Elsevier

Gynecologic Oncology

Volume 92, Issue 1, January 2004, Pages 347-352
Gynecologic Oncology

Case Report
Conservative management of a uterine tumor resembling an ovarian sex cord-stromal tumor

https://doi.org/10.1016/j.ygyno.2003.09.011Get rights and content

Abstract

Background. Sex cord-stromal tumors usually arise in the ovary but may arise in the uterus. Only 55 cases have been reported thus far. A hysterectomy is typically recommended. We report a case of uterine tumor resembling an ovarian sex cord-stromal tumor managed conservatively.

Case. A 32-year-old nulliparous woman presented with infertility secondary to suspected uterine leiomyomata. A laparoscopic resection of the presumed leiomyomata was performed, and the pathology showed a uterine tumor resembling an ovarian sex cord tumor. Because of the patient's desire to preserve fertility, a hysterectomy was not performed. She has been followed for the past 18 months, and there is no evidence of tumor recurrence.

Conclusion. Resection of the tumor without hysterectomy and close follow-up may preserve fertility without compromising survival in patients with uterine tumors resembling ovarian sex cord-stromal tumors.

Introduction

Uterine tumors resembling ovarian sex cord-stromal tumors were first described by Morehead and Bowman [1] in 1945. These tumors closely resemble granulosa cell tumors of the ovary. In 1976, Clement and Scully [2] described 14 such tumors and classified these tumors as ovarian sex cord-like neoplasms into groups I and II. The groups are defined by the amount of sex cord-like elements present. Group I tumors are endometrial stromal tumors with less than 40% differentiation into sex cord-like aggregates. Group II tumors are myometrial tumors comprised almost entirely of sex cord-like components. Of the 55 cases that have been described thus far in the literature [1], [2], [3], [4], [5], [6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], only 29 were classified as group II. Although the two groups may seem at first quite similar, their histologic appearances and clinical behaviors are actually quite different [2]. These tumors are typically managed with a hysterectomy. Here, we describe a group II tumor managed without hysterectomy to preserve fertility.

Section snippets

Case report

A 32-year-old nulliparous woman presented to her local physician in Greece in November 2001 with irregular vaginal spotting. She had been actively trying to conceive unsuccessfully for 1 year. During her physical examination, the only pertinent findings were multiple uterine leiomyomata. She had no prior history of leiomyomas. The patient then underwent diagnostic hysteroscopy and laparoscopic myomectomy, with complete removal of the presumed leiomyoma. The intraoperative findings revealed

Discussion

The histologic appearances and clinical behaviors of groups I and II sex cord-stromal tumors are quite different. The tumors in group I are endometrial stromal tumors in which the epithelial-like sex cord tissue is a minor component, involving only 10–40% of the total volume. Therefore, these tumors have been named endometrial stromal tumors with sex cord-like elements (ESTSCLE) [2], [3]. These tumors have focal differentiation described as anastomosing trabeculae, plexiform cords one cell in

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