Abnormal Uterine Bleeding in Adolescence: When Menarche Reveals other Surprises

Abstract Introduction Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described. Clinical case A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severemenstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma. Discussion Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.

【摘要】异常子宫出血在青少年群体中更为常见。尽管其多数为非结构性病因，但也可由各类已知病因引发。
临床病例：一名12岁青少年女性，无相关既往病史，于1个月前迎来初潮，因进行性加重的重度月经出血伴血流动力学异常，需输血支持，于急诊科就诊。初步考虑为生理性排卵功能障碍合并既往未被发现的凝血功能异常，并启动药物治疗。经治疗后症状无缓解，患者接受镇静观察及子宫抽吸术，最终确诊为伯基特淋巴瘤（Burkitt Lymphoma）。
讨论：尽管结构性病因，尤其是良恶性肿瘤（无论是否起源于妇科系统）在该年龄段异常子宫出血的病因中极为罕见，但仍需将其纳入鉴别诊断范畴，以保障患者能够获得及时且恰当的诊疗。