Effect of dietary with Zhibai dihuang pills and gonadotropinreleasing-hormone-analogue on girls with precocious and rapidly progressive puberty

BACKGROUND At present,the clinical mechanisms underlying precocious puberty remain unclear,making effective intervention for children experiencing this condition and rapidly progressive puberty essential.AIM To explore the effects of Zhibai dihuang pills and gonadotropin-releasing hormone analogue(GnRHa)on growth and ovarian function in girls with precocious puberty.METHODS The clinical data of 84 adolescent girls with precocious puberty and rapidly progressive puberty from February 2017 to August 2023 were retrospectively analyzed.Girls were divided into a control group and an observation group,with 42 cases in each group.The control group received diet intervention combined with GnRHa treatment,while the observation group received diet intervention combined with Zhibai dihuang pills+GnRHa treatment.Outcomes such as clinical efficacy,growth indicators,ovarian function,and adverse reactions were compared between the two groups.RESULTS The observation group showed superior clinical efficacy compared to the control group(P<0.05).Prior to the intervention,no significant differences were found in growth or ovarian function between the groups(P>0.05).Post-intervention,the observation group exhibited significantly lower rates in growth,height,and bone age,along with reduced levels of progesterone,testosterone,estradiol,prolactin,luteinizing hormone,and follicle-stimulating hormone compared to the control group(P<0.05).The incidence of adverse reactions was similar across both groups(P>0.05).CONCLUSION Combining Zhibai dihuang pills with GnRHa and dietary intervention effectively improves growth,enhances ovarian function,and minimizes adverse reactions in adolescent girls with precocious and rapidly progressive puberty.

Comparison of methods for deriving phenotypes from incomplete observation data with an application to age at puberty in dairy cattle

Background Many phenotypes in animal breeding are derived from incomplete measures,especially if they are challenging or expensive to measure precisely.Examples include time-dependent traits such as reproductive status,or lifespan.Incomplete measures for these traits result in phenotypes that are subject to left-,interval-and rightcensoring,where phenotypes are only known to fall below an upper bound,between a lower and upper bound,or above a lower bound respectively.Here we compare three methods for deriving phenotypes from incomplete data using age at first elevation(>1 ng/mL)in blood plasma progesterone(AGEP4),which generally coincides with onset of puberty,as an example trait.Methods We produced AGEP4 phenotypes from three blood samples collected at about 30-day intervals from approximately 5,000 Holstein–Friesian or Holstein–Friesian×Jersey cross-bred dairy heifers managed in 54 seasonal-calving,pasture-based herds in New Zealand.We used these actual data to simulate 7 different visit scenarios,increasing the extent of censoring by disregarding data from one or two of the three visits.Three methods for deriving phenotypes from these data were explored:1)ordinal categorical variables which were analysed using categorical threshold analysis;2)continuous variables,with a penalty of 31 d assigned to right-censored phenotypes;and 3)continuous variables,sampled from within a lower and upper bound using a data augmentation approach.Results Credibility intervals for heritability estimations overlapped across all methods and visit scenarios,but estimated heritabilities tended to be higher when left censoring was reduced.For sires with at least 5 daughters,the correlations between estimated breeding values(EBVs)from our three-visit scenario and each reduced data scenario varied by method,ranging from 0.65 to 0.95.The estimated breed effects also varied by method,but breed differences were smaller as phenotype censoring increased.Conclusion Our results indicate that using some methods,phenotypes derived from one observation per offspring for a time-dependent trait such as AGEP4 may provide comparable sire rankings to three observations per offspring.This has implications for the design of large-scale phenotyping initiatives where animal breeders aim to estimate variance parameters and estimated breeding values(EBVs)for phenotypes that are challenging to measure or prohibitively expensive.

Precocious Puberty in a 5-Year-Old Girl with a Giant Hypothalamic Hamartoma Discovered Perinatally: Case Report

Background: Hypothalamic hamartoma is a rare non-neoplastic lesion, typically identified in early childhood during investigations for precocious puberty and/or gelastic seizures. However, cases of diagnosis even earlier or during fetal development have been documented. Case Presentation: A newborn girl was diagnosed with hydrocephalus during pregnancy. An MRI revealed a large oval hypothalamic process, which suggested a hypothalamic hamartoma. At the age of 2, she experienced alternating crying and laughing seizures, followed by a decrease in visual acuity. Due to involvement of the optic pathways, surgery was not performed and she underwent antiepileptic medicines and gamma knife radiotherapy. At the age of 5 years and 3 months, she presented with breast development and laboratory tests confirmed central precocious puberty. Quarterly injections of GnRH agonists have since been administered with favorable results. Conclusion: Early-diagnosed hypothalamic hamartomas require close monitoring, by an experienced multidisciplinary, to promptly detect and treat potential complications, especially precocious puberty, and prevent any undesirable impact on final height.

Pandemic and precocious puberty-a Google trends study

BACKGROUND Recent publications from several countries have reported that more young people(mainly girls)are experiencing precocious puberty(PP)/menarche during the coronavirus disease 2019 pandemic compared to the past.This variation is attributed to the stress of confinement,lack of exercise,obesity and disturbed sleep patterns.A common feature of the relevant papers,however,is the small number of reported cases of PP.Studies have shown that searches for diseases on the internet also reflect to some extent the epidemiology of these diseases.AIM To estimate,through internet searches for PP,any changes in the epidemiology of PP.METHODS We assessed in Google Trends searches for 21 PP-related terms in English internationally(which practically dwarf searches in other languages),in the years 2017-2021.Additionally,we assessed local searches for selected terms,in English and local languages,in countries where a rise in PP has been reported.Searches were collected in Relative Search Volumes format and analyzed using Kendall’s Tau test,with a statistical significance threshold of P<0.05.RESULTS Internationally,searches for three PP-related terms showed no noticeable change over the study period,while searches for eight terms showed a decrease.An increase was found over time in searches for nine PP-related terms.Of the 17 searches in English and local languages,in countries where a rise in PP has been reported,5 showed a significant increase over time.CONCLUSION Over the study period,more than half of the search terms showed little change or declined.The discrepancy between internet searches for PP and the reported increase in the literature is striking.It would be expected that a true increase in the incidence of PP would also be aptly reflected in Google trends.If our findings are valid,the literature may have been biased.The known secular trend of decreasing age of puberty may also have played a role.

Clinical efficacy of leprerelin acetate with different dosage forms in central precocious puberty girls

Objective:To observe the clinical efficacy of different dosage forms of lepraline acetate(LA)in the treatment of girls with central precocious puberty(CPP).Methods:72 CPP girls treated in the Department of Pediatrics of Huai'an First People's Hospital from February 2021 to August 2022 were included as subjects and divided into two groups:3-month LA group(n=34)and 1-month LA group(n=38).Both group girls were treated for 6 months.Serum hormone levels,body mass index(BMI),bone age/chronological age(BA/CA)and pelvic color ultrasound were detected at 0 and 6 months after treatment,and the changes of various indexes were compared before and after treatment.Results:1)There were no significant differences in baseline data between the two groups before treatment(P>0.05).2)After 6 months of treatment,BA/CA decreased,growth rate slowed down,and predicted adult height increased in both groups(P<0.05),but there were no significant differences between groups(P>0.05).3)After 6 months of treatment,there waere no significant differences in luteinizing hormone(LH)inhibition ratio between the 3 month and 1 month dosage groups(P>0.05).After treatment,the peak value of serum LH and FSH,estradiol level,uterine volume,bilateral ovarian volume,maximum follicle diameter and the number of follicles 4mm were significantly decreased in the two groups,but there were no significant differences between the two groups(P>0.05).4)There were no significant differences in the levels of thyroid hormone,fasting blood glucose and triglyceride between the two groups before and after treatment(P>0.05).Total cholesterol levels were increased after treatment(P<0.05),but there was no significant difference between groups(P>0.05).5)No serious adverse reactions occurred during the treatment of the two dosage forms of LA,but the 3-month dosage form of LA reduced the treatment cost and improved the treatment compliance.Conclusion:The short-term efficacy of 3-month LA in the treatment of CPP in girls is similar to that of 1-month LA.The 3-month dosage form LA is a safe,effective,and economical method for the treatment of CPP in girls.

Premature Puberty Revealing an Ovarian Tumor in a Five-Year-Old Girl

Background: Ovarian tumors in the girl child are sometimes revealed by the development of secondary sexual characteristics. The authors report the case of a five-year-old girl in whom the disease was revealed by early puberty. Case presentation: A five-year-old girl with an enlarged abdomen for about four months. The onset of pain and the sensation of a mass prompted the consultation. The development of secondary sexual characteristics (SSC) noted by the family had not been mentioned. The patient was classified as pubertal stage 2 according to the Tanner classification. An abdominal ultrasound and a CT scan showed a large left ovarian mass, an enlarged uterus for the patient’s age and a normal right ovary. The hormonal workup was not contributive. The treatment consisted only of a left salpingo-ovarectomy, without complementary chemotherapy. Anatomic pathological examination of the surgical specimen concluded to a juvenile tumor of the granulosa. The evolution was good with a beginning of regression of the HSC one month after the ovarectomy. Discussion: Granulosa tumors are sometimes secretory cancers, generally with a low potential for malignancy and therefore a very good prognosis. Surgery based on total adnexectomy is the first-line treatment. The large size of the tumor, the presence of ascites and capsular rupture are factors of poor prognosis, hence the importance of early diagnosis. Conclusion: Routine comprehensive physical examination should be de rigueur for abdominal masses in girls, especially in the context of various beliefs that may impede early referral to care.

Treatment of central precocious puberty by GnRH analogs： long-term outcome in men

In boys, central precocious puberty （CPP） is the appearance of secondary sex characteristics driven by pituitary gonadotropin secretion before the age of 9 years. In the last years, relevant improvements in the treatment of CPP have been achieved. Because CPP is rare in boys, the majority of papers on this issue focus on girls and do not address specific features of male patients regarding end results and safety. In the present paper, recent advances of CPP management with GnRH analogs in men are summarized. End results in untreated and treated patients are also reviewed by an analysis of the recently published literature on treatment of CPP in men. The available data indicate that therapy with GnRH analogs can improve final height into the range of target height without significant adverse short-term and long-term effects, but longer follow-up of larger series of patients is still required to draw definitive conclusions.

Genomic and transcriptomic analyses reveal selection of genes for puberty in Bama Xiang pigs

The Bama Xiang pig （BMX） Chinese indigenous breed is a famous early-maturing with a two-end black coat To uncover the genetic basis of the BMX phenotype, we conducted comparative genomic analyses between BMX and East Asian wild boars and Laiwu pigs, respectively. Genes under positive selection were enriched in pathways associated with gonadal hormone and melanin synthesis, consistent with the phenotypic changes observed during development in BMX pigs. We also performed differentially expressed gene analysis based on RNA-seq data from pituitary tissues of BMX and Large White pigs. The CTTNBP2NL, FRS2, KANK4, and KATNAL1 genes were under selection and exhibited expressional changes in the pituitary tissue, which may affect BMX pig puberty. Our study demonstrated the positive selection of early maturity in the development of BMX pigs and advances our knowledge on the role of regulatory elements in puberty evolution in pigs.

Major royal jelly proteins accelerate onset of puberty and promote ovarian follicular development in immature female mice

The major royal jelly proteins(MRJPs)are the central constituents responsible for the specific activities of royal jelly.Here MRJPs via oral administration daily for 45 consecutive days were evaluated the effects on the reproductive parameters in immature female mice(FM).Neonatal FM were divided into four groups fed MRJPs with doses of 0,125,250 and 500 mg/kg/body weight(M125,M250 and M500).The results in M125,M250 and M500 showed that the times of estrus were accelerated by 10.7%,15.5%and 10.7%,the secondary follicles number were increased by 50.7%,78.8%and 38.6%,the Graafian follicles were increased by 600.0%and 774.0%and 150.0%,respectively.M500 induced multi-oocyte follicles.The serum estradiol levels of the three groups were increased by 47.1%,64.9%and 31.1%,the action of MRJPs raising hormone secretion level is mainly via upregulating expression of ERˇgene.Antioxidant parameters of ovarian tissue showed that the malondialdehyde levels in M125 and M250 were decreased,the superoxide dismutase activities and glutathione peroxidase activities in M125 and M250 were increased.In conclusion,MRJPs may accelerate onset of puberty and promote follicular development in FM.Our findings would facilitate better understanding of the benefit effect of MRJPs as the key ingredient in royal jelly on promoting fertility performance.

Comparison of Changes in Body Composition during Puberty Development of Obese and Normal-weight Children in China

Objective To compare the changes in body composition, including fat mass index （FMI） and fat free mass index （FFMI） during puberty development of obese and normal-weight children in China, and to explore the effect of age and gender on body composition. Methods A total of 356 children at the age of 7-15 years were enrolled in this study. Body composition of 10 normal-weight and obese children in each age group was measured by dual-energy x-ray absorptiometry （DEXA）. FFMI and FMI were calculated according to the following formula： FFMI （kg·m^-2）=FFM（kg）/ height^2（m^2） and FMI（kg·m^-2）=FM （kg）/ height^2（m^2）. Results The fat mass and fat free mass of obese children were significantly higher than those of normal-weight children （P〈0.05）. The FMI and FFMI of obese children increased significantly with age and were higher than those of the same sex, gender, and age normal-weight children （P〈0.05）. Conclusion The levels of fat mass, fat free mass, FMI, and FFMI are different in obese and normal-weight children, and gender effects are significant in boys having higher levels of these indicators than in girls. FFMI and FMI can be used as monitoring indexes in weight control of obese children.

Expression and significance of netrin-1 and its receptor UNC5C in precocious puberty female rat hypothalamus

Objective:To study expressions of netrin-1 and its receptor UNC5 C in female precocious puberty rat hypothalamus,and explore its effect on precocious puberty process.Methods:Forty female one-week-old SD rats were randomly divided into four groups:experimental group A(precocious puberty early youth),experimental group B(precocious puberty medium youth),group A(normal pre-puberty).group B(normal early youth) with 10 rats in each group.Precocious puberty experimental rats were induced with Danazol and rals in control group were injected with saline.Uterus and ovaries were removed,specimens were weighed,litems index and ovarian index were calculated,and amount of luteinizing hormone(LH) and follicle-stimulating hormone(FSH) were detected from the blood by ELISA.Real-time PCR was used to delect netrin-1 and its receptor UNC5 C.as well as hypothalamic gonadolropinreleasing hormone(GnRH) mRNA expression in hypothalamus tissues:and then,a coimmunoprecipitation study of interactions between netrin-1 and its receptor UNC5 C was carried out.Results:Relative target gene expression levels of control group A,control group B.experimental group A,and experimental group B(with,3-actin as an internal control for normalization) were as follows:Netrin-1:3.5±0.9,5.4±0.7.4.9±1.0.5.3±0.3:UNC5C:0.8±0.04.1.7±0.2.1.82±0.23.1.58±0.4:GnRH:1.2±0.3.2.7±0.3.2.4±0.7.3.2±0.4.Conclusions:LH and FSH concentrations,netrin-1 and its receptor expression are increased in precocious puberty animal models.

Localization of Porcine Neturopetide Y-Y1 mRNA in Hypothalamus-Pituitary-Ovary Axis during Puberty

[ Objective] To observe the disposition and localization of neturopetide Y-Y1 （ NPY-Y1 ） mRNA in hypothalamus, pituitary and ovary during puberty. [ Methed] Three 60-day-old Sujiang sows weighing 20 kg and three 160-day-old Sujiang sows weighing 80 kg were selected and anaesthetized. The hypothalamus, pituitary and ovary were taken out for preparation of frozen sections. The expression and localization of the NPY-Y1 mRNA in hypothalamus-pituitary-ovary axis was observed by the in situ hybridization. The PBS was substituted for hybridization solution to set up a control. ~ Result] Positive hybridization signals of the NPY-Y1 mRNA were detected in the hypothalamus, pituitary and ovary at different develop- mental stages, and these signals were stronger in the 60-day-old sows （before the puberty） than in the 160-day-old sows （during the puberty）. E Conclusion] The NPY-Y1 mRNA is distributed in the hypothalamus-pituitary-ovary axis and can regulate reproductive process of sows.

Efficacy of Subcutaneous Administration of Gonadotropin-releasing Hormone Agonist on Idiopathic Central Precocious Puberty

In order to assess the feasibility of subcutaneous administration of Triptorelin with 6-week intervals for the suppression of pituitary-gonadal axis and changes of clinical signs in girls with idiopathic central precocious puberty （ICPP）, 46 girls with ICPP were treated with GnRHa. Triptorelin （Decapeptyl, 3.75 mg） was administered subcutaneously （SC） at 6-weeks intervals or intramuscularly （IM） at 4-weeks intervals randomly for more than 12 months consecutively. During GnRHa therapy, clinical parameters and laboratory data, including height, weight, pubertal stage, bone age, uterine volume and ovarian size, serum levels of luteinizing hormone （LH）, follicle stimulating hormone （FSH） and estradiol （E2）, were monitored and analyzed. It was found that both treatment regimes led to regression of precocious puberty and reversal of secondary sexual characteristics. Breast developments regressed. Uterine volume was decreased after treatment, but there was no statistically significant difference. Mean ovarian volume did not change significantly during treatment. The height velocity was decreased significandy from 6.3±1.4 cm/year to 5.8：1：1.2 cm/year in group SC and 6.7±1.3 cm/year to 5.4±1.0 cm/year in group IM, respectively. The rate of bone maturation was reduced significantly during treatment. The ratio of deltaBAgdeltaCA was 1.2±0.2 or 1.3±0.3 at the onset of therapy and decreased significantly after the treatment to 0.7±0.2 or 0.9±0.1, respectively. The predicted adult height was increased significantly and progressively during therapy. The levels of serum LH, FSH and E2 returned to the prepubertal condition. No significant side effects of therapy were noted. The most common side effect during SC treatment was that a non-irritating, 1 cm in di- ameter mass was palpated at the site of subcutaneous injection in the abdominal wall of patients, which disappeared after 6- 12 weeks. Two girls had minimal withdrawal vaginal bleeding episodes after the first injection. It was concluded that both IM and SC triptorelin administrations were clinically effective. They induce profound suppression of hypothalamic-pituitary-gonadal axis while stabilizing height velocity, slowing bone maturation and increasing predicted adult height. These results suggest that subcutaneous injection of triptorelin in 6-weeks intervals at a dosage of 3.75 mg be a safe and acceptable regimen for ICPP.

Rare mutation in MKRN3 in two twin sisters with central precocious puberty: Two case reports

BACKGROUND Caused by premature activation of the hypothalamic-pituitary-gonadal axis,there is increasing incidence of central precocious puberty(CPP),especially in girls.Makorin ring finger protein 3(MKRN3),a maternal imprinted gene with a highly conserved sequence,is the most common genetic etiology associated with CPP.Approximately 50 different mutations in MKRN3 have been found in CPP.CASE SUMMARY This case report involves identical twin sisters presenting with premature thelarche at the age of 6 years.The left hand bone age of both patients revealed advanced age(9 years).Pelvic B ultrasound indicated enlargement of the ovaries.Luteinizing hormone(LH)releasing hormone testing confirmed CPP.Wholeexome sequencing detected the c.841C>T mutation in MKRN3,leading to a single base substitution,in the twins.This mutation was inherited from the father and paternal grandmother.After 3 mo of treatment with a gonadotropin-releasing hormone analog,levels of LH,follicle-stimulating hormone,and estradiol in the proband’s sister returned to normal levels.CONCLUSION Here,we report a rare mutation(c.841C>T)in MKRN3 in identical twin sisters with CPP.

Changes in 5α-reductase (type 2) gene expression in epididymis of puberty diabetic rats

The changes in 5α-reductase (type 2 ) gene expression in the epi-didymis of puberty diabetic rats were studied by the Northern blot and Dotblot method. Rats were divided into 3 groups: the control group (C), thediabetic group (D), and the diabetic group with insulin treatment (DI).Results: The Northern blot intensity of the caput epididymis in Group D is

Precocious puberty: Pathology, related risks, and support strategies

Children are currently starting pubertal development much earlier than 20 to 30 years ago. Data from the National Health and Nutrition Examination Survey (NHANES III) conducted from 1988-1994 revealed that the median age for breast development in white girls was approximately 9.7 years and 8 years in African-American girls versus 10.9 years ago. More recent data, however, indicate that some children are starting pubertal development even earlier (age 7 or 8 in girls or age 9 in boys). Very early pubertal development is identified as precocious puberty, a phenomenon that brings great concern to others besides parents: the child, their peers, school nurses, teachers and counselors. This paper discusses precocious pubertal development, possible causes or relationships, related risks, treatment and helping strategies.

Expression of Long Form Leptin Receptor mRNA in Pituitary of Pigs around Puberty

[ Objective] To study the expression of long form leptin receptor （Ob.Rb） mRNA in pituitary of pigs around puberty and explore the rela- tionship between Ob-Rb mRNA and porcine development around pituitary. [Method] Three Sujiang pigs were randomly selected at the age of 120 d, puberty and 180 d, respectively. A pair of primers was designed according to the Ob-Rb sequence published in the GenBank. Total RNAs were extracted from pituitary. The expression of Ob-Rb mRNA was detected by the real-time quantitative RT-PCR. [ Result] The Ob-Rb mRNA was de- tected in pituitaries of pigs at the age of 120 d, puberty and 180 d, respectively. The expression level of Ob-Rb mRNA was lowest at puberty. It was significantly different from that in the 120-day-old pigs and not significantly different from that in the 180-day-old pigs. [ Conclusion] The low expres- sion level of Ob-Rb mRNA is conductive to the arrival of puberty.

The Process by Which Girls Who Develop Type 1 Diabetes before School Age Acquire Self-Management Skills during Puberty and Adolescence

Our aim was to clarify the process by which girls who develop type 1 diabetes before school age acquire self-management skills during puberty and adolescence. We conducted semi-structured interviews with such women who had reached adolescence, and analyzed the results using the modified grounded theory approach (M-GTA). We found the process to be composed of eight categories: Girls begin to feel they understand their own bodies;Girls give precedence to fun, and forget about their disease;Girls build a foundation for taking control of their physical health;Girls feel “out of sync” with their physical sensations;Girls gain new awareness of their disease due to discrimination and comparing themselves to others;Girls revisit their lifestyle and diabetes care practices, with an eye to their future;Girls employ the wisdom and knowledge they have gained from experience;Girls are frustrated at diabetes’ relent-less presence in their lives. The learning process could be roughly divided into two periods: a period dominated by annoyance, where girls prioritize fun activities and try to forget about their disease, and a period where they leverage their wisdom to revisit their care behaviors and change their lifestyle.

The Onset of Puberty in Indigenous Gilts in the North-East of Thailand Confirmed by the First Ovulation

This experiment was aimed to investigate some changes of ovarian structure in order to confirm the onset of puberty in Thai indigenous gilts. Fifty female animals collected from the North-Eastern area of Thailand were slaughtered in the different age groups as 0, 1, 2, 3, 3.5, 4, 4.5, 5, 5.5 and 6 months of age, respectively （each group = 5 pigs）, for monitoring corpus luteum （CL） occurrence on ovarian surface and some changes of reproductive structure. CL was clearly found for the first time in the 4.5 months age group （P 〈 0.05） which was defined as the first ovulation; nevertheless, group of follicles with 〉 2.0 mm in diameter appeared for the first time in the 3.5 month age group （P 〈 0.05）. For other conformations, size of uterine horns, oviducts or ovaries, including weight of ovaries or whole reproductive tracts, were significantly developed （P 〈 0.05） that was initially taken place in the 3.5 months age group onwards. Thus, it was summarized that the onset of puberty in Thai indigenous gilts, affirmed by CL appearance at the first time, should be happened between 4.0 and 4.5 months of age; however, the development of reproductive structure and follicles to prepare in approaching puberty should be started before 3.5 months of age.

Investigation of the Cause of Precocious Puberty in an 8-Year-Old Girl Ended up in Juvenile Granulosa and Theca Cell Tumor of the Ovary

Isosexual precocious puberty in girls has several etiologies. Juvenile granulose cell tumor is one of the rarest causes that only stands for 1.5% of ovarian cancers. This tumor mostly encounters in first 2 decades of life. This paper is a report of an 8-year-old girl with precocious puberty that within five months developed breast enlargement followed by menarche. Works which are done to find the underlying cause of precocious puberty revealed juvenile granulosa cell tumor in her left ovary. She then under went laparoscopic surgery and 3 courses of chemotherapy. She did not experience any vaginal bleeding after that and the serum level of estradiol lay among its normal ranges, but after that the tumor relapsed and presented as abdominal pain and a huge mass which under went resection of all afflicted tissues. After 2 courses of chemotherapy, her status deteriorated and unfortunately she died after 6 months from the time of diagnosis. Treatment for this disease is consists of resection surgery and chemotherapy. If this tumor is diagnosed in its early stages, it will be curable, but in its advanced stages, up to 80% of patients die from recurrent tumors. The reported patient was diagnosed at stage IIIC that had poor prognosis.