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Successful delivery after conservative resectoscopic surgery in a patient with a uterine tumor resembling ovarian sex cord tumor with myometrial invasion.

Jeong KH, Lee HN, Kim MK, Kim ML, Seong SJ, Shin E - Obstet Gynecol Sci (2015)

Bottom Line: Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation.The clinical characteristics of a UTROSCT are not fully understood.Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.

ABSTRACT
Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation. The clinical characteristics of a UTROSCT are not fully understood. Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility. We present a case of UTROSCT with myometrial invasion, which resulted in a successful delivery after the patient was treated by resectoscopic surgery and conservation of the uterus, and a brief review of the literature.

No MeSH data available.


Related in: MedlinePlus

Microscopic architectural patterns of the mass removed by resectoscopic surgery. (A) A relatively well-demarcated nodular mass within the superficial myometrium (H&E, ×40). (B) The tumor cells have relatively benign appearing, small round vesicular nuclei with nucleoli and eosinophilic cytoplasm (H&E, ×200). Immunohistochemical profile of the uterine tumors resembling ovarian sex cord tumor. (C) Positive for calretinin (calretinin, ×200). (D) Positive for CD99 (CD99, ×200). (E) Positive for CD56 (CD56, ×200). (F) Negative for CD10 (CD10, ×200).
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Figure 1: Microscopic architectural patterns of the mass removed by resectoscopic surgery. (A) A relatively well-demarcated nodular mass within the superficial myometrium (H&E, ×40). (B) The tumor cells have relatively benign appearing, small round vesicular nuclei with nucleoli and eosinophilic cytoplasm (H&E, ×200). Immunohistochemical profile of the uterine tumors resembling ovarian sex cord tumor. (C) Positive for calretinin (calretinin, ×200). (D) Positive for CD99 (CD99, ×200). (E) Positive for CD56 (CD56, ×200). (F) Negative for CD10 (CD10, ×200).

Mentions: A 32-year-old igravid woman visited our hospital in September 2010 for 3 years of infertility and prolonged menstruation. Previously, she underwent infertility work-up at another hospital. And she was diagnosed with right tubal obstruction on hysterosalpingography. In addition, a 3 cm sized submucosal myoma and multiple small follicles consistent with polycystic ovaries were observed in both ovaries on transvaginal ultrasonography. She failed to conceive despite multiple timed coitus and intrauterine insemination. In the initial transvaginal ultrasonography in our institution, a 3.2×2.6-cm-sized heterogeneous echoic mass was protruding into the endometrial cavity. Magnetic resonance imaging was conducted to study the possibility of a hysteroscopic approach, and a 3.6×3-cm-sized intracavitary protruding mass was observed in the anterior uterine wall. The image findings and treatment options were discussed with the patient, and she selected hysteroscopic resection of the mass despite the possible risk of incomplete removal or laparoscopic conversion. She underwent resectoscopic submucosal mass resection with complete removal of the presumed submucosal myoma. A diagnosis of type II UTROSCT with myometrial invasion was reported after pathologic evaluation. On hematoxylin/eosin staining, tumor showed a mixed pattern of cords, tubules, and nests related to sex cord-like differentiation with myometrial invasion (Fig. 1A, B). According to the immunohistochemical results, the neoplastic cells were positive for calretinin, CD99, CD56, and cytokeratin, but negative for CD10, CD34, inhibin, and WT1 (Fig. 1C-F). The diagnostic criteria for UTROSCT in immunohistochemical markers of sex cord differentiation should include calretinin and one of either melan A, CD99, or inhibin, WT1. Additionally, CD10, the endometrial stromal cell marker, should be negative. Therefore, final diagnosis of this tumor was type II UTROSCT with myometrial invasion. After detailed discussions regarding the clinical behavior of UTROSCT with myometrial invasion, the patient chose to undergo pregnancy trial with in vitro fertilization (IVF), despite the possible risk of recurrence or metastasis.


Successful delivery after conservative resectoscopic surgery in a patient with a uterine tumor resembling ovarian sex cord tumor with myometrial invasion.

Jeong KH, Lee HN, Kim MK, Kim ML, Seong SJ, Shin E - Obstet Gynecol Sci (2015)

Microscopic architectural patterns of the mass removed by resectoscopic surgery. (A) A relatively well-demarcated nodular mass within the superficial myometrium (H&E, ×40). (B) The tumor cells have relatively benign appearing, small round vesicular nuclei with nucleoli and eosinophilic cytoplasm (H&E, ×200). Immunohistochemical profile of the uterine tumors resembling ovarian sex cord tumor. (C) Positive for calretinin (calretinin, ×200). (D) Positive for CD99 (CD99, ×200). (E) Positive for CD56 (CD56, ×200). (F) Negative for CD10 (CD10, ×200).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588850&req=5

Figure 1: Microscopic architectural patterns of the mass removed by resectoscopic surgery. (A) A relatively well-demarcated nodular mass within the superficial myometrium (H&E, ×40). (B) The tumor cells have relatively benign appearing, small round vesicular nuclei with nucleoli and eosinophilic cytoplasm (H&E, ×200). Immunohistochemical profile of the uterine tumors resembling ovarian sex cord tumor. (C) Positive for calretinin (calretinin, ×200). (D) Positive for CD99 (CD99, ×200). (E) Positive for CD56 (CD56, ×200). (F) Negative for CD10 (CD10, ×200).
Mentions: A 32-year-old igravid woman visited our hospital in September 2010 for 3 years of infertility and prolonged menstruation. Previously, she underwent infertility work-up at another hospital. And she was diagnosed with right tubal obstruction on hysterosalpingography. In addition, a 3 cm sized submucosal myoma and multiple small follicles consistent with polycystic ovaries were observed in both ovaries on transvaginal ultrasonography. She failed to conceive despite multiple timed coitus and intrauterine insemination. In the initial transvaginal ultrasonography in our institution, a 3.2×2.6-cm-sized heterogeneous echoic mass was protruding into the endometrial cavity. Magnetic resonance imaging was conducted to study the possibility of a hysteroscopic approach, and a 3.6×3-cm-sized intracavitary protruding mass was observed in the anterior uterine wall. The image findings and treatment options were discussed with the patient, and she selected hysteroscopic resection of the mass despite the possible risk of incomplete removal or laparoscopic conversion. She underwent resectoscopic submucosal mass resection with complete removal of the presumed submucosal myoma. A diagnosis of type II UTROSCT with myometrial invasion was reported after pathologic evaluation. On hematoxylin/eosin staining, tumor showed a mixed pattern of cords, tubules, and nests related to sex cord-like differentiation with myometrial invasion (Fig. 1A, B). According to the immunohistochemical results, the neoplastic cells were positive for calretinin, CD99, CD56, and cytokeratin, but negative for CD10, CD34, inhibin, and WT1 (Fig. 1C-F). The diagnostic criteria for UTROSCT in immunohistochemical markers of sex cord differentiation should include calretinin and one of either melan A, CD99, or inhibin, WT1. Additionally, CD10, the endometrial stromal cell marker, should be negative. Therefore, final diagnosis of this tumor was type II UTROSCT with myometrial invasion. After detailed discussions regarding the clinical behavior of UTROSCT with myometrial invasion, the patient chose to undergo pregnancy trial with in vitro fertilization (IVF), despite the possible risk of recurrence or metastasis.

Bottom Line: Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation.The clinical characteristics of a UTROSCT are not fully understood.Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.

ABSTRACT
Uterine tumor resembling ovarian sex cord tumors (UTROSCT) is an extremely rare type of uterine stromal neoplasm that exhibits prominent sex cord-like differentiation. The clinical characteristics of a UTROSCT are not fully understood. Most reported cases of UTROSCT were treated by hysterectomy with or without bilateral salpingo-oophorectomy; however, a few cases have been treated by only tumor resection in patients who had a strong desire to preserve their fertility. We present a case of UTROSCT with myometrial invasion, which resulted in a successful delivery after the patient was treated by resectoscopic surgery and conservation of the uterus, and a brief review of the literature.

No MeSH data available.


Related in: MedlinePlus