17 yaşında bir kızda çift taraflı disgerminom ve tek taraflı erişkin tip granüloza hücreli over tümörüne B hücreli akut lenfoblastik lösemi'nin eşlik ettiği olgu sunumu.

Abstract

Giriş Overde eş zamanlı germ hücreli tümör ile seks kord stromal tümör varlığı çok nadir görülen bir durumdur. Overde tek taraflı granüloza hücreli tümör ile çift taraflı disgerminom nedeniyle opere olduktan sonra adjuvan BEP (Bleomisin+Etoposid+cisPlatin) kemoterapisinden sonraki ilk yıl içinde B hücreli akut lenfoblastik lösemi ile presente olan nadir bir malignite kombinasyon olgusunu sunuyoruz. Olgu Karyotipi normal olan (46, XX) 17 yaşında bir genç kız, 65 mm çapa kadar ulaşan çift taraflı adneksiyal kitle ile başvurdu. Hastaya fertilite koruyucu cerrahi evreleme yapıldı ve patolojik incelemede çift taraflı disgerminom ile tek taraflı erişkin tip granuloza hücreli seks-kord bileşenleri içeren tümör saptandı. Adjuvan BEP kemoterapisi sonrası remisyonda iken, onuncu ayda hastaya akut lenfoblastik lösemi teşhisi kondu. Sonuç Olgumuza eş zamanlı saptanan çift taraflı disgerminom ile tek taraflı granüloza hücreli tümör ve ilk tanı üzerinden bir yıl geçmeden ortaya çıkan akut lenfoblastik lösemi tanısı konulmuştur. Gonadal tümör nedeniyle BEP kemoterapisi almış hastalarda, yakın ve dikkatli takip ayrıca önem taşır, Bu hasta grubunda hematolojik malignitelerin de sekonder olarak gelişebileceği mutlaka akılda tutulmalıdır.

Keywords

• çift taraflı disgerminom
• tek taraflı granülosa hücreli tümör
• B hücreli lenfoblastik lösemi

Bilateral dysgerminoma and unilateral adult type granulosa cell tumour of the ovary accompany B-cell acute lymphoblastic leukemia in a young woman

Abstract

Introduction Synchronous germ cell and sex cord stromal tumor is a unique and very rare phenomenon. We present a case of a rare combination of malignancies, bilateral dysgerminoma accompanied by unilateral granulosa cell tumor and acute lymphoblastic leukemia within the first year after adjuvant BEP chemotherapy during the remission period. Case We report a case of a 17-year-old female with a normal karyotype (46, XX), presenting with bilateral adnexal masses measuring up to 65 mm in diameter, containing germ cells bilaterally and sex cord compo¬nents with granulosa cell tumor on the left side unilaterally. While she has been in remission for ten months after adjuvant chemotherapy following surgery, she was diagnosed with acute lymphoblastic leukemia. Conclusion In our case, an extremely rare entity of simultaneous bilateral germ cell, unilateral granulosa cell tumor and subsequently occurred acute lymphoblastic leukemia were reported. Close and careful follow-up is additionally important in patients who have received BEP chemotherapy for gonadal tumors. It should be kept in mind that hematological malignancies may develop in this patient group.

Keywords

• Bilateral dysgerminoma
• adult-type granulosa cell tumour
• Acute lymphoblastic leukemia

References

1. Referans 1. Krege S, Beyer J, Souchon R, et al. European consensus conference on diagnosis and treatment of germ cell cancer: A report of the second meeting of the European Germ Cell Cancer Consensus group (EGCCCG): Part I. Eur Urol. 2008; 53: 478–496.
2. Referans 2. Zhang M, Jiang W, Li G, Xu C. Ovarian masses in children and adolescents - an analysis of 521 clinical cases. J Pediatr Adolesc Gynecol. 2014 Jun; 27(3): e73-7.
3. Referans 3. Chen VW, Ruiz B, Killeen J, et al. Pathology and classification of ovarian tumors. Cancer. 2003; 97(suppl. 10):2631–2642.
4. Referans 4. Chaudhary UB, Haldas JR. Long-term complications of chemotherapy for germ cell tumours. Drugs. 2003;63:1565– 1577.
5. Referans 5. Berek JS, Friedlander ML, Hacker NF. Germ Cell and Nonepithelial Ovarian Cancer. In: Berek & Hacker’s Gynecologic Oncology. Sixth edition, 2015, Wolters Kluwer, Philadelphia, USA. Chapter 12, pp 828-9.
6. Referans 6. Boyce EA, Costaggini I, Vitonis A, et al. The epidemiology of ovarian granulosa cell tumors: A case-control study. Gynecol Oncol. 2009;115:221–225.
7. Referans 7. Zanagnolo V, Pasinetti B, Sartori E. Clinical review of 63 cases of sex cord stromal tumors. Eur J Gynaecol Oncol. 2004;25(4):431-8.
8. Referans 8. Roth LM, Cheng L. On the histogenesis of mixed germ cell-sex cord stromal tumour of the gonads. J Clin Pathol. 2017 Mar; 70 (3): 222-227.

9. Referans 9. Jacobsen GK, Talerman A (Eds.) In: Atlas of germ cell tumours. Munksgaard, Copenhagen; 1989.
10. Referans 10. Bremer GL, Land JA, Tiebosch A, et al. Five different histologic subtypes of germ cell malignancies in an XY female. Gynecol Oncol. 1993;50:247–248.
11. Referans 11. Prat J, Noglales FF, Cao D. Germ cell-sex cord-stromal tumors. In: Kurman RJ, Carcangiu ML, Herrington S, Yong RH, editors. Who Classific¬aion of Tumours of Female Reproductive Or¬gans. Lyon: IARC; 2014. pp. 67-8.
12. Referans 12. Talerman A, Russell V. Mixed germ cell-sex cord-stromal tumor. In: Kurman RJ, editor. Blaustin’s Pathology of the Female Genital Tract. New York: Springer; 2013. pp. 897-901.
13. Referans 13. Arroyo JG, Harris W, Laden SA. Recurrent mixed germ cell-sex cord-stromal tumor of the ovary in an adult. Int J Gynecol Pathol 1998; 17: 281-3.
14. Referans 14. Jacobsen GK, Braendstrup O, Talerman A. Bi¬lateral mixed germ cell sex-cord stroma tumour in a young adult woman. Case report. APMIS Suppl 1991; 23: 132-7.
15. Referans 15. Shujie Pang, Lin Zhang, Yiquan Shi, Yixin Liu. Unclassified mixed germ cell-sex cord-stromal tumor with multiple malignant cellular elements in a young woman: a case report and review of the literature. Int J Clin Exp Pathol 2014;7(8):5259-5266
16. 16. Talerman A, Roth LM. Recent Advances in the Pathology and Classification of Gonadal Neoplasms Composed of Germ Cells and Sex Cord Derivatives. Int J GynReferans ecol Pathol. 2007 Jul;26(3):313-21.
17. Referans 17. Billmire D, Vinocur C, Rescorla F, et al. Outcome and staging evaluation in malignant germ cell tumors of the ovary in children and adolescents: An intergroup study. J Pediatr Surg. 2004;39(3):424–429.
18. Referans 18. Pui, C.H. Epipodophyllotoxin-related acute myeloid leukaemia. Lancet 1991, 338.
19. Referans 19. Ezoe S. Secondary Leukemia Associated with the Anti-Cancer Agent, Etoposide, a Topoisomerase II Inhibitor. Int. J. Environ. Res. Public Health 2012, 9, 2444-2453;
20. Referans 20. Schneider DT, Hilgenfeld E, Schwabe D, et al. Acute myelogenous leukemia after treatment for malignant germ cell tumors in children. J Clin Oncol. 1999;17:3226–3233.
21. Referans 21. Kollmannsberger C, Beyer J, Droz JP, et al. Secondary leukemia following high cumulative doses of etoposide in patients treated for advanced germ cell tumors. J Clin Oncol. 1998;16:3386–3391.
22. Referans 22. Houck, W.; Abonour, R.; Vance, G.; Einhorn, L.H. Secondary leukemias in refractory germ cell tumor patients undergoing autologous stem-cell transplantation using high-dose etoposide. J. Clin. Oncol. 2004, 22, 2155–2158.