gynecology 성균관대학교 의과대학 2007313075 손의영. c.c. & p.i. 정 o 록, f/76...
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Case Presentation Gynecology
성균관대학교 의과대학2007313075 손의영
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C.C. & P.I. 정 O 록 , F/76
Previously healthy
2011.04 보라매병원에서 건강검진 시행MRI 상 Granulosa cell tumor
의심수술 권유 받음
2011.05.04 본원으로 전원 후 w/u
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Other HistoryPMHx.
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
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Review of systemGW / 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 (-)
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Physical ExamVital Sign 2011-05-22 17:26
147/69 mmHg - 45 - 20 - 36℃G/A Generally well-looking appear-
anceMentality Alert & well orientationAbdomen Palpation – Soft & flat
No tenderness/rebound tenderness
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CT (2011-04-08, 보라매 병원 )
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MRI (2011-04-21, 보라매 병원 )
( 장축 6.5 cm)
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PET (2011-05-04, 보라매 병원 )
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Problem List / AssessmentProblem List
#1. Left ovary mass#2. Hypothyroidism
Assessment#1. : R/O ovary cancer
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Therapeutic PlanSurgery & Biopsy
Laparoscopy assisted vaginal hysterectomy Bi-lateral Salphingo-Oophorectomy
Total Omentectomy, adhesiolysis
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Pre-op. Tumot Marker
CEA/CA19-9/CA 125 : 1.4/14/10
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Surgery
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수술중 발견사항Pelvic cavity
Adhesion : (Yes) ; Omentum 과 abdominal ante-rior wall 이 붙어 있었음 adhesiolysis was done
Ascites : Serous small amount
AdnexaRt. size : normalLt. size : goose egg
shape : cysticcapsule : intact
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수술중 발견사항Omentum : None
Skin incision : subumbilical 5mm, RUQ 5mm LLQ 12mm, suprapubic 5mm
Pelvic cavity : small amount fluid collection washing cytology, adhesion (-), bleeding (-)
Uterus :grossly normal, size normal, no adhesion Mass (+) 2cm in EM (frozen : cystic hyperplasia)
Adnexa : Lt ovary tumor (over hens egg size)adhesion (+) Lt ov tumor 와 uterus, tube 사이frozen : granulosa tumor
PCDS : obliteration (-), ascites (-)
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PathologyGranulosa 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
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Progression
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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. Gynandroblastoma4. Unclassified
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Feature; Sex cord-Stromal Tumor5~8% of ovarian malignancy
Synthesis of gonadal and adrenal steroid hormonesEstrogens, progesterone, testosterone ……
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Granulosa cell tumorFeatures
Low grade malignancym/c stromal ovarian tumorUsually unilateralAll age group (mean : 51y)
SymptomsAbnormal uterine bleedingPelvic or abdominal painPelvic massAscitesHormonal effect by Estrogen (EM hyperplasia, Mens irregu-
larity)
과립막 세포종
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Granulosa cell tumorPathology
Granulosa cells w/ large, pale, oval nucleiCoffee bean groovingMicrofollicullar pattern(Call-Exner bodies) – m/c
TreatmentsSurgery : USO, TAH w/ BSOPost-op radiation : Recurrent disease 의 예방
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Granulosa cell tumorPrognosis
Late relapseResidual tumor 의 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
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FIGO stage
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FIGO stage