Wang Bo, Xu Xin, Zhao Zhenya, Yao Dongying, Qi Lei, Zhou Yang
Department of Pathology, Xingtai People's Hospital, Hebei Medical University Affiliated Hospital, Xingtai, Hebei, P.R. China.
Medicine (Baltimore). 2020 Oct 2;99(40):e22511. doi: 10.1097/MD.0000000000022511.
Granulosa cell tumors (GCTs) are rare, hormonally active sex cord-stromal tumors that generally present as solid unilateral ovarian lesions. It's quite uncommon that they present as pure bilateral ovarian cysts. Histopathology remains the gold standard for making a diagnosis of GCTs. However, as the differential diagnosis is difficult, cystic GCTs are frequently misdiagnosed as benign or other cystic tumors either prior to surgery or during pathologic diagnosis. Accordingly, herein, we describe a fairly rare case of bilateral ovarian cystic GCTs, along with a review of the related literature.
A 43-year-old woman presented with abdominal distension and chronic pain since 1 day. The patient had a history of dysmenorrhea.
Physical examination revealed palpable bilateral adnexal tumors; ultrasonography revealed cystic and septate masses with a maximum diameter of 7.8 and 10.7 cm, respectively, in the bilateral ovaries. Hormonal analysis revealed that the blood estradiol levels were elevated. Postoperative pathological and immunohistochemical examinations of the surgical specimens revealed a final diagnosis of cystic adult GCTs of the ovaries.
The patient first underwent laparoscopic bilateral ovarian cystectomy. On the basis of the final pathological diagnosis report, abdominal total hysterectomy, bilateral oophoro-salpingectomy, and partial omentectomy were then performed. Microscopic examination revealed that there were no residual CGT cells. The patient's federation international of gynecology and obstetrics (FIGO) Stage was IB period.
The surgeries were successful. The tumor was a FIGO Stage IB tumor, and the patient did not require any additional treatment. The patient had been followed-up regularly for 2 years after surgery; she did not experience any complications and remained disease-free.
Cystic GCTs should be considered in the differential diagnosis if a female patient shows bilateral ovarian cysts. They are extremely rare ovarian malignant tumors that must be differentiated from other ovarian tumors, especially purely cystic tumors and benign cysts. Although pathological and immunohistochemical findings are important for making the diagnosis, the varying histopathological features on microscope make diagnosis difficult, including tumor cells with luteinization or free cell clusters. The current case highlights the importance of physicians being aware of and suspecting cystic CGTs in similar cases, along with knowing the characteristics of GCTs for the diagnosis and differential diagnosis.
颗粒细胞瘤（GCTs）是一种罕见的、具有激素活性的性索间质肿瘤，通常表现为单侧卵巢实性病变。它们表现为单纯双侧卵巢囊肿的情况相当罕见。组织病理学仍然是诊断GCTs的金标准。然而，由于鉴别诊断困难，囊性GCTs在手术前或病理诊断期间经常被误诊为良性或其他囊性肿瘤。因此，在此我们描述一例相当罕见的双侧卵巢囊性GCTs病例，并对相关文献进行综述。
一名43岁女性自1天前开始出现腹胀和慢性疼痛。该患者有痛经病史。
体格检查发现双侧附件区可触及肿物；超声检查显示双侧卵巢分别有最大直径为7.8 cm和10.7 cm的囊性及分隔状肿物。激素分析显示血雌二醇水平升高。手术标本的术后病理及免疫组化检查最终诊断为卵巢囊性成人GCTs。
患者首先接受了腹腔镜双侧卵巢囊肿切除术。根据最终病理诊断报告，随后进行了腹式全子宫切除术、双侧卵巢输卵管切除术及部分大网膜切除术。显微镜检查显示无残留CGT细胞。患者的国际妇产科联盟（FIGO）分期为ⅠB期。
手术成功。该肿瘤为FIGOⅠB期肿瘤，患者无需任何额外治疗。术后对患者进行了2年的定期随访；她未出现任何并发症，且无疾病复发。
如果女性患者出现双侧卵巢囊肿，在鉴别诊断时应考虑囊性GCTs。它们是极其罕见的卵巢恶性肿瘤，必须与其他卵巢肿瘤，尤其是单纯囊性肿瘤和良性囊肿相鉴别。虽然病理和免疫组化结果对诊断很重要，但显微镜下不同的组织病理学特征使诊断困难，包括伴有黄素化的肿瘤细胞或游离细胞团。本例突出了医生在类似病例中意识到并怀疑囊性CGT的重要性，以及了解GCTs的特征以进行诊断和鉴别诊断的重要性。
