Ovarian Sex Cord-Stromal Tumors in Postmenopausal Women and Total Laparoscopical Management

Andrea Tinelli, Marcello Pellegrino, Vincenzo Emanuele Chiuri, Antonio Malvasi

Department of Gynecology and Obstetric, Santa Maria Hospital, Bari, Italy.
Department of Gynecology and Obstetric, Vito Fazzi Hospital, Lecce, Italy.
Department of Oncology, Vito Fazzi Hospital, Lecce, Italy.
Department of Pathology, Vito Fazzi Hospital, Lecce, Italy.

DOI: 10.4236/jct.2010.11005                

Abstract

BACKGROUND: Ovarian sex-cord stromal tumors (SCST) take up 5% of the ovarian neoplasm and may develop in to an ovarian mass or a haemoperitoneum. The surgical management of SCST in early-stage adult patients is not well defined. CASE REPORT: A 69 year-old postmenopausal woman was admitted for metrorrhagia, a right ovary mass and increasing pelvic pain. Preoperative clinical and instrumental examination suspected an ovarian tumor, and the laparoscopic right ophorectomy and the frozen section suggested an ovarian SCST. To fast restore and preserve woman integrity, total laparoscopic hysterectomy (TLH) plus left salpingo-ophorectomy (SO) were performed, without complications in the short and long term follow-up. CONCLUSION: In the authors’ opinion, the minimally invasive management of SCST by TLH plus bilateral SO followed by a prolonged surveillance and without intensive surgical staging, could be an appropriate clinical and surgical choice in elder patient at early stage, since these tumors are slow at growth, recurring locally and only a long time after initial treatment. We suggest, after a minimally invasive treatment, a possible “wait and see” option, as in our case report.

Keywords

Menopause, Laparoscopy, Ovarian Cancer, Sex Cord-Stromal Ovarian Tumors, Granulosa Cell Tumors, Minimally Invasive Treatment.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	D. Hasiakos, K. Papakonstantinou, E. Karvouni, and S. Fotiou, “Recurrence of granulosa cell tumor 25 years after initial diagnosis,” Report of a case and review of the literature, European Journal Gynaecolology Oncology, Vol. 29, No. 1, pp. 86–88, 2008.
[2]	Rosai and Ackerman’s surgical pathology, 9th edition, Mosby Ed., Edinburgh, pp. 1691–1694, 2004.
[3]	P. B. Clement and R. H. Young, “Atlas of Gynecologic Surgical Pathology, 2nd edition,” Saunders Elsevier Ed., New York, USA, pp. 386–391, 2008.
[4]	S. Leibl, K. Bodo, M. Gogg-Kammerer, and M Ovarian, “granulosa cell tumors frequently express EGFR (Her-1), Her-3, and Her-4: An immunohistochemical study,” Gynecol Oncol, Vol. 101, No. 1, pp. 18–23, 2006.
[5]	Y. K. Lee, N. H. Park, J. W. Kim, Y. S. Song, S. B. Kang, and H. P. Lee, “Characteristic of recurrence in adult-type granulosa cell tumor,” International Journal of Ginecological Cancer, Vol. 18, No. 4, pp. 642–647, 2008.
[6]	J. Brown, A. K. Sood, M. T. Deavers, L. Milojevic, and D. M. Gershenson, “Patterns of metastasis in sex cordstromal tumors of the ovary: Can routine staging lymphadenectomy be omitted?” Gynecologic Oncology, Vol. 113, No. 1, pp. 86–90, 2009.
[7]	D. M. Gershenson, “Management of early ovarian cancer: Germ cell and sex cord-stromal tumors,” Gynecologic Oncology, Vol. 55, (3 Pt 2), pp. S62–72, 1994.
[8]	O. Ismi, Y. Vayisoglu, T. Karabacak, and M. Unal, “Supraclavicular metastases from a sex cord stromal tumor of the ovary,” Tumori, Vol. 95, No. 2, pp. 254–257, 2009.
[9]	A. Chauhan, P. Dahiya, H. Singh, M. Gill, and S. Verma, “Isolated breast metastasis from granulosa cell tumor of the ovary,” Arch Gynecol Obstet, Vol. 280, No. 6, pp. 997–999, December 2009.
[10]	N. Colombo, G. Parma, V. Zanagnolo, and A. Insinga, “Management of ovarian stromal cell tumors,” Journal of Clinical Oncology, Vol. 25, No. 20, pp. 2944–2951, 2007.
[11]	A. Auranen, J. Sundstr?m, J. Ij?s, and S. Grènman, “Prognostic factors of ovarian granulosa cell tumor: A study of 35 patients and review of the literature,” International Journal of Gynecological Cancer, Vol. 17, No. 5, pp. 1011–1018, 2007.
[12]	S. E. Rha, S. N. Oh, S. E. Jung, Y. J. Lee, A. W. Lee, Byun, and J. Y. Recurrent, “Ovarian granulosa cell tumors: Clinical and imaging features,” Abdom Imaging, Vol. 33, No. 1, pp. 119–125, 2008.
[13]	X. Tao, A. K. Sood, M. T. Deavers, K. M. Schmeler, A. M. Nick, R. L. Coleman, L. Milojevic, D. M. Gershenson, and J. Brown, “Anti-angiogenesis therapy with bevacizumab for patients with ovarian granulosa cell tumors,” Gynecology Oncology, Vol. 114, No. 3, pp. 431–436, September 2009.
[14]	M. A. Farinola, A. M. Gown, and K. Judson, “Estrogen receptor alpha in ovarian adult granulosa cell tumors and Sertoli-Leydig cell tumors,” International Journal of Gynecological Pathology, Vol. 26, No. 4, pp. 375–382, 2007.
[15]	G. H?lscher, C. Anthuber, G. Bastert, A. Burges, D. Mayr, E. Oberlechner, G. Schubert-Fritschle, S. Sinz, H. Sommer, B. Schmalfeldt, and J. Engel, “Malignant Ovarian Tumors' of the Munich Cancer Center. Improvement of survival in sex cord stromal tumors—an observational study with more than 25 years follow-up,” Acta Obstetricia et Gynecologica Scandinavica, Vol. 88, No. 4, pp. 440–448, 2009.
[16]	G. V. Koukourakis, V. E. Kouloulias, M. J. Koukourakis, G. A. Zacharias, C. Papadimitriou, K. Mystakidou, K. Pistevou-Gompaki, J. Kouvaris, and A. Gouliamos, “Granulosa cell tumor of the ovary: Tumor review,” Integrative Cancer Therapies, Vol. 7, No. 3, pp. 204–215, 2008.