Successful management of diagnosed ovarian Leydig cell tumor without ovarian enlargement

Autor: Tsubasa Hobo, Yuta Endo, Shigenori Furukawa, Asami Kato, Chikako Okabe, Hirotaka Isogami, Norihito Kamo, Makiko Ueda, Satoshi Kawana, Manabu Kojima, Shu Soeda, Takafumi Watanabe, Yuko Hashimoto, Keiya Fujimori
Rok vydání: 2023
Předmět:
Zdroj: FUKUSHIMA MEDICAL JOURNAL. 73:1-6
ISSN: 2436-7826
0016-2582
DOI: 10.5387/fmedj.73.1_1
Popis: 患者は71歳女性，4妊3産。不正性器出血と子宮内膜肥厚を認めた。子宮内膜細胞診で疑陽性であり，子宮体癌を疑われたため，当科紹介となった。経腟超音波検査では子宮内膜は11.5mmと肥厚を認めたが，両側付属器の腫大を認めなかった。続く子宮内膜全面掻爬による組織診では悪性所見を認めなかった。骨盤部MRIでは9mmの子宮内膜肥厚を認めたが，両側卵巣の腫大を認めなかった。血清エストラジオール（E2）は55pg/mLと高値であったが，CA125，CA19-9，CEAの上昇を認めなかった。ホルモン産生卵巣腫瘍を疑い，腹腔鏡下子宮全摘術，両側付属器切除術を施行した。卵巣に肉眼的に明らかな腫瘍性病変を認めなかったが，病理組織学的に右卵巣に1.5×1.5mm大のライディッヒ細胞腫を認めた。術後に血清E2の低下を認めた。閉経後の不正出血，子宮内膜肥厚では，画像検索で卵巣腫瘍を認めない場合にも臨床症状によりライディッヒ細胞腫を鑑別に置くことが肝要である。
A 71-year-old woman, gravida 4 para 3, presented with abnormal genital bleeding. Transvaginal ultrasonography showed a thickened endometrium of 11.5 mm, but no bilateral adnexal enlargement. Cervical cytology was negative for intraepithelial lesion or malignancy, and endometrial curettage was performed, and no malignant findings were found histologically. Pelvic MRI showed only 9 mm endometrial thickening and no ovarian tumor. Serum estradiol was elevated (55 pg/mL), and CA125, CA19-9, and CEA were not elevated. A hormone-producing ovarian tumor was suspected, and total laparoscopic hysterectomy and bilateral salpingo-oophorectomy were performed. Although no tumor was found macroscopically in the bilateral ovaries, histopathology revealed a 1.5 × 1.5 mm Leydig cell tumor in the right ovary. Serum E2 decreased after surgery. Thus, in cases with postmenopausal irregular bleeding and endometrial thickening, it is essential to consider Leydig cell tumor, even in the absence of ovarian tumors on imaging.
Databáze: OpenAIRE
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