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 의심되어 수술 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 G/A Mentality Abdomen 2011-05-22 17:26 147/69 mmHg - 45 - 20 - 36℃ Generally well-looking appearance Alert & well orientation Palpation – Soft & flat No tenderness/rebound tenderness CT 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 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. Gynandroblastoma 4. Unclassified Feature; Sex cord-Stromal Tumor 5~8% of ovarian malignancy Synthesis of gonadal and adrenal steroid hormones Estrogens, progesterone, testosterone …… 과립막 세포종 Granulosa cell tumor 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 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