evaluates hormonal and semen parameters of 290 normozoospermic patients attending the Laboratory of Seminology - Sperm Bank "Loredana Gandini" (Rome, Italy) for cryopreservation of seminal fluid following a diagnosis of testicular cancer (TC group) and 117 healthy, normozoospermic men as a control group (CTR group). The percentile distribution of gonadotropin and inhibin B values in the TC and CTR groups was analyzed. There was a statistically significant difference between the two groups in the levels of all hormones (P ≤ 0.001) and in all semen parameters (P < 0.05). About 20% of TC patients revealed inhibin B levels below the 5th percentile of CTR group, despite normozoospermia, and 31.4% had normal spermatogenesis in the presence of FSH values >95th percentile of CTR group. Orchiectomised patients for testicular cancer presented inhibin B levels lower than healthy patients, despite normozoospermia. Our study revealed the poor sensitivity of the current inhibin B reference range when applied to monorchidic patients, suggesting the need to establish more representative ranges to enable more appropriate counseling in relation to the patient's new endocrine condition.

Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men / 亚洲男科学杂志(英文版)

The purpose of this study was to determine the diagnostic accuracy of serum inhibin B (INHB) as a predictor of the retrieval outcome of testicular haploid gametes (spermatids and testicular spermatozoa) in nonobstructive azoospermic men. Serum hormone levels, testicular volume, and histological evaluation were performed in 403 Chinese nonobstructive azoospermic men. Testicular haploid gamete was successfully retrieved in 213 of 403 patients (52.85%). The haploid gamete group always had higher INHB levels than the non-haploid gamete group. According to the receiver operating characteristic (ROC) curve analysis, INHB was a good predictor of testicular haploid gamete retrieval outcome in all patients (sensitivity: 77.93% and specificity: 91.58%) and patients with normal follicle-stimulating hormone (FSH; sensitivity: 88.52% and specificity: 70.83%). The area under the ROC curve (AUC) of INHB was similar to that of FSH in all patients or patients with normal FSH. In patients with elevated FSH, INHB was superior to FSH in predicting the presence of haploid gamete (AUC: 0.73 vs 0.55, P < 0.05), with a sensitivity of 60.00% and a specificity of 80.28%. It concluded that serum INHB as an effective marker for spermatogenesis was a significant predictor of testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Especially, INHB is superior to FSH in predicting the presence of haploid gamete in the patients with elevated FSH.

Application of serum AMH and INHB quantification in the auxiliary diagnosis of polycystic ovary syndrome / 中华检验医学杂志

Objective To investigate the detection and significance of anti-Müllerian hormone (AMH) and inhibin B (INHB) in patients with polycystic ovary syndrome (PCOS). Methods This study randomly selected 240 PCOS patients from January to October 2018 in Obstetrics and Gynecology Hospital of Fudan University, and 240 healthy women who were admitted to the physical examination center of Obstetrics and Gynecology Hospital of Fudan University as control group during the same period. Retrospective study was adopted. Serum samples of patients were collected and the serum estradiol (E2), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), sex hormone binding globulin (SHBG), AMH and INHB were detected. The data were analyzed by single sample Kolmogorov-Smimov test, independent sample T test and logistic regression analysis. Results The detection values of AMH, INHB, E2, LH, FSH, T, SHBG and INHB/AMH in PCOS group were (8.55±3.17) ng/ml, (101.7±15.2) pg/ml, (63± 50) pg/ml, (13.0±5.8) mIU/ml, (6.5±1.5) mIU/ml, (0.68±0.23) ng/ml, (62±52) nmol/ml and (24.03±26.35) respectively. In the control group, the detection values of AMH, INHB, E2, LH, FSH, T, SHBG, INHB and AMH were (4.34±2.07) ng/ml, (83.3±7.7) pg/ml, (66±25) pg/ml, (7.1±3.7) mIU/ml, (7.2±1.9) mIU/ml, (0.40± 0.11) ng/ml, (67±37) nmol/ml and (42.83±62.22). The detection values of AMH, INHB, LH, T and SHBG in PCOS group were higher than those in control group (the t values were 9.843, 7.373, 9.021, 9.349 and 3.867), and the difference was statistically significant (P<0.05). The detection values of E2 and FSH in PCOS group were lower than those in control group(the t values were 0.762 and -1.342), with no significant difference (P>0.05). The INHB/AMH value was lower than that in control group(the t value was -2.332), and the difference was statistically significant(P<0.05). The area under the curve of AMH, INHB and AMH+INHB in the diagnosis of PCOS was 0.762, 0.677 and 0.789, respectively. The cut-off value of AMH in predicting polycystic ovary syndrome was 6.96 ng/mL, the sensitivity was 61.0％, and the specificity was 82.1％. The cut-off value of INHB in predicting polycystic ovary syndrome was 94.9 pg/mL, with a sensitivity of 59.0％ and a specificity of 74.1％. The sensitivity and specificity of combined detection of AMH and INHB in predicting polycystic ovary syndrome were 83.6％ and 60.6％. The positive rates of ultrasound, T, AMH and INHB in PCOS group were 51.25％, 61.25％, 69.58％ and 66.25％, respectively. Conclusion The combined detection of AMH and INHB may improve the sensitivity and specificity of PCOS diagnosis, and its serum level is stable.

Expression and significance of serum INHB, IGF-1, VEGF and E2 in patients with polycystic ovary syndrome / 国际检验医学杂志

Objective To study the expression and significance of serum inhibin B (INHB), insulin-like growth factor-1 (IGF-1), vascular endothelial growth factor (VEGF) and estradiol (E2) in patients with polycystic ovary syndrome (PCOS).Methods A total of 45patients with PCOS in the hospital from April 2015to May 2016, were selected as observation group.In addition, 45healthy women who underwent physical examination due to male infertility were selected as control group.The significance and diagnostic value of serum INHB, IGF-1, VEGF and E2in PCOS were analyzed.Results The levels of serum INHB, IGF-1, VEGF and E2in observation group were significantly higher than those of control group (P＜0.05).The receiver operating characteristic curve (ROC curve) analysis showed that the AUC of INHB, IGF-1, VEGF and E2were 0.935, 0.988, 0.992and 0.759, respectively.The sensitivity of PCOS were 80.93％, 81.18％, 79.12％and79.07％, while the specificity of PCOS were 73.05％, 75.17％, 77.49％and 78.59％, respectively.ConclusionSerum INHB, IGF-1, VEGF and E2are highly expressed in patients with PCOS, which can be used as an important indicators in the diagnosis of PCOS.

Predictive significance of serum inhibin B on testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men / 亚洲男科学杂志(英文版)

The purpose of this study was to determine the diagnostic accuracy of serum inhibin B (INHB) as a predictor of the retrieval outcome of testicular haploid gametes (spermatids and testicular spermatozoa) in nonobstructive azoospermic men. Serum hormone levels, testicular volume, and histological evaluation were performed in 403 Chinese nonobstructive azoospermic men. Testicular haploid gamete was successfully retrieved in 213 of 403 patients (52.85%). The haploid gamete group always had higher INHB levels than the non-haploid gamete group. According to the receiver operating characteristic (ROC) curve analysis, INHB was a good predictor of testicular haploid gamete retrieval outcome in all patients (sensitivity: 77.93% and specificity: 91.58%) and patients with normal follicle-stimulating hormone (FSH; sensitivity: 88.52% and specificity: 70.83%). The area under the ROC curve (AUC) of INHB was similar to that of FSH in all patients or patients with normal FSH. In patients with elevated FSH, INHB was superior to FSH in predicting the presence of haploid gamete (AUC: 0.73 vs 0.55, P < 0.05), with a sensitivity of 60.00% and a specificity of 80.28%. It concluded that serum INHB as an effective marker for spermatogenesis was a significant predictor of testicular haploid gamete retrieval outcomes in nonobstructive azoospermic men. Especially, INHB is superior to FSH in predicting the presence of haploid gamete in the patients with elevated FSH.

Inhibin B: Are modified ranges needed for orchiectomised testicular cancer patients? / 亚洲男科学杂志(英文版)

Inhibin B is a gonadal hormone that downregulates the pituitary production of follicle-stimulating hormone (FSH). In recent years, inhibin B has proved to be an excellent marker of spermatogenesis and even a predictive factor for the recovery of fertility in patients undergoing orchiectomy and antineoplastic treatments. We propose to study inhibin B levels in orchiectomised testicular cancer patients, in order to identify a minimum value representative of normal semen quality. This retrospective study evaluates hormonal and semen parameters of 290 normozoospermic patients attending the Laboratory of Seminology - Sperm Bank 'Loredana Gandini' (Rome, Italy) for cryopreservation of seminal fluid following a diagnosis of testicular cancer (TC group) and 117 healthy, normozoospermic men as a control group (CTR group). The percentile distribution of gonadotropin and inhibin B values in the TC and CTR groups was analyzed. There was a statistically significant difference between the two groups in the levels of all hormones (P ≤ 0.001) and in all semen parameters (P 95th percentile of CTR group. Orchiectomised patients for testicular cancer presented inhibin B levels lower than healthy patients, despite normozoospermia. Our study revealed the poor sensitivity of the current inhibin B reference range when applied to monorchidic patients, suggesting the need to establish more representative ranges to enable more appropriate counseling in relation to the patient's new endocrine condition.

The relationship between serum and seminal plasma vitamin D and male reproductive function / 医学研究生学报

Objective Male infertility accounts for 40 to 50% of the total number of infertility in the world. Among many factors that cause male infertility, vitamin D is considered to be directly related to male fertility. The purpose of this study was to explore the relationship between serum and seminal plasma vitamin D and male reproductive function, and provide a more comprehensive research direction for studying the specific mechanism of vitamin D on male reproduction. Methods A total of 198 infertile males, receiving andrological examination from June 2017 to January 2018 in the Center for Reproductive Medicine, Jinling Hospital (Nanjing, China) was included in our study. Serum and seminal plasma vitamin D levels were measured by electrochemiluminescence immunoassay (ECLIA) kits. The associations between vitamin D and biomarkers of male reproduction were analyzed. Results Serum 25(OH) vitamin D level [26.17(19.61-31.99)ng/mL] was in positive relation with semen volume[3.8(3.1-4.8)ng/mL] (r=0.229,P=0.003). Seminal plasma 25(OH) vitamin D level was not related to serum 25(OH) vitamin D level, but in negative relation with sperm concentration(r=0.174,P=0.016) and positive relation with semen volume(r=0.271,P=0.0001). Serum 25(OH) vitamin D level was in positive relation with seminal plasma fructose concentration(r=0.256,P=0.002), total fructose content (r=0.310,P=0.0002) and total zinc content(r=0.26,P=0.002). The level of serum and seminal plasma vitamin D leve was not related to serum anti-Mullerian hormone(AMH), seminal plasma AMH, serum inhibin (INH B) and seminal plasma INH B(P>0.05). Conclusion Vitamin D is associated with affiliated gland function. The seminal vesicles and prostate produced by semen may be the main source of vitamin D in the male reproductive system.

Inhibin B level helps evaluate the testicular function of prepubertal patients with varicocele / 中华男科学杂志

<p><b>Objective</b>To investigate the role of the serum inhibin B (INHB) level in evaluating the testicular function of the prepubertal patient with varicocele (VC) after high ligation of the spermatic vein (HLSV).</p><p><b>METHODS</b>This study included 31 prepubertal male patients with left VC, averaging 12.55 years of age and 9 complicated by right VC. We collected peripheral blood samples before and at 4, 12 and 26 weeks after HLSV as well as spermatic venous blood samples intraoperatively for determination of the levels of follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone (T), anti-sperm antibody (AsAb) and serum INHB by ELISA.</p><p><b>RESULTS</b>Compared with the baseline, statistically significant differences were observed in the INHB level in the peripheral blood at 12 and 26 weeks after operation (［255.18 ± 69.97］ vs ［141.78 ± 59.82］ pg/ml, P < 0.05) and that in the spermatic venous blood intraoperatively (［255.18 ± 69.97］ vs ［412.44 ± 259.42］ pg/ml, P < 0.01). Spearman's analysis showed a negative correlation between the level of INHB and that of FSH (r = －0.224, P < 0.01).</p><p><b>CONCLUSIONS</b>The level of serum INHB in the peripheral blood of the prepubertal VC patient is decreased within 6 months after HLSV and negatively correlated with that of FSH. The levels of INHB and FSH may well reflect the testicular function of the prepubertal VC patient.</p>

Serum inhibin B and varicocele: An update / 中华男科学杂志

Inhibin B, a glycoprotein produced predominantly by Sertoli cells and preferentially suppressing the production and secretion of follicle-stimulating hormone (FSH) in the pituitary, is closely related to spermatogenesis. Varicocele is the abnormal dilatation and tortuosity of the pampiniform plexus veins, which may contribute to spermatogenic dysfunction and male infertility. More and more evidence has shown that the level of serum inhibin B is negatively correlated with the severity of varicocele. Determination of the inhibin B level may help assess the severity of spermatogenic dysfunction of the patient and predict the outcomes of varicocele repair and therefore has a potential application value in the diagnosis and treatment of varicocele.

Tumor de las células de granulosa: pubertad precoz en lactante menor de 1 año. Caso clínico / Granulosa cell ovarian tumor: precocious puberty in infant less than 1 year of age. Case report

Resumen Introducción: Los tumores de las células de la granulosa de tipo juvenil (TCGJ) son muy poco fre cuentes, especialmente en menores de 1 año. Los signos de pubertad precoz constituyen la presenta ción clínica más importante. Objetivo: Presentar una lactante con pubertad precoz periférica, con diagnóstico de TCGJ, discutiendo las claves de su tratamiento y seguimiento. Caso Clínico: Lactante de 10 meses que presentó telarquia, vello púbico y tumor abdominal palpable acompañado de niveles plasmáticos de Estradiol aumentados, gonadotrofinas muy bajas e imágenes que mostraban masa ovárica gigante. Se realizó salpingooforectomía, obteniéndose regresión absoluta de signos y síntomas. La biopsia demostró TCGJ por lo que se tomó inhibina B (InB) como marcador después de la cirugía. Esta hormona estaba alta inicialmente, pero descendió rápidamente. El seguimiento se basó en InB, Hormona antimulleriana (AMH) y estradiol como se describe en este tipo de tumores. Conclusiones: Los TCGJ son muy infrecuentes en pediatría; deben sospecharse en niñas con puber tad precoz periférica. El tratamiento quirúrgico en la gran mayoría es curativo, pero debe mantenerse un estricto control con marcadores tumorales, siendo los más específicos la InB y la AMH y en menor escala los niveles de Estradiol.

Abstract Introduction: Juvenile granulosa cell tumors (JGCT) are very rare, especially in infants under the age of one. The most frequent presentation is with signs of precocious puberty. Objective: Present an in fant with peripheral precocious puberty, diagnosis of JGCT and follow up. Clinical case: 10-month-old female infant with thelarche, pubic hair and palpable abdominal mass accompanied with eleva ted levels of estradiol, very low gonadotrophins and images that show a very large ovarian mass. A sapingooforectomy was carried out with full regression of symptoms and signs and improvement of laboratory exams. The biopsy showed TCGJ so inhibin B (InB) was taken as tumoral marker after surgery. This hormone was high initially, but rapidly declined. Follow-up was based on InB, antimu-llerian Hormone (AMH) and estradiol as described in this type of tumors. Conclusions: Juvenil gra nulosa cell tumors are very infrequent in pediatric age, but should be suspected in girl with peripheral precocious puberty. The majority of cases improve with surgery, but strict surveillance of tumoral markers is needed. The most specific markers are inhibin B and anti mullerian hormone (AMH), followed by estradiol levels.

Causa muy rara de pubertad precoz periférica en una niña: tumor de cordones sexuales con túbulos anulares / A very rare cause of peripheral precocious puberty in a girl: ovarian sex cord tumor with annular tubules

El tumor de los cordones sexuales con túbulos anulares es una neoplasia del estroma gonadal muy infrecuente. Representa el 0,05-0,6% de todos los tumores ováricos, según series. Se presenta un caso especialmente inusual, en una niña de 6 años, detectado a raíz de una pubertad precoz periférica isosexual. Su interés radica en que no se halló ninguna masa anexa al ovario, sino únicamente una asimetría gonadal, sin signos radiológicos de malignidad. Se realizó una salpingo-ooforectomía unilateral con linfadenectomía pélvica y paraaórtica ipsilateral, por vía laparoscópica, tras confirmarse la presencia de células tumorales en la biopsia intraoperatoria. La evolución posterior de la paciente fue favorable.

Sex cord tumor with annular tubules is an extremely uncommon gonadal stromal neoplasm. It represents 0.05-0.6% of all ovarian tumors, according to series. An unusual case is presented in a 6-year-old girl, detected as a result of an isosexual peripheral precocious puberty. The highlight of this case is that no mass attached to the ovary was found, but only a gonadal asymmetry without radiological signs of malignancy. After confirming the presence of tumoral cells by intraoperative biopsy, unilateral salpingo-oophorectomy with ipsilateral para-aortic and pelvic lymphadenectomy was performed. Afterwards, the evolution of the patient was favorable.

An analysis on inhibin A and activin A combined with uterine artery doppler in the prediction of preeclampsia / 预防医学

Objective To evaluate the predictive value of pre-eclampsia with the combination of inhibin A,activin A and uterine artery doppler.Methods The single pregnant pregnant women were divided into 9-12 week of pregnancy groups and 13-16 week of gestation group based on examination of gestational age.According to the outcome of further follow-up the women are divided into normal pregnancy (9-12 week pregnant or 13-16 week pregnant normal group) and the PE group (9-12 weeks pregnant or pregnant 13-16 PE group).Enzyme-linked immunosorbent assay (ELISA) was used to detect the concentration of inhibin A and activin A.Doppler ultrasound were used to examine UAPI.The results were converted to MoM values to calculate the combined detection specificity and sensitivity.Results The concentration of serum inhibin A and activin A and UAPI in 9-12 week pregnant PE group were significantly higher than that in 9-12 week normal pregnant (P ＜0.05).The concentration of serum inhibin A and activin A and UAPI in 13-16 week pregnant PE group were significantly higher than that in 13-16 week normal pregnant (P ＜0.05).When the maximum area under the curve of three indicator combined application (AUC =0.836) in 9-12 week pregnant,the specificity was 72％ and the sensitivity was 83％.When the maximum area under the curve of three indicators combined application (AUC =0.912) in 13-16 week pregnant,the specificity was 87％ and the sensitivity was 86％.Conclusion The combined application of peripheral blood inhibin A,activin A and UAPI could predict PE.The combined application of three indicator detection index provides a high degree of specificity,sensitivity and predictive value in 13-16 week pregnant.

Clinical Value of Serum Anti-Mullerian Hormone and Inhibin B in Prediction of Ovarian Response in Patients with Polycystic Ovary Syndrome / 华中科技大学学报（医学）（英德文版）

The present study aimed to investigate the clinical value of serum anti-mullerian hormone (AMH) and inhibin B (INHB) in predicting the ovarian response of patients with polyeystic ovary syndrome (PCOS).A total of 120 PCOS patients were enrolled and divided into three groups in terms of the ovarian response:a low-response group (n=36),a normal-response group (n=44),and a high-response group (n=40).The serum AMH and INHB levels were measured by enzyme-linked immunosorbent assay (ELISA).The follicle stimulating hormone （FSH),luteinizing hormone (LH),and estradiol (E2) levels were determined by chemiluminescence microparticle immunoassay.The correlation of the serum AMH and INHB levels with other indicators was analyzed.A receiver operating characteristic (ROC) curve was established to analyze the prediction of ovarian response by AMH and INHB.The results showed that there were significant differences in age,body mass index (BMI),FSH,total gonadotropin-releasing hormone (GnRH),LH,E2,and antral follicle counts (AFCs) between the groups (P＜0.05).The serum AMH and INHB levels were increased significantly with the ovarian response of PCOS patients increasing (P＜0.05).The serum AMH and INHB levels were negatively correlated with the age,BMI,FSH level,Gn,and E2 levels (P＜0.05).They were positively correlated with the LH levels and AFCs (P＜0.05).ROC curve analysis of serum AMH and INHB in prediction of a low ovarian response showed that the area under the ROC curve (AUC) value of the serum AMH level was 0.817,with a cut-off value of 1.29 ng/mL.The sensitivity and specificity were 71.2％ and 79.6％,respectively.The AUC value of serum INHB was 0.674,with a cut-off value of 38.65 ng/mL,and the sensitivity and specificity were 50.7％ and 74.5％,respectively.ROC curve analysis showed when the serum AMH and INHB levels were used to predict a high ovarian response,the AUC value of the serum AMH level was 0.742,with a cut-off value of 2.84 ng/mL,and the sensitivity and specificity were 72.7％ and 65.9％,respectively;the AUC value of the serum INHB level was 0.551 with a cut-off of 45.76 ng/mL,and the sensitivity and specificity were 76.3％ and 40.2％,respectively.It was suggested the serum AMH and INHB levels have high clinical value in predicting the ovarian response of PCOS patients.