OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ

Öz

Amaç: Geç nüks eğilimli ve çoğunlukla iyi prognozlu olan granüloza hücreli tümörler overin en sık görülen sex-cord stromal tümörleridir. Tüm over kanserlerinin ise %2-3’ünü oluştururlar. Klinikte en çok östrojenik etki gösteren over tümörü olarak bilinirler ve endometriyumun tümörden salınan östrojene uzun süre maruz kalması nedeniyle ortaya çıkan postmenopozal kanama en sık izlenen klinik bulgusudur. Bu nedenle granüloza hücreli tümörlü hastalarda östrojen ilişkili endometriyal anormallikler sıklıkla beklenir. Çalışmamızda hastanemizde opere olan granüloza hücreli tümör vakalarının literatür ışığında endometrial bulgularını tartışmayı amaçladık.

Gereç ve yöntemler: Zeynep Kamil Eğitim ve Araştırma Hastanesi’nde opere olan hastaların endometrial bulguları retrospektif olarak incelendi. Olguların patoloji arşivindeki materyalleri tekrar gözden geçirildi ve endometriumda izlenen değişiklikler not edildi. Endometriumdaki bulgular endometriyal kanser, endometrial hiperplazi (kompleks,atipili, atipisiz ve basit, atipili, atipisiz), endometriyal polip, düzensiz proliferatif endometrium varlığı ve özellik izlenmeyen olarak gruplandırıldı.

Bulgular: Yirmidokuz olgunun endometriumlarında; 8 olguda endometriyal polip, 3 olguda düzensiz proliferatif endometrium, 7 olguda endometrial hiperplazi ve 1 olguda endometrioid adenokarsinom saptandı. Endometrial hiperplazi saptanan hastalardan 2’sinde kompleks atipili endometriyal hiperplazi, 1’inde kompleks atipisiz endometrial hiperplazi, 4’ünde de basit atipisiz endometrial hiperplazi mevcuttu. Tümörlerin diferansiyasyon dereceleri ile endometrium bulguları arasında bir ilişki saptanmadı. Tümör çapları ile endometrium bulguları arasında bir ilişki söz konusu değildi.

Sonuç: Granüloza hücreli tümörler hormon olarak aktif olmaları sebebiyle endometrial patolojilere sebep olarak sekonder bulgu ve semptomlara yol açmaktadırlar. Bu sebeple adneksiyel patoloji saptanıp granüloza hücreli tümör düşünülen olgularda endometrial patolojiler iyi değerlendirilmelidir.

Anahtar Kelimeler

• Granüloza hücreli tümör
• Endometrial bulgular
• Over

EVALUATION OF ENDOMETRIAL FINDINGS OF OVARIAN GRANULOSA CELL TUMORS

Öz

Introduction : Characterized by tendency for delayed recurrences and good prognosis mostly, granulosa cell tumors represent the most common sex-cord stromal tumors of the ovary and form 2-3% of all ovarian cancers. Clinically, they are well-known for their potent estrogenic capacity and postmenopausal bleeding constitutes its most common clinical sign, which usually ensues following the prolonged exposure of the endometrium to estrogen released from the tumor. Therefore, estrogen-related endometrial anomalies are frequently encountered in patients with granulosa cell tumors. In this study we aimed to present the patients with granulosa cell tumors operated in our institution and to evaluate their endometrial findings in the light of a literature review.

Material and methods: Endometrial findings of the patients who had been operated in the Obstetrics and Gynecology Department of Zeynep Kamil Training and Research Hospital were retrospectively analyzed. The pathological specimens belonging to the individual cases were re-evaluated and changes in the endometrium were noted. Endometrial findings were classified as endometrial cancer, endometrial hyperplasia (complex with/without atypia, simple with/without atypia), endometrial polyp, irregular proliferative endometrial layer and non-significant findings.

Results: The analysis of 29 endometrial specimens has revealed endometrial polyp in 8 cases, irregular proliferative endometrium in 3 patients, endometrial hyperplasia in 7 cases and endometrioid adenocarcinoma in one patient. Among the patients diagnosed with endometrial hyperplasia 2 patients had complex endometrial hyperplasia with atypia, one had complex endometrial hyperplasia without atypia and 4 patients had simple endometrial hyperplasia without atypia. Neither the tumor differentiation grades nor the tumor diameters have demonstrated a correlation with the endometrial findings.

Conclusion: Granulosa cell tumors are hormonally active, therefore they can give rise to endometrial pathologies leading to secondary symptoms and findings. Therefore when an adnexial mass is detected and a granulosa cell tumor is suspected, the evaluation of the patient should be extended for all endometrial pathologies

Anahtar Kelimeler

• Granulosa cell tumors
• Endometrial findings
• Ovary

Kaynakça

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