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Granulosa cell tumor induced massive recurrence of post hysterectomy leiomyoma.

Chalanki MV, Dattatreya S, Padmaja P, Dayal M, Parakh M, Rao VV - Indian J Nucl Med (2014)

Bottom Line: The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT).The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Andhra Pradesh, India.

ABSTRACT
The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.

No MeSH data available.


Related in: MedlinePlus

(a) The attached ovarian lesion showing fleshy cut sections with septated cystic and hemorrhagic areas (arrow). (b) High power view showing cohesive sheets of cells with focal trabecular pattern having vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm, suggesting granulosa cell tumor-adult type
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Figure 5: (a) The attached ovarian lesion showing fleshy cut sections with septated cystic and hemorrhagic areas (arrow). (b) High power view showing cohesive sheets of cells with focal trabecular pattern having vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm, suggesting granulosa cell tumor-adult type

Mentions: An asymptomatic, 44-year-old, primiparous woman on routine examination for medical fitness was found to have a large lower abdominal mass. The mass was nontender, not ballotable, nor freely mobile, and there was no free fluid in the abdomen. Her last child birth was 18 years back by lower segment cesarean section (LSCS). She underwent total abdominal hysterectomy 16 years back for massive uterine fibroids extending high up into the upper abdomen with a histopathological confirmation of benign leiomyoma. Ultrasonography performed reported as hysterectomy status with a large 17 × 11 cm hypoechoic pelvic mass of left ovarian origin and right ovary appearing enlarged measuring 5.7 × 3.4 cm with multiple, thin-walled cysts with a maximum size of 2.8 × 2.2 cm. No free fluid in the pelvis or abdomen. T2-weighted magnetic resonance imaging (MRI) pelvis revealed post hysterectomy status and a hypointense lobulated mass 15 × 13 × 10 cm in the left side of pelvis extending up to fourth lumbar vertebral level with a 3 × 2 × 2 cm cystic mass adherent to the main mass [Figure 1]. Carcinoembryonic antigen (CEA) was elevated with 20.2 pg/ml and alpha fetoprotein (AFP), cancer antigen (CA) 125, and CA-15.3 were with in normal limits. In view of the large pelvic mass and elevated CEA, a F-18-FDG PET/CT of abdomen was performed. Transaxial, sagittal, and coronal reformatted images revealed a non-FDG, avid, uniform-density, large mass with lobular contour arising from pelvis isodense to muscle and showing continuity with the anterior cervical wall. No abnormal calcifications or necrosis was noted within the mass. The mass was abutting the left posterolateral vesicle wall pushing the bladder to the right and superiorly. The fat planes with adjoining rectum and vesicle wall were well-maintained [Figure 2a and b]. Visualized ovary appeared enlarged measuring 6.0 × 4.5 cm with multiple cystic areas within and adherent to the abdominopelvic mass. No FDG avidity was seen in the ovarian mass [Figure 3]. In view of the homogeneous and myomatous texture of the mass being strikingly non-FDG avid and the mass being traceable and contiguous with the cervical stump, possibility of a metabolically inactive benign pathology of recurrent leiomyoma was considered despite a hysterectomy status. Patient underwent laparotomy which showed a large pelvic mass with multiple lobulations and adherent to the bladder, viscera, and the anterior abdominal wall. The mass could be easily dissected from the adjoining structures and excised completely along with the ovary adherent to the mass posteriorly. Postoperative period was uneventful and patient discharged on the 4th postoperative day. Gross specimen showing a large, homogeneous, mural mass with a septated cystic ovarian mass was seen adherent posteriorly. Histopathology of the mural mass revealed intersecting short fascicles of smooth muscle cells with intervening abundant collagen and no mitosis or necrosis, features suggesting benign Leiomyoma [Figure 4a and b]. The attached ovarian lesion revealed a 4 cm mass with fleshy cut sections and the tumor composed of cohesive sheets of cells showing focal trabecular pattern. These cells had vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm. Increased mitosis or necrosis was not seen. The tumor was concluded as granulosa cell tumor-adult type [Figure 5a and b]. In view of the metabolically bland lesion comprising of normal uterine muscularity and the associated cystic ovarian mass being low-grade, well-differentiated, GCT; no further treatment was envisaged and the patient is on follow-up with no evidence of any disease.


Granulosa cell tumor induced massive recurrence of post hysterectomy leiomyoma.

Chalanki MV, Dattatreya S, Padmaja P, Dayal M, Parakh M, Rao VV - Indian J Nucl Med (2014)

(a) The attached ovarian lesion showing fleshy cut sections with septated cystic and hemorrhagic areas (arrow). (b) High power view showing cohesive sheets of cells with focal trabecular pattern having vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm, suggesting granulosa cell tumor-adult type
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4157197&req=5

Figure 5: (a) The attached ovarian lesion showing fleshy cut sections with septated cystic and hemorrhagic areas (arrow). (b) High power view showing cohesive sheets of cells with focal trabecular pattern having vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm, suggesting granulosa cell tumor-adult type
Mentions: An asymptomatic, 44-year-old, primiparous woman on routine examination for medical fitness was found to have a large lower abdominal mass. The mass was nontender, not ballotable, nor freely mobile, and there was no free fluid in the abdomen. Her last child birth was 18 years back by lower segment cesarean section (LSCS). She underwent total abdominal hysterectomy 16 years back for massive uterine fibroids extending high up into the upper abdomen with a histopathological confirmation of benign leiomyoma. Ultrasonography performed reported as hysterectomy status with a large 17 × 11 cm hypoechoic pelvic mass of left ovarian origin and right ovary appearing enlarged measuring 5.7 × 3.4 cm with multiple, thin-walled cysts with a maximum size of 2.8 × 2.2 cm. No free fluid in the pelvis or abdomen. T2-weighted magnetic resonance imaging (MRI) pelvis revealed post hysterectomy status and a hypointense lobulated mass 15 × 13 × 10 cm in the left side of pelvis extending up to fourth lumbar vertebral level with a 3 × 2 × 2 cm cystic mass adherent to the main mass [Figure 1]. Carcinoembryonic antigen (CEA) was elevated with 20.2 pg/ml and alpha fetoprotein (AFP), cancer antigen (CA) 125, and CA-15.3 were with in normal limits. In view of the large pelvic mass and elevated CEA, a F-18-FDG PET/CT of abdomen was performed. Transaxial, sagittal, and coronal reformatted images revealed a non-FDG, avid, uniform-density, large mass with lobular contour arising from pelvis isodense to muscle and showing continuity with the anterior cervical wall. No abnormal calcifications or necrosis was noted within the mass. The mass was abutting the left posterolateral vesicle wall pushing the bladder to the right and superiorly. The fat planes with adjoining rectum and vesicle wall were well-maintained [Figure 2a and b]. Visualized ovary appeared enlarged measuring 6.0 × 4.5 cm with multiple cystic areas within and adherent to the abdominopelvic mass. No FDG avidity was seen in the ovarian mass [Figure 3]. In view of the homogeneous and myomatous texture of the mass being strikingly non-FDG avid and the mass being traceable and contiguous with the cervical stump, possibility of a metabolically inactive benign pathology of recurrent leiomyoma was considered despite a hysterectomy status. Patient underwent laparotomy which showed a large pelvic mass with multiple lobulations and adherent to the bladder, viscera, and the anterior abdominal wall. The mass could be easily dissected from the adjoining structures and excised completely along with the ovary adherent to the mass posteriorly. Postoperative period was uneventful and patient discharged on the 4th postoperative day. Gross specimen showing a large, homogeneous, mural mass with a septated cystic ovarian mass was seen adherent posteriorly. Histopathology of the mural mass revealed intersecting short fascicles of smooth muscle cells with intervening abundant collagen and no mitosis or necrosis, features suggesting benign Leiomyoma [Figure 4a and b]. The attached ovarian lesion revealed a 4 cm mass with fleshy cut sections and the tumor composed of cohesive sheets of cells showing focal trabecular pattern. These cells had vesicular oval nuclei, longitudinal nuclear grooving, and minimal eosinophilic cytoplasm. Increased mitosis or necrosis was not seen. The tumor was concluded as granulosa cell tumor-adult type [Figure 5a and b]. In view of the metabolically bland lesion comprising of normal uterine muscularity and the associated cystic ovarian mass being low-grade, well-differentiated, GCT; no further treatment was envisaged and the patient is on follow-up with no evidence of any disease.

Bottom Line: The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT).The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Oncology, Omega Hospitals, Banjara Hills, Hyderabad, Andhra Pradesh, India.

ABSTRACT
The authors report a very unusual occurrence of a massive recurrence of leiomyoma from post hysterectomy stump diagnosed on fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (F-18-FDG PET/CT). The case also has an additional complexity of granulosa cell tumor (GCT) of ovary probably contributing to the recurrence and massive size.

No MeSH data available.


Related in: MedlinePlus