Transcript Case Presentation

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
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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
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1) Thecoma (난포막종)
2) Fibroma (섬유종)
3) Unclassified (미분류종양)
 2. Sertoli-Leydig-cell tumors
 Well-differentiated
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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