Case ReportConservative management of a uterine tumor resembling an ovarian sex cord-stromal tumor
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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Cited by (39)
Therapeutic management of uterine tumours resembling ovarian sex cord tumours including a focus on fertility: A systematic review
2024, European Journal of Obstetrics and Gynecology and Reproductive BiologyUterine tumor resembling ovarian sex-cord tumor: Conservative surgery with successful delivery and case series
2021, European Journal of Obstetrics and Gynecology and Reproductive BiologyCitation Excerpt :Only one patient (case 9) reported no symptoms and diagnosis was an incidental finding. As seen in other case reports, fertility preservation surgery had been considered for patients who expressed a wish for this [4–9,14,24,27–29]. To our knowledge, 14 cases of fertility-sparing conservative surgery have been reported in the literature to date including the current study [5,5,6,7,8,9,27–31,43].
Uterine Tumors Resembling Ovarian Sex Cord Tumors – Treatment, recurrence, pregnancy and brief review
2017, Gynecologic Oncology ReportsCitation Excerpt :The patient is still being monitored clinically and radiologically and is disease free 46 months after the last surgery. A fertility-preserving option for younger women with UTROSCT has only recently been suggested by some authors (O'Meara et al., 2009; Blake et al., 2014; Jeong et al., 2015; De Franciscis et al., 2016; Berretta et al., 2009; Giordano et al., 2010; Anastasakis et al., 2008; Hillard et al., 2004; Garuti et al., 2009). The goal of this article is to show that tumor resection alone, instead of hysterectomy, may be an option for treating UTROSCT.
Uterine tumors resembling ovarian sex-cord tumor: A case-report and a review of literature
2016, Gynecologic Oncology ReportsCitation Excerpt :Pelvic lymphadenectomy, omentectomy, parametrectomy, or even uterine cervical resection are rarely described and should be individualized (Franco et al., 2003). Some authors, however, propose conservative surgery as a standard approach (Garuti et al., 2009; Hillard et al., 2004). The role of adjuvant therapy in UTROSCT is uncertain.
Clinical characteristics and outcomes of uterine tumors resembling ovarian sex-cord tumors (UTROSCT): A systematic review of literature
2014, European Journal of Obstetrics and Gynecology and Reproductive BiologyUterine tumors resembling ovarian sex cord tumors, a clinicopathologic study of six cases
2014, Annals of Diagnostic Pathology