Recurrent endometrial hyperplasia as a presentation of estrogen-secreting thecoma – case report and minireview of the literature

Abstract

Thecoma is a rare ovarian tumor, presenting usually in postmenopausal women as unilateral, benign, solid lesion. About 15% of affected patients develop endometrial hyperplasia (EH) and 20% are diagnosed with endometrial cancer. In this case report, we present 60-year-old women admitted because of recurrent spotting of 5 years duration, which started 1 year after menopause. In history, the patient underwent three times curettage procedures and once (1 year before admission) had estradiol levels typical for reproductive-age women. At admission, we found elevated serum levels of estradiol (222.5 pg/ml) and a small mass in the right ovary. The markers of germ cell tumors were negative. After the initial diagnosis, the patient was qualified for total abdominal hysterectomy with bilateral salpingo-oophorectomy. The histopathological examination and immunohistochemical staining confirmed the thecoma diagnosis. In follow-up examination after 8 weeks, we found decreased serum estradiol levels and relief of the symptoms. In conclusion, we want to underline that in cases of EH, especially in patients with a history of recurrences, the special attention should be paid for differential diagnosis. In such cases, the estrogen-secreting tumors should be excluded.

Chinese abstract

卵泡膜细胞瘤是一种罕见的卵巢肿瘤，多为单侧、良性和实性肿物，好发于绝经后女性。15%的患者伴有子宫内膜增生，其中又有20%的患者诊断为子宫内膜癌。本病例为一位60岁的绝经后女性，因绝经6年，反复阴道点滴流血5年来诊。病程中，她经历了3次诊断性刮宫，入院前1年检测雌激素水平提示符合育龄期女性水平，入院后检测雌激素水平结果为222.5pg/ml，B超发现右侧卵巢小肿物，生殖细胞肿瘤标志物水平正常。随后该患者进行了开腹全子宫及双侧附件切除术，术后病理及免疫组化结果证实为卵泡膜细胞瘤。术后8周随访时，该患者阴道流血症状消失，血清雌激素水平恢复正常。通过该病例的学习，我们认为，在反复出现子宫内膜增生的患者，有必要排除分泌雌激素的肿瘤可能。

• Endometrial hyperplasia
• hormone-secreting ovarian tumors
• thecoma

Declaration of interest

The authors report no conflicts of interest.