Poster Abstracts / J Pediatr Adolesc Gynecol 25 (2012) e27ee48

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was nally decided that the patient would be followed with serial breasts ultrasounds every 6 months and that biopsy would be performed only if the ultrasound was suspect for neoplasia. This patient is now 14 years old. On her last ultrasound, the lesions had increased in volume, were very tender, and were beginning to be more typical of neurobromas. Neurobromatosis type 1 has been associated with a ve-fold increased risk of breast cancer in women younger than 50 years old. Counselling and close follow-up are of utmost importance in these patients who frequently delay consultation because they mistakenly supposed that the tumor is a manifestation of neurobromatosis.

Table 1 Population Characteristics Variable n %

15. 7 Year-Old Girl Presenting With Vaginal Discharge as First Symptom of Pelvic Lymphangiomatosis: A Case Report
Janie Benot MD, Elise Dubuc MD, Suzy Gascon MD, Diane Francoeur MD (Senior Author)  CHU Ste-Justine, Obstetrics and Gynecology Department, Universite de   Montreal, Quebec, Canada

Background: Lymphangiomatosis is a condition marked by the presence

of cysts that result from an increase both in the size and number of thinwalled lymphatic channels that are abnormally interconnected and dilated. Although the condition is benign, these deranged lymphatics invade surrounding tissues and cause problems due to invasion and compression of adjacent structures. Pelvic lymphangiomatosis usually present with abdominal pain. We present here a case of a 7 year-old girl who presented with vaginal discharge as primary symptom of this rare condition. Case: A 7 year-old girl consulted at the emergency room in September 2008 for vaginal bleeding. She experienced the bleeding for the rst time 3 weeks earlier, and it happened three more times until her visit to the hospital. At each time, her underwear was soiled by a mix of wateous and bleeding secretions. She was in good health and had only a history of constipation. At exam, she was Tanner 1 in her puberty development and had no abdominal mass. At external gynecologic exam, she had an intact perforated hymen, a small angioma on the left labia and no anal stricture was found. Cultures were done and came back negative. She underwent a pelvic ultrasound that showed normal uterus and ovaries without sign of a mass, foreign body or sign of precocious puberty. An exam under anesthesia was planned and the vaginoscopy failed to explain the discharge. She came back to the emergency because of increasing discharge and another exam under anesthesia was performed with a cystoscopy without any result. A MRI was done and diagnosed an extensive abdominal, pelvic and retroperitoneal lymphatic anomaly. An exploratory laparoscopy was done and showed an conrmed the disseminated pelvic lymphangiomatosis. Because of the worsening of the symptomatology of the patient (she had to wear a diaper to manage the vaginal discharge), four Doxycycline sclerotherapies were performed from July 2009 to February 2011. Comments: To our knowledge, this is the rst case published in the literature of pelvic lymphangiomatosis that presented initially with vaginal discharge in a child.

Total 52 Age in years; mean13,5 Age at menarche in years; mean11,9 Time between menarche and admission in months, mean19 Comorbidities None 42 Asthma 2 PTI 1 Cardiac pathology 4 Others 3 Personnal history of diathesis 4 Family history of diathesis 3 Anticoagulation medication Aspirin 1 Warfarine 3 History of treatment for menorrhagia n 13 Bleeding disorder n Von Willebrand's disease 1 Hemophilia carrier 1 ITP 1 Leukemia 2 Hemoglobin at arrival in g/L; mean72 Hemoglobin at transfusion in g/L; mean51,4 Hemoglobin at discharge in g/L; mean79

80,8 3,8 1,9 7,7 5,8 7,7 5,8 1,9 5,8 % 25 % 1,9 1,9 1,9 3,8

16. Management of Acute Menorrhagia in Adolescents

Elise Dubuc MD, Janie Benot MD, Suzy Gascon MD, Sandrine Wavrant MD, Diane Francoeur MD (Senior author)  CHU Ste-Justine, Obstetrics and Gynecology Department, Universite de   Montreal, Quebec, Canada

excluded. The details of interest analyzed: the use or not of a standardized treatment protocol for menorrhagia, the type of medical treatment used, the need of blood product transfusions, hemoglobin level and coagulation prole; the need for surgical intervention. The protocol includes coagulation study, von Willebrand's disease work-up, and treatment with conjugated estrogens (2.5mg orally four times per day) or 17-beta-estradiol (4mg orally four times per day) and tranexamic acid (10mg/kg/dose, max 1500mg/dose orally three times per day) in conjunction with an antiemetic regimen. Results: Fifty-two adolescents (mean age of 13.5 years) were identied. The mean hemoglobin on admission was 72g/L. This protocol was used in 45.9% (17/37) when the patient was admitted to the gynecology service and 36.4% (4/11) when admitted in Pediatrics. Coagulation study was done in 100% (52/52) of patients. Von Willebrand's disease work-up was performed in 50% (17/24) of patients for which the protocol was used and in 39.3% (11/28) of patients when the protocol wasn't used (p0.04). The dosages of hormonal treatment was adequate in 95.8% (23/24) of patients for which the protocol was used compared with 67.9% (19/28)when no protocol used. Tranexamic acid was used in a greater proportion if the protocol was used (83.3% vs 50% p0.001). Blood product transfusion was needed in 34.6% of patients globally, there was no statistical difference if the protocol was used or not. A bleeding disorder was found in ve patients (9.6%). A total of four patients (7.7%) required a dilation and curettage for ongoing bleeding. Conclusion: It known that high dose estrogen therapy and tranexamic acid is an effective treatment for menorrhagia in adolescents. The use of a standardized protocol seems to enhance proper use of these medications and increases the proportion of patients investigated for von Willebrand's disease.

17. Abnormal Vaginal Bleeding in Children and Adolescents

Anne-Marie Priebe DO, Pratibha Sareen MD, Julie L. Strickland MD Children's Mercy Hospital, Kansas City, Missouri

Background: The aim of this study was to determine if the use of

a standardized treatment protocol for menorrhagia in adolescents helped adequately manage this condition. Methods: This was a retrospective study done at CHU Ste-Justine. Charts between January 2000 and December 2010, of adolescent girls with a diagnosis of admission of menorrhagia and a hemoglobin <110 g/L, were included. Adolescents with genital tract pathology and pregnancy were

Background: Primary cancer of the vagina only accounts for 1-3% of all
gynecologic malignancies. Less than 1% of these cancers occur in children under the age 15 years. Nevertheless, when an adolescent child presents with abnormal vaginal bleeding or discharge, the rare possibility of