Clinical, Hormonal, and Neuroradiological Characteristics and Therapeutic Outcomes of Prolactinomas in Children and Adolescents at a Single Center.

Background/Purpose: A prolactinoma is the most common pituitary adenoma, but it is relatively rare in childhood and adolescence. There is only limited research about the clinical spectrum, treatment, and outcomes of prolactinomas in childhood and adolescence. In this single-center cohort study, we assessed the clinical, hormonal, and neuroradiological characteristics and therapeutic outcomes of children and adolescents with prolactinomas. Methods: This retrospective cohort study included 25 patients with prolactinomas diagnosed before 19 years of age, who presented at Samsung Medical Center during a 15-year period (March 2005 to August 2019). Results: The median age at diagnosis was 16.9 (range 10.1-18.5) years, and 80% of the patients were female. The common clinical manifestations at diagnosis were galactorrhea (10/20, 50%) and amenorrhea (9/20, 45%) among females and visual field defects (3/5, 60%) and headaches (2/5, 40%) among males. In our cohort, macroadenomas accounted for 56% of cases, and the rate of overall responsiveness to dopamine agonists (DAs) was 56% (10/18). Male gender, the prolactin (PRL) level at diagnosis, and the presence of panhypopituitarism were positively correlated with maximum tumor diameter (r = 0.443, P = 0.026; r = 0.710, P < 0.001; and r = 0.623, P = 0.001, respectively). After the trans-sphenoidal approach (TSA), 53% (8/15) of patients showed normalization of the PRL level. Three patients, who underwent gamma knife surgery (GKS) owing to either resistance or intolerance to DAs or recurrence after the TSA, achieved a normal PRL level accompanied with marked tumor reduction and symptom remission. Conclusions: A macroprolactinoma is more prevalent than a microprolactinoma in children and adolescents than in adults. Male gender, increased PRL levels, and the presence of panhypopituitarism at diagnosis are closely related to macroprolactinomas in children and adolescents.

Más allá del botón mamario y la ginecomastia puberal / Beyond de breas buds and pubertal gynecomastia. Knowing the breast pathology

Introducción. Los pediatras estamos poco familiarizados con la patología de la mama de niños y adolescentes, debido en parte a su baja incidencia en la edad pediátrica y al escaso conocimiento que tenemos de. las diferentes patologías que pueden asentar en ella. Es importante ampliar nuestros conocimientos en esta patología, sobre todo en relación con la patología del adolescente, para así mejorar el manejo de estas patologías. Material y métodos. Revisamos las historias de 7 pacientes atendidos en el Servicio de Urgencias y en las consultas de Pediatría en relación a patología de la mama, y revisamos la bibliografía al respecto. Conclusiones. Queremos hacer hincapié en las diferentes patologías de la mama en la edad pediátrica para facilitar el diagnóstico y manejo de esta patología (AU)

Introduction. Pediatricians are not very familiar with breast diseases of children and adolescents due to the low incidence in pediatric age and our spare knowledges. It's important to improve our understanding, above all concerning the adolescent group. Material and methods. We reviewed the medical records of 7 patients attended in the emergency department or in the consulting rooms of the hospital diagnosed of different breast diseases. We also reviewed the related references. Conclusion. We want to remember the different breast diseases to case diagnosis and management of these pathologies (AU)

Galactorrhoea of the neck following pectoralis major reconstruction of a pharyngeal defect.

We describe a case of postoperative galactorrhea following the use of a pedicled pectoralis major myocutaneous flap for reconstruction of a pharyngolaryngeal defect in a woman with squamous cell carcinoma. We believe this to be unique in the literature, and an important complication to be reported, due to the similarities in appearance of galactorrhoea and postoperative aerodigestive tract/cutaneous fistula.

Diagnostic accuracy of abnormal galactographic and sonographic findings in the diagnosis of intraductal pathology in patients with abnormal nipple discharge.

The purpose of the study was to compare the diagnostic accuracy of the combination of galactography and ultrasound in patients with pathologic nipple discharge. Fifty-six patients with pathologic nipple discharge were included in the study. Sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for each method and the combination of both were calculated. Both methods together had a sensitivity, specificity, PPV, and NPV of 91%, 17%, 61%, and 57%. The combined sensitivity of galactography and ultrasound for intraductal pathologies is higher than either modality alone, with a low specificity. No specific signs exist to predict benign or malignant lesions.

Hiperprolactinemia y embarazo: aspectos clínicos / Hyperprolactinemia and pregnancy: clinical aspects

Se hizo un estudio retrospectivo que incluyó 54 pacientes hiperprolactinémicas que lograron embarazo en el período comprendido entre enero de 1979 y diciembre de 1992, con el objetivo de describir su comportamiento clínico antes y después del embarazo. Se dividió la muestra en 2 grupos: funcional (n = 21) y tumoral (n = 33). Se comprobó que la galactorrea y la infertilidad fueron los motivos de consulta más frecuentes en la causa idiopática y la amenorrea y la galactorrea, en las tumorales. El tratamiento previo al embarazo en todas las pacientes del grupo idiopático y en el 67,5 porciento de las de causa tumoral fue con agonistas dopaminérgicos. Más de la mitad de las pacientes de ambos grupos tuvo mejoría clínica en el primer año posparto, el resto se mantuvo sin cambios, excepto una paciente del grupo funcional que empeoró clínicamente. En el segundo año posparto aumentó el número de mujeres cuyos síntomas clínicos fueron similares a los referidos previo al embarazo. En conclusión, en nuestra serie se pudo constatar mejoría de los síntomas de la hiperprolactinemia después del embarazo en la mayoría de las pacientes(AU)

[Digital mammography: experiences in its clinical application]. / Digitale Mammographie: Erfahrungen bei klinischer Anwendung.

TARGET: In 1989 in the Cantonal Hospital of Lucerne conventional film-screen mammography was replaced by digital mammography. With the support of a retrospective study, it was checked whether or not digital mammography represents an equally valid diagnostic procedure in daily routine. METHODS: 1204 patients were examined using digital mammography. A reevaluation of these patients was carried out using clinical and radiological routine controls. Additionally a radiological and histological examination was performed in 127 cases in which excisional biopsies had been done, paying particular attention to detail perception. RESULTS: The sensitivity of digital mammography achieved a total of 85%, whereas the accuracy was 81%. With additional use of ultrasound and galactography the sensitivity attained 91%. By reevaluation the sensitivity amounted to 87%, the accuracy remaining at 81%. The positive predictive value was especially high with 76% and 77%. CONCLUSION: Digital mammography offers satisfactory diagnostic performance.

Radioiodine breast uptake in nonbreastfeeding women: clinical and scintigraphic characteristics.

UNLABELLED: We studied the scintigraphic and associated clinical characteristics of radioiodine breast uptake in nonbreastfeeding thyroid cancer patients undergoing routine whole-body radioiodine scanning. METHODS: We performed a retrospective review of the radioiodine scans and medical records of 30 prospectively collected cases. RESULTS: Twenty-three nonpregnant patients had discontinued breastfeeding for a mean of 11.4 mo. Three postmenopausal and four single nulliparous patients had radioiodine breast uptake on one or more occasions. This represented about 6% of all female patients who had radioiodine scans over a 3-yr period. Four patterns of uptake, full, focal, crescentic and irregular, were observed. Breast uptake mimicked lung metastasis in nine patients. Expressible galactorrhea and moderately elevated prolactin levels were present in 48% and 24%, respectively, of patients examined. In 14 patients followed for an average of 11.4 mo, there were no consistent changes in the pattern or intensity of breast uptake. In 18 patients who had both 123I diagnostic and 131I postablation scans within a few days, breast uptake was present on both scans in 75%. In four patients, breast uptake was present, despite the 4%-9% radioiodine uptake by the thyroid; in one patient, iodinated contrast material blocked the uptake of the thyroid gland but not of the breast. CONCLUSION: Although the mechanisms of radioiodine breast uptake remain unclear, breast uptake should be suspected in all female patients with radioiodine uptake in the chest area, even in the absence of a history of breastfeeding.

[Galactography]. / Galactografie.

Spontaneous single duct discharge is the main indication for galactography. This abnormality has in most cases a benign aetiology (> 90%). With a meticulous technique and sufficient experience, the ducts can be cannulated in 95% of the cases. A nipple adenoma with a blood stained discharge is seldom to pass for cannulation. Because cytology of the nipple discharge is not always positive in case of intraductal proliferations, microdochectomy must be used to obtain the differential diagnosis. Galactography shows multiple normal duct variations, depending on age, surrounding tissue, and a possible history of lactation. Pathologic images can be seen in dystrophic breasts, solitary papillomas, (juvenile) papillomas or (intraductal) carcinomas. In addition to high frequency ultrasonography (> or = 10 MHz), which is able to visualise the retro-areolar and superficial ducts, galactography can give a more detailed and better overview of the pathology.

[Localization of pathologically secreting lactiferous ducts]. / Poznámky k lokalizaci patologicky secernujících mlékovodu.

During the investigation of ductographic findings in 200 patients with secretory disease of the breasts it was discovered that pathologically secreting lactiferous ducts were statistically predominantly localized in the retroareolar region and in the lower quadrates of the breasts. This prevalence does not correspond with the regions of the most voluminous portions of the mammary gland and with the most frequent localization of mammography manifestations of its fibroepithelial dysplasia.

[Xeroductogalactography. Case reports]. / Xeroduttogalattografia. Contributo casistico.

Xerogalactography represents the most important instrumental examination in the diagnosis of the secreting breast. The authors describe the radiological findings in the ductal ectasia, intraductal papillomas and papillomatosis and carcinomas in a personal experience concerning 52 patients with mammary secretion.

Breast disease in the male: galactographic evaluation.

Seven men with unilateral nipple discharge underwent galactography. In two patients the diagnosis was carcinoma, two were benign papillomas, one was a breast abscess, and two were ductal ectasia. Galactography is useful in men and women with nipple discharge, especially when the discharge is bloody and there is no palpable tumor. The precise location of an intraductal lesion through the use of galactography guides the biopsy and makes conservative surgery easier.

Serum prolactin levels before and after galactography in patients with pathological nipple discharge.

Serum prolactin levels were determined in 25 women who underwent galactography on account of pathological nipple discharge. The test samples were obtained immediately before galactography as well as 5, 10, 15 and 30 minutes after. There was no significant change in serum prolactin levels following galactography. In 2 cases out of 25, the basal level of prolactin was well above normal while in 1 case it was below normal. Those three were cases of galactorrhea. The clinical aspect of pathological nipple discharge did not correlate with serum prolactin levels, and galactorrhea would appear to be compatible with serum prolactin levels below normal.