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KMID : 0378020070500050044
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New Medical Journal
2007 Volume.50 No. 5 p.44 ~ p.49
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A Clinical Analysis of Sex-Cord Stromal Tumors of the Ovary
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Oh Eun-kyeong
Kim Hyo-Jin
Ro Duck-Yeong
Park Byung-Joon
Kim Tae-Eung
Kim Yong-Wook
Jung Jae-Keun
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Abstract
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Objective: The purpose of this study is to evaluate the clinical and pathological characteristics of sex-cord stromal tumor of the ovary.
Methods: From January 1990 to December 2005, 103 patients with sex-cord stromal tumor of the ovary, including fibrothecoma group, granulosa cell and Sertoli-Leydig cell tumor treated in the Department of Obstetrics and Gynecology, College of Medicine, Catholic University of Korea, Our Lady of Mercy hospital, Taejon Saint Mary’s hospital, and Cheongju Saint Mary’s hospital, were identified and reviewed retrospectively for patients profiles, mode of therapy and length of survival and so on.
Results: There were 76 cases of fibrothecoma group (73.8%) including 46 fibromas, 10 thecomas, and 20 fibrothecomas, 22 cases of granulosa cell tumor (21.4%), 5 cases of Sertoli-Leydig cell tumors (4.9%). The overall mean age of patients with sex-cord stromal tumor was 52 years old, with fibrothecoma was 52.2 years old, with granulosa cell tumor was 48.9 years old and with Sertoli-Leydig tumor was 44.2 years old. Initial symptoms were asymptomatic (66.0%), palpable mass (19.4%), abdominal pain (15.5%), irregular menstruation (5.8%), and vaginal bleeding (5.8%) in order. The 16 of 58 (27.6%) patients with fibrothecoma, 6 of 20 (30%) patients with granulosa cell tumor had elevated CA125 values (cut-off value>35 U/ml). CA 125 were normal range in all Sertoli-Leydig tumor patients. We measured CA 19-9 levels in 32 fibrothecoma patients, 14 women with granu-losa cell tumors, and 4 Sertoli-Leydig cell tumor patients. Only 2 of the fourteen women (14.3%) with granulosa cell tumor had elevated (cut-off value>36.9 U/ml). AFP (alpha fetoprotein, cut-off value>10.5 ng/ml) and CEA (carcinoembryonic antigen, cut-off value>5 ng/ml) were not increased in any cases. Of 76 patients with fibrothecoma, TAH (total abdominal hysterectomy) with BSO (bilateral salpingo-oophorectomy) was performed in 38 cases, TAH with USO (unilateral salpingo- oophorectomy) in 2, USO in 26, BSO for 2 and ovarian wedge resection for 8. TAH with BSO (14), TAH with USO (2) and USO (6) were performed in granulosa cell tumor patients. TAH with BSO (1), TAH with USO (1), USO (2) and right oophrectomy (1) were performed in Sertoli-Leydig cell tumor patients. Bilaterality was absent, and the mean size of the fibrothecoma group was 7.5 cm, granulosa cell tumor was 11.8cm, Sertoli-Leydig tumor was 7.4 cm in diameter. There were 4 simple endometrial hyperplasia in patients with granulosa cell tumor (18.2%). All granulosa cell tumor patients were FIGO (International Federation of Gynecology and Obstetrics) stage IA except 3 cases. TAH with BSO was performed in those 3 cases under the diagnosis of stage IC. Of those, 2 cases were treated with BEP (bleomycin, etoposide, cisplatin), the other case with VAC (vincristine, actinomycin, cyclophosphamide). All Sertoli-Leydig cell tumor were stage IA. In malignant cases, the duration of follow-up was 48-108 months, all patients survived.
Conclusion: The recognition and identification of sex cord stromal tumors may be difficult because they are encountered infrequently, and clinical and histological features vary widely. Postoperative therapy is probably not indicated in the majority of patients with fibrothecoma, granulosa cell and Sertoli-Leydig cell tumor confined to the ovary, because there are no histologic features that predict the biologic behavior of the tumor. Patients with biopsy-proven metastatic disease may respond to combination chemotherapy. The patients with granulosa and Sertoli-Leydig cell tumor should be followed up indefinitely.
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KEYWORD
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Sex-cord stromal tumor, Ovary
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