Sonkusare Abhishek, Dixit Prachi, Karmarkar Pragati J, Thombare Dipanjali
Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND.
Department of Pathology, NKP Salve Institute of Medical Sciences and Research Centre and Lata Mangeshkar Hospital, Nagpur, IND.
Cureus. 2023 Feb 23;15(2):e35359. doi: 10.7759/cureus.35359. eCollection 2023 Feb.
An uncommon form of cancer known as a granulosa cell tumor (GCT) arises from ovarian sex cord cells that produce estrogen. The goal of conservative surgery in cancer is to retain organ functions while avoiding severe excision wherever possible. In oncologic gynecological surgery, fertility-sparing surgery (FSS) is a technique that tries to preserve the uterus and ovarian tissue. A 26-year-old woman with nulligravida presented with the main complaints of pain in the right iliac fossa for 10 to 15 days and fullness in the abdomen for one month, along with a change in appetite and noticeable weight loss. The Magnetic Resonance Imaging (MRI) revealed a large, well-defined, multiloculated, solid cystic mass with altered signal intensity. On exploratory laparotomy, an intraoperatively left ovarian cystic mass was seen. The ovarian mass was histopathologically diagnosed as a sex cord tumor of the ovary, with characteristics compatible with adult GCT. Disregarding the follow-up advice on discharge four months later, the patient conceived spontaneously and gave birth to a male child via emergency lower segment cesarean section. In GCTs that have not spread beyond the ovary or in people who have had relapses of the disease, FSS created the groundwork for conception and appeared safe. In the lack of any compelling supporting evidence, the line of care of terminal surgery should always be thoroughly discussed with the patient and advised for women after their families are complete.
一种罕见的癌症,称为颗粒细胞瘤(GCT),起源于产生雌激素的卵巢性索细胞。癌症保守手术的目标是在尽可能避免广泛切除的同时保留器官功能。在肿瘤妇科手术中,保留生育功能手术(FSS)是一种试图保留子宫和卵巢组织的技术。一名26岁未孕女性,主要主诉为右下腹疼痛10至15天、腹部胀满1个月,伴有食欲改变和明显体重减轻。磁共振成像(MRI)显示一个大的、边界清晰的、多房的、实性囊性肿块,信号强度改变。在剖腹探查术中,发现一个术中左侧卵巢囊性肿块。该卵巢肿块经组织病理学诊断为卵巢性索肿瘤,具有与成人GCT相符的特征。四个月后出院时患者无视随访建议,自行受孕并通过急诊下段剖宫产分娩一名男婴。在尚未扩散至卵巢以外的GCT患者或疾病复发的患者中,FSS为受孕奠定了基础且似乎是安全的。在缺乏任何有力支持证据的情况下,对于晚期手术的治疗方案应始终与患者进行充分讨论,并建议女性在完成生育后再考虑。