Ovarian Tissue Autologous Transplantation to the Upper Extremity for Girls Receiving Abdominal/Pelvic Radiation: 20-year Follow-up of Reproductive Endocrine Function
published online 06 November 2009.
Abstract
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.
1Division of Gynecology, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
2Department of Surgery, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
3Division of Hematology/Oncology, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
4Division of Adolescent/Young Adult Medicine, Children's Hospital Boston; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
5Division of Pediatric Oncology, Dana-Farber Cancer Institute; Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts
6Division of Reproductive Endocrinology, Department of Obstetrics, Gynecology, and Reproductive Biology, Brigham and Women's Hospital; Harvard Medical School, Boston, Massachusetts, USA
Address correspondence to: Marc R. Laufer, MD, Division of Gynecology, Children's Hospital Boston, 300 Longwood Ave, Boston, MA 02115; Phone: (617) 355-5785; Fax: (617) 730-0186
The work described in this article was done at Children's Hospital Boston, Massachusetts. The authors declare no financial support. The results from this study were presented at the North American Society of Pediatric and Adolescent Gynecology, Miami, Florida, 2002.
Capsule: The first cases of ovarian autotransplantation to the upper extremity for girls receiving abdominal pelvic radiation therapy resulted in long-term sex steroid production for spontaneous puberty, menarche, follicular development, and menses.
ABSTRACT