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OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ

Yıl 2014, Cilt: 77 Sayı: 4, 55 - 59, 21.01.2015
https://doi.org/10.18017/iuitfd.13056441.2015.77/4.55-59

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.

Kaynakça

  • American College of Gynecologists. ACOG practice bulletin, clinical management gynecologists, Management of endometrial cancer. Obstet Gynecol 2005;106(2):413–25 Obstetricians and guidelines number 65,August 2005:
  • Ayhan A, Salman MC, Velipasaoglu M, et al. Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol 2009;20:158-163.
  • Ayhan A, Tuncer ZS, Tuncer R, et al. Granulosa cell tumors of the ovary. A clinicopathologic evaluation of 60 cases. Eur J Gyneacol Oncol. 1994;15:320- 324.
  • Balen AH. Polycystic ovary syndrome and cancer. Human Reprod Update 2001;7:522-525.
  • Bokhman JV. Two pathogenic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10-17.
  • Calaminus G, Wessalowski R, Harms K. Juvenile granulosa cell tumor of the ovary in children and adolescents. Results from 33 patients registred in a prospective cooperative study. Gynecol Oncol 1997;65:447-452.
  • Colombo N, Parma G, Zanagnolo V, Insinga A. Management of ovarian stromal cell tumors. J Clin Oncol.2007;25(20):2944–512
  • Deligdisch L, Holinka CF. Endometrial carcinoma: two disease? Cancer Detect Prev 1987;10:237-246.
  • Evans At III, Gaffey Ta, Malkasian GD Jr et al. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Cynecol. 1980;55:231-238.
  • Fink D, Kubik-Huch RA, Wildermuth S. Juvenile tumor. granulosa 2001;26:5502-5503. Abdom Imaging 11. Fox H, Agrawal K, Clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis. Cancer 1975;35:231- 241. Langley FA. A
  • Gates EJ, Hirschfield L, Matthews RP, Yap OW. Body mass index as a prognostic factor in endometrioid adenocarcinoma of the endometrium. J Natl Med Assoc 2006;98:1814-1822.
  • Gebhart JB, Roche PC, Keeney GL, et al. Assessment of inhibin and p53 in granulosa cell tumors of the ovary. Gynecol Oncol. 2000;77:232- 236.
  • Kim SH. Granulosa cell tumor of the ovary: Common findings and unusual appearances on CT and MR. J Comp Assist Tomography 2002;26:756- 761.
  • Lane AH, Lee MM, Fuller AF. Diagnostic utility of mullerian inhibiting substance determination in patients with primary and recurrent granulosa cell tumors. Gynecol Oncol 1999;73:51-55.
  • Lappohn RE, Burger HG, Bouma J, et al. Inhibin as a marker for granulosa cell tumors. N Eng J Med 1989;321:790-793.
  • Malmström H, Högberg T, Risberg B, Simonsen E. Granulosa cell tumors of the ovary: Prognostic factors and outcome. Gynecol Oncol 1994;52:50-5.
  • Ohel G, Kaneti H, Schenker JG. Granulosa cell tumors in Israel: a study of 172 cases. Gynecol Oncol. 1983;15:278-2862Segal R, DePetrillo AD, Thomas G. Clinical review of adult granulosa cell tumors of the ovary. Gynecol Oncol 1995;56:338- 44.
  • Ottolina J, Ferrandina G, Gadducci A, Scollo P, Lorusso D,Giorda G. at all. Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary? Gynecologic Oncology 2015;136 230-34
  • Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009;200(6):678
  • Segal R, DePetrillo AD, Thomas G. Clinical review of adult granulosa cell tumors of the ovary. Gynecol Oncol 1995;56:338-44.
  • Schumer St, Cannistra SA. Granulosa cell tumor of the ovary. J Clinc Oncol 2003;21:1180-1189.
  • Stenwig JT, Hazelkamp JT, Beecham JB. Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow up. Gynecol Oncol 1979;7:136-152.
  • Terek MC, Akman L, Zekioğlu O, Dikmen Y. Postmenopozal Dönemde Endometriyal Hiperplazi Nedeni Olan Overin Granülosa Hücreli Tümörü: Olgu Sunumu Ve Literatür Derlemesi. Ege Tıp Der 2004;43:52-54.
  • Ukah CO, Ikpeze OC, Eleje GU, Eke AC. Adult granulosa cell tumor associated with endometrial carcinoma: a case report. J Med Case Rep 2011;5:340-44.
  • Unkila-Kallio L, Tiitinen A, Wahlstrom T, et al. Reproductive features in women developing ovarian granulosa cell tumour at a fertile age. Hum Reprod. 2000;15:589-593.
  • Van Meurs HS, Bleeker MCG, van der Velden J, et al. The Incidence of Endometiral Hyperplasia and Cancer in 1031 Patients with a Granulosa Cell Tumor Of The Ovary. Long Therm Follow-up in a Population-Based Cohort Study. 2013;23:1417- 1422.
  • Young RH, Scully RE. Sex cord-stromal, steroid cell, and other ovarian tumors with endocrine, paraendocrine and paraneoplastic manifestations, in Kurman RJ (ed): Pathology of the Female Genital Tract (ed4). New York NY, Springer, 1994, pp783- 847.

EVALUATION OF ENDOMETRIAL FINDINGS OF OVARIAN GRANULOSA CELL TUMORS

Yıl 2014, Cilt: 77 Sayı: 4, 55 - 59, 21.01.2015
https://doi.org/10.18017/iuitfd.13056441.2015.77/4.55-59

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

Kaynakça

  • American College of Gynecologists. ACOG practice bulletin, clinical management gynecologists, Management of endometrial cancer. Obstet Gynecol 2005;106(2):413–25 Obstetricians and guidelines number 65,August 2005:
  • Ayhan A, Salman MC, Velipasaoglu M, et al. Prognostic factors in adult granulosa cell tumors of the ovary: a retrospective analysis of 80 cases. J Gynecol Oncol 2009;20:158-163.
  • Ayhan A, Tuncer ZS, Tuncer R, et al. Granulosa cell tumors of the ovary. A clinicopathologic evaluation of 60 cases. Eur J Gyneacol Oncol. 1994;15:320- 324.
  • Balen AH. Polycystic ovary syndrome and cancer. Human Reprod Update 2001;7:522-525.
  • Bokhman JV. Two pathogenic types of endometrial carcinoma. Gynecol Oncol 1983; 15:10-17.
  • Calaminus G, Wessalowski R, Harms K. Juvenile granulosa cell tumor of the ovary in children and adolescents. Results from 33 patients registred in a prospective cooperative study. Gynecol Oncol 1997;65:447-452.
  • Colombo N, Parma G, Zanagnolo V, Insinga A. Management of ovarian stromal cell tumors. J Clin Oncol.2007;25(20):2944–512
  • Deligdisch L, Holinka CF. Endometrial carcinoma: two disease? Cancer Detect Prev 1987;10:237-246.
  • Evans At III, Gaffey Ta, Malkasian GD Jr et al. Clinicopathologic review of 118 granulosa and 82 theca cell tumors. Obstet Cynecol. 1980;55:231-238.
  • Fink D, Kubik-Huch RA, Wildermuth S. Juvenile tumor. granulosa 2001;26:5502-5503. Abdom Imaging 11. Fox H, Agrawal K, Clinicopathologic study of 92 cases of granulosa cell tumor of the ovary with special reference to the factors influencing prognosis. Cancer 1975;35:231- 241. Langley FA. A
  • Gates EJ, Hirschfield L, Matthews RP, Yap OW. Body mass index as a prognostic factor in endometrioid adenocarcinoma of the endometrium. J Natl Med Assoc 2006;98:1814-1822.
  • Gebhart JB, Roche PC, Keeney GL, et al. Assessment of inhibin and p53 in granulosa cell tumors of the ovary. Gynecol Oncol. 2000;77:232- 236.
  • Kim SH. Granulosa cell tumor of the ovary: Common findings and unusual appearances on CT and MR. J Comp Assist Tomography 2002;26:756- 761.
  • Lane AH, Lee MM, Fuller AF. Diagnostic utility of mullerian inhibiting substance determination in patients with primary and recurrent granulosa cell tumors. Gynecol Oncol 1999;73:51-55.
  • Lappohn RE, Burger HG, Bouma J, et al. Inhibin as a marker for granulosa cell tumors. N Eng J Med 1989;321:790-793.
  • Malmström H, Högberg T, Risberg B, Simonsen E. Granulosa cell tumors of the ovary: Prognostic factors and outcome. Gynecol Oncol 1994;52:50-5.
  • Ohel G, Kaneti H, Schenker JG. Granulosa cell tumors in Israel: a study of 172 cases. Gynecol Oncol. 1983;15:278-2862Segal R, DePetrillo AD, Thomas G. Clinical review of adult granulosa cell tumors of the ovary. Gynecol Oncol 1995;56:338- 44.
  • Ottolina J, Ferrandina G, Gadducci A, Scollo P, Lorusso D,Giorda G. at all. Is the endometrial evaluation routinely required in patients with adult granulosa cell tumors of the ovary? Gynecologic Oncology 2015;136 230-34
  • Reed SD, Newton KM, Clinton WL, Epplein M, Garcia R, Allison K, et al. Incidence of endometrial hyperplasia. Am J Obstet Gynecol 2009;200(6):678
  • Segal R, DePetrillo AD, Thomas G. Clinical review of adult granulosa cell tumors of the ovary. Gynecol Oncol 1995;56:338-44.
  • Schumer St, Cannistra SA. Granulosa cell tumor of the ovary. J Clinc Oncol 2003;21:1180-1189.
  • Stenwig JT, Hazelkamp JT, Beecham JB. Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow up. Gynecol Oncol 1979;7:136-152.
  • Terek MC, Akman L, Zekioğlu O, Dikmen Y. Postmenopozal Dönemde Endometriyal Hiperplazi Nedeni Olan Overin Granülosa Hücreli Tümörü: Olgu Sunumu Ve Literatür Derlemesi. Ege Tıp Der 2004;43:52-54.
  • Ukah CO, Ikpeze OC, Eleje GU, Eke AC. Adult granulosa cell tumor associated with endometrial carcinoma: a case report. J Med Case Rep 2011;5:340-44.
  • Unkila-Kallio L, Tiitinen A, Wahlstrom T, et al. Reproductive features in women developing ovarian granulosa cell tumour at a fertile age. Hum Reprod. 2000;15:589-593.
  • Van Meurs HS, Bleeker MCG, van der Velden J, et al. The Incidence of Endometiral Hyperplasia and Cancer in 1031 Patients with a Granulosa Cell Tumor Of The Ovary. Long Therm Follow-up in a Population-Based Cohort Study. 2013;23:1417- 1422.
  • Young RH, Scully RE. Sex cord-stromal, steroid cell, and other ovarian tumors with endocrine, paraendocrine and paraneoplastic manifestations, in Kurman RJ (ed): Pathology of the Female Genital Tract (ed4). New York NY, Springer, 1994, pp783- 847.
Toplam 27 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Sağlık Kurumları Yönetimi
Bölüm Klinik Araştırma
Yazarlar

Meryem Eken

Ecmel Kaygusuz

Gülçin Şahin Ersoy

Ebru Çöğendez

Dilşad Herkiloğlu

Ateş Karateke Bu kişi benim

Yayımlanma Tarihi 21 Ocak 2015
Gönderilme Tarihi 21 Ocak 2015
Yayımlandığı Sayı Yıl 2014 Cilt: 77 Sayı: 4

Kaynak Göster

APA Eken, M., Kaygusuz, E., Şahin Ersoy, G., Çöğendez, E., vd. (2015). OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ. Journal of Istanbul Faculty of Medicine, 77(4), 55-59. https://doi.org/10.18017/iuitfd.13056441.2015.77/4.55-59
AMA Eken M, Kaygusuz E, Şahin Ersoy G, Çöğendez E, Herkiloğlu D, Karateke A. OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ. İst Tıp Fak Derg. Mart 2015;77(4):55-59. doi:10.18017/iuitfd.13056441.2015.77/4.55-59
Chicago Eken, Meryem, Ecmel Kaygusuz, Gülçin Şahin Ersoy, Ebru Çöğendez, Dilşad Herkiloğlu, ve Ateş Karateke. “OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ”. Journal of Istanbul Faculty of Medicine 77, sy. 4 (Mart 2015): 55-59. https://doi.org/10.18017/iuitfd.13056441.2015.77/4.55-59.
EndNote Eken M, Kaygusuz E, Şahin Ersoy G, Çöğendez E, Herkiloğlu D, Karateke A (01 Mart 2015) OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ. Journal of Istanbul Faculty of Medicine 77 4 55–59.
IEEE M. Eken, E. Kaygusuz, G. Şahin Ersoy, E. Çöğendez, D. Herkiloğlu, ve A. Karateke, “OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ”, İst Tıp Fak Derg, c. 77, sy. 4, ss. 55–59, 2015, doi: 10.18017/iuitfd.13056441.2015.77/4.55-59.
ISNAD Eken, Meryem vd. “OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ”. Journal of Istanbul Faculty of Medicine 77/4 (Mart 2015), 55-59. https://doi.org/10.18017/iuitfd.13056441.2015.77/4.55-59.
JAMA Eken M, Kaygusuz E, Şahin Ersoy G, Çöğendez E, Herkiloğlu D, Karateke A. OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ. İst Tıp Fak Derg. 2015;77:55–59.
MLA Eken, Meryem vd. “OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ”. Journal of Istanbul Faculty of Medicine, c. 77, sy. 4, 2015, ss. 55-59, doi:10.18017/iuitfd.13056441.2015.77/4.55-59.
Vancouver Eken M, Kaygusuz E, Şahin Ersoy G, Çöğendez E, Herkiloğlu D, Karateke A. OVERİN GRANÜLOZA HÜCRELİ TÜMÖRLERİNDE ENDOMETRİAL BULGULARIN DEĞERLENDİRİLMESİ. İst Tıp Fak Derg. 2015;77(4):55-9.

Contact information and address

Addressi: İ.Ü. İstanbul Tıp Fakültesi Dekanlığı, Turgut Özal Cad. 34093 Çapa, Fatih, İstanbul, TÜRKİYE

Email: itfdergisi@istanbul.edu.tr

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