Case Presentation Gynecology 성성성성성성 성성성성 2007313075 성성성
Case Presentation Gynecology
성균관대학교 의과대학2007313075 손의영
Chief Complain
정 O 록 , F/76
외부 건강 검진상 발견된 이상소견Onset : 1MA
Present IllnessPreviously healthy
2011.04 보라매병원에서 건강검진 시행MRI 상 ovary cancer 의심되어수술 권유 받음
2011.05.04 본원으로 전원 후 w/u
Other HistoryPMHx.
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 systemGW / 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 ExamVital Sign 2011-05-22 17:26
147/69 mmHg - 45 - 20 - 36℃G/A Generally well-looking appear-
anceMentality Alert & well orientationAbdomen Palpation – Soft & flat
No tenderness/rebound tenderness
CT
Problem List / AssessmentProblem List
#1. Left ovary mass#2. Hypothyroidism
Assessment#1. : R/O ovary cancer
Therapeutic PlanSurgery & Biopsy
BSOTotal OmentectomyLAVH
Supracervical Hysterectomy
Total Hysterectomy
TH w/ Bilateral Salpingo-Oophorectomy
PathologyGranulosa 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 gonadal Stroma <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. Gynandroblastoma4. Unclassified
Feature; Sex cord-Stromal Tumor5~8% of ovarian malignancy
Synthesis of gonadal and adrenal steroid hormonesEstrogens, progesterone, testosterone ……
Granulosa cell tumorFeatures
Low grade malignancym/c stromal ovarian tumorUsually unilateralAll age group (mean : 51y)
SymptomsAbnormal uterine bleedingPelvic or abdominal painPelvic massAscitesHormonal effect by Estrogen (EM hyperplasia, Mens irregu-
larity)
과립막 세포종
Granulosa cell tumorPathology
Granulosa cells w/ large, pale, oval nucleiCoffee bean groovingMicrofollicullar pattern(Call-Exner bodies) – m/c
TreatmentsSurgery : USO, TAH w/ BSOPost-op radiation : Recurrent disease 의 예방
Granulosa cell tumorPrognosis
Late relapseResidual tumor 의 크기가 가장 중요
Stage and Survival of Ovarian sex cord-stromal tumors
Adult Granulosa cell Sertoli-Leydig cell
Stage at Dx I II-IV
80~90% 10~20%
97% 2~3%
5YSR I II-IV
85~95% 30~50%
90~95% 10~20%
William’s Gynecology TABLE 36-6
FIGO stage
FIGO stage