Taner TURAN, Alper KARALÖK, Tolga TAŞÇI, Işın ÜREYEN, Günsu KİMYON, Nurettin BORAN, Gökhan TULUNAY, Yağmur SOYKAN

Sklerozan stromal ovariyan tümör olgularının analizi

Amaç: Bu çalışmada kliniğimizde sklerozan stromal ovariyan tümör (SSOT) tanısı alan hastaların klinik, radyolojik özelliklerinin ve bu nadir görülen benign tümöre sahip hastalara ilişkin cerrahi tedavi deneyimlerimizin değerlendirilmesi amaçlandı. Gereç ve Yöntem: Nisan 2002 ile Ocak 2014 yılları arasında jinekolojik onkoloji kliniğinde adneksiyal kitle ön tanısıyla opere edilmiş ve postoperatif SSOT tanısını almış 11 olgunun verileri retrospektif olarak incelendi. Uygulanan cerrahinin sınırı, kliniğimizde adneksiyal kitlelerin yönetiminde rutin olarak kullanılan frozen/section ile belirlenmiştir. Bulgular: Olguların tanı anında yaş ortalaması 28 (minimum:14- maksimum:60)di. Hastaların 7si reprodüktif, 2si postmenopozal ve 2si adölesan dönemdeydi. Başvuru şikayeti 4 (%36.4)ünde pelvik ağrı, 3 (%27.3)ünde primer infertiliteydi. Kitlelerin boyut ortalaması 94.8 mm (minimum:23mm- maksimum 240mm)di. Kitlelerin tümü unilateraldi. Altı (%54.5) hastada kitle sağ tarafa lokalizeydi. Tümör hastaların 10unda ovariyan, 1inde paraovariyan yerleşimliydi. Ultrasonografide kitlelerin %80inde solid komponent, %70inde yer yer kistik yapılar, %60ında multilobulasyon saptanmıştı. Asit saptanan 2 hastada CA 125 düzeyleri de yüksekti. Dört hastaya kistektomi, 1 hastaya paraovariyan kitle eksizyonu, 2 hastaya ooforektomi ve 3 hastaya unilateral salpingo-ooforektomi uygulanmıştı. Hastalardan birine sebat eden endometriyal hiperlazi nedeniyle total abdominal histerektomi ve bilateral salpingo-ooforektomi yapılmıştı. Sonuç: SSOTnin preoperatif tanısı oldukça zordur ve kesin tanısı postoperatif patolojik değerlendirme ile konulabilmektedir. Nadir görülen benign bir tümör olan ve cerrahi sonrası kür sağlanabilen SSOTe konservatif cerrahiyi uygulayabilmek için cerrahi prosedürün sınırının belirlenmesinde frozen/sectionı kullanmak doğru bir yönetim olacaktır.

Analysis of the ovarian sclerosing stromal tumor cases

Aim: The main purpose of this study is to evaluate clinical and radiological features of patients who are diagnosed with sclerosing stromal tumor of the ovary (SSOT) in our clinic and our surgical treatment experiences about these patients who have this rarely seen benign tumor. Materials and Methods: Between April 2002 and January 2014, data of 11 cases that were operated with prediagnosis of adnexal mass and diagnosed as SSOT after postoperative histopathologic evaluation in gynecology oncology clinic were retrospectively examined. The limit of the performed operation was determined with the frozen/section which is routinely used in adnexal mass management in our clinic. Results: The mean age of the patients was 28 (minimum: 14- maximum: 60) in the course of the diagnosis. Seven patients were in reproductive, 2 patients were in postmenopausal and the other 2 patients were in adolescence period. The presenting symptom was pelvic pain in 4 of the patients (36.4%) and primary infertility in 3 of the patients (27.3%). The mean size of the masses was 95 mm (minimum: 23 mm-maximum: 240 mm). All of the masses were unilateral. The masses were localized in right-hand- side in 6 patients (54.5%). Tumor was in ovarian localization for 10 patients, in paraovarian localization for 1 patient. In ultrasonography, 80% of the masses had a solid component, 70% of them had a partly cystic areas and 60% of them had a multilobular structure. Two patients who were detected ascites had high CA 125 levels too. Cystectomy to 4 patients, paraovarian mass excision to 1 patient, oophorectomy to 2 patients and unilateral salpingo-oophorectomy to 3 patients were performed. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed to one of the patients who had also persistence endometrial hyperplasia. Conclusion: The preoperative diagnosis of SSOT is extremely difficult and definitive diagnosis of SSOT is made with postoperative pathologic evaluation. Using frozen/section for determining the limits of surgical procedure to perform conservative surgery to SSOT, which is rarely seen benign tumor and is cured after surgery, will be a true management.

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