Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas HCFMUSP, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Gynecol Endocrinol. 2022 Jun;38(6):531-533. doi: 10.1080/09513590.2022.2047921. Epub 2022 Mar 7.
Estrogen modulates platelet activation and aggregation, and it increases the levels of the von Willebrand factor, factors II, VII, VIII, and X, and of fibrinogen, all of which increase the risk for thromboembolism. We report the case of a 59-year-old woman, postmenopausal for 4 years, not using hormone replacement therapy, who was admitted into the emergency room with shortness of breath and increased abdominal volume. After physical examination and imaging and biochemical tests, she was diagnosed with pulmonary thromboembolism and a large left adnexal tumor. The patient was promptly received full anticoagulation therapy for the pulmonary thromboembolism. High levels of estradiol (810.4 pg/mL), anti-Mullerian hormone (16.39 ng/mL), inhibin (11250 pg/mL), and suppressed FSH (<0.16 IU/L) led to a suspicion of granulosa-cell tumor. After clinical stabilization, she underwent to an exploratory laparotomy with total hysterectomy and bilateral adnexectomy to treat the pelvic tumor. Pathologic report confirmed a granulosa-cell tumor.
雌激素调节血小板的激活和聚集，并增加血管性血友病因子、因子 II、VII、VIII 和 X 以及纤维蛋白原的水平，所有这些都会增加血栓栓塞的风险。我们报告了一例 59 岁的绝经后 4 年的女性患者，未接受激素替代疗法，因呼吸急促和腹部体积增加而被收入急诊室。经过体格检查、影像学和生化检查，诊断为肺血栓栓塞症和左侧附件的一个大肿瘤。患者立即接受了肺血栓栓塞症的全抗凝治疗。雌二醇（810.4 pg/mL）、抗苗勒管激素（16.39ng/mL）、抑制素（11250pg/mL）和 FSH 水平抑制（<0.16IU/L）高度怀疑为颗粒细胞瘤。在临床稳定后，她接受了剖腹探查术，行全子宫切除术和双侧附件切除术以治疗盆腔肿瘤。病理报告证实为颗粒细胞瘤。
