Moro F, Giudice M T, Bolomini G, Moruzzi M C, Mascilini F, Quagliozzi L, Ciccarone F, Scambia G, Fagotti A, Valentin L, Testa A C
Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy.
Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy.
Ultrasound Obstet Gynecol. 2024 Mar;63(3):399-407. doi: 10.1002/uog.27504. Epub 2024 Feb 6.
To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli-Leydig cell tumors.
This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center), Italy. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli-Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition.
We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli-Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli-Leydig tumors (6/7, 85.7%) were classified as solid or multilocular-solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli-Leydig cell tumors were unilocular cysts and 9/55 (16.4%) recurrent granulosa cell tumors were multilocular cysts. The nine unilocular cysts had contents that were anechoic (n = 2) or had low-level echogenicity (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged in largest diameter from 8 to 38 mm, with three being < 20 mm and five being 20-30 mm. On retrospective review of the images, two typical ultrasound patterns were described: small solid tumor measuring < 2 cm (15/62, 24.2%) and tumor with vascularized echogenic ground-glass-like content (12/62, 19.4%).
Some granulosa cell and Sertoli-Leydig cell recurrences manifest one of two typical ultrasound patterns, while some appear as unilocular cysts. These are usually classified as benign, but in patients being followed up for a granulosa cell tumor or Sertoli-Leydig cell tumor, a unilocular cyst should be considered suspicious of recurrence. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
描述复发性颗粒细胞瘤和支持-间质细胞瘤的临床及超声特征。
这是一项在意大利罗马圣心天主教大学综合医院（Gemelli中心）进行的回顾性观察研究。从妇科肿瘤学数据库中识别出经组织学诊断为复发性颗粒细胞瘤或支持-间质细胞瘤的患者。纳入2012年至2020年间在Gemelli中心接受术前超声检查的患者，并从原始超声报告中检索数据。在所有这些报告中，使用国际卵巢肿瘤分析（IOTA）术语描述复发性肿瘤。如果患者有不止一次复发，收集所有复发事件的信息。如果在同一超声检查中有不止一个复发性肿瘤，则纳入所有肿瘤。一名专业超声检查医师还回顾了所有可用的超声图像，以通过模式识别确定典型的超声模式。
我们识别出30例经组织学诊断为复发性颗粒细胞瘤（25例患者，55个肿瘤）或支持-间质细胞瘤（5例患者，7个肿瘤）的患者。所有30例患者均在Gemelli中心接受了至少一次术前超声检查并被纳入研究。这些女性共有66次复发事件，其中34次在Gemelli中心进行了术前超声检查，发现62个复发病变：22/34（64.7%）次复发事件中有1个病变，4/34（11.8%）次复发事件中有2个病变，8/34（23.5%）次复发事件中有3个或更多病变。大多数复发性颗粒细胞瘤（38/55，69.1%）和复发性支持-间质细胞瘤（6/7，85.7%）被分类为实性或多房实性肿瘤，而8/55（14.5%）的复发性颗粒细胞瘤和1/7（14.3%）的复发性支持-间质细胞瘤为单房囊肿，9/55（16.4%）的复发性颗粒细胞瘤为多房囊肿。这9个单房囊肿的内容物为无回声（n = 2）或低水平回声（n = 7），内部囊肿壁要么光滑（n = 4）要么不规则（n = 5），最大直径为8至38毫米，其中3个<20毫米，5个为20 - 30毫米。回顾图像时，描述了两种典型的超声模式：直径<2厘米的小实性肿瘤（15/62，24.2%）和具有血管化回声性磨玻璃样内容物的肿瘤（12/62，19.4%）。
一些颗粒细胞瘤和支持-间质细胞瘤复发表现出两种典型超声模式之一，而有些表现为单房囊肿。这些通常被分类为良性，但在对颗粒细胞瘤或支持-间质细胞瘤进行随访的患者中，单房囊肿应被视为可疑复发。© 2023作者。《妇产科超声》由John Wiley & Sons Ltd代表国际妇产科超声学会出版。
