First one with correct answer with justification win.

 

A 14-year old girl is admitted to the pediatric psychiatric service with symptoms of agitation, nausea, vomiting, focal seizures and catatonia. An abdominal radiograph is obtained because of the gastrointestinal symptoms, and Ultrasound suggests a mature ovarian teratoma.

 

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[size=20px]For this adolescent with an ovarian mass, you recommend

 

A observation and follow-up after current condition is resolved.

 

B complete work up (imaging, serum markers) now and proceed with early resection.

 

C complete work up during this admission and elective plan resection at later date.

 

D complete work up and plan observation only if work up suggests benign lesion.

 

E emergent resection.[/size]

B complete work up (imaging, serum markers) now and proceed with early resection

B complete work up (imaging, serum markers) now and proceed with early resection

correct

 

Anti-N-methyl-D-aspartate receptor (NMDAR) antibody encephalitis is a recently identified autoimmune disorder that is increasingly recognized in children. Most cases occur in girls and women and may be paraneoplastic with an associated ovarian teratoma.

 

Characteristic clinical features include neuropsychiatric symptoms, dyskinesia, decreased consciousness and autonomic instability. The pathogenesis is believed to be secondary to autoantibodies that are generated against important central nervous syste (CNS) ion channels and receptors resulting in the clinical features.

 

Teratomas frequently express neurogenic tissue and perhaps stimulate autoantibodies production which secondarily effect the CNS. The diagnosis is made by serum and cerebrospinal fluid antibody detection. Up to 40% of cases of antiNMDAR encephalitis are in children and adolescents. Treatment includes immunotherapy (steroids, IVIG and plasma exchange) and early tumor resection. In patients with tumor resection +/- immunotherapy 50% are significantly improved at four weeks and 81% good results at two years.