Case Presentation

Case Presentation Gynecology 성균관대학교 의과대학 2007313075 손의영

Chief Complain • 정O록, F/76 • 외부 건강 검진상 발견된 이상소견 • Onset : 1MA

Present Illness • Previously healthy • 2011.04 보라매병원에서 건강검진 시행 MRI 상 ovary cancer 의심되어수술 권유 받음 • 2011.05.04 본원으로 전원 후 w/u

Other History • PMHx. • HTN/DM/Tb/hepatitis/Allergy ( - / - / - / - / - ) • Hypothyroidism (+), MDD (+) • 약물력 : 씬지로이드(40YA)정신과약– 가스모틴, 사미온정, 자나팜정, 졸로푸트정 • 수술력: 없음 • FHx. • 당뇨 : 넷째 여동생, 다섯째 여동생 • 위암 : 첫째 오빠 • SHx. • Marriage : 기혼 • smoking: no • alcohol: no

Review of system • GW / EF ( - / - ) • Weight change (-) • fever/chill ( - / - ) • Headache/dizziness ( - / - ) • Rhinorrhea/ cough /sputum ( - / - / - ) • Dyspnea (-) • chest pain / palpitation ( - / - ) • anorexia/nausea/vomiting ( - / - / - ) • abdominal pain/discomfort ( - / - ) • constipation/diarrhea ( - / - ) • hematemesis/melena/hematochezia ( - / - / + ) • Urinary Sx (-) • Arthralgia (-) • Myalgia (-)

Physical Exam • Vital Sign 2011-05-22 17:26147/69 mmHg - 45 - 20 - 36℃ • G/A Generally well-looking appearance • Mentality Alert & well orientation • Abdomen Palpation – Soft & flat No tenderness/rebound tenderness

Problem List / Assessment • Problem List • #1. Left ovary mass • #2. Hypothyroidism • Assessment • #1. : R/O ovary cancer

Therapeutic Plan • Surgery & Biopsy • BSO • Total Omentectomy • LAVH Supracervical Hysterectomy Total Hysterectomy TH w/ Bilateral Salpingo-Oophorectomy

Pathology • Granulosa cell tumor, adult type, left ovary • 1) tumor size : 7 x 6 x 4 cm • 2) surface involvement : cannot be evaluated • 3) mitosis : 2/10 HPF • 4) confined to left ovary • Complex hyperplasia w/o atypia • Chronic cervicitis, cervix • No diagnostic abnormalities recognized • left salpinx, right ovary and salpinx • No evidence of malignancy, omentum

Tumors derived from gonadalStroma<WHO classification of Sex core-Stromal tumor> • 1. Granulosa-stromal-cell tumors • Granulosa-cell tumor • Tumors in thecoma-fibroma group • 1) Thecoma (난포막종) • 2) Fibroma (섬유종) • 3) Unclassified (미분류종양) • 2. Sertoli-Leydig-cell tumors • Well-differentiated • 1) Sertoli cell tumor • 2) Sertoli-Leydig-cell tumor • 3) Leydig-cell tumor ; hilus cell tumor • Moderately differentiated • Poorly differentiated • With heterologous elements • 3. Gynandroblastoma • 4. Unclassified

Feature; Sex cord-Stromal Tumor • 5~8% of ovarian malignancy • Synthesis of gonadal and adrenal steroid hormones • Estrogens, progesterone, testosterone ……

Granulosa cell tumor 과립막세포종 • Features • Low grade malignancy • m/c stromal ovarian tumor • Usually unilateral • All age group (mean : 51y) • Symptoms • Abnormal uterine bleeding • Pelvic or abdominal pain • Pelvic mass • Ascites • Hormonal effect by Estrogen (EM hyperplasia, Mens irregularity)

Granulosa cell tumor • Pathology • Granulosa cells w/ large, pale, oval nuclei • Coffee bean grooving • Microfollicullar pattern(Call-Exner bodies) – m/c • Treatments • Surgery : USO, TAH w/ BSO • Post-op radiation : Recurrent disease 의 예방

Granulosa cell tumor • Prognosis • Late relapse • Residual tumor의 크기가 가장 중요 • Stage and Survival of Ovarian sex cord-stromal tumors William’s Gynecology TABLE 36-6

FIGO stage

Case Presentation