A Benign Ovarian Tumour developing an Endometrial Cancer ?

Introduction: Sertoli cells tumours are neoplasms with a very low incidence, being sertoliform cystoadenomae extremely unusual. Its first description was made on 1982 by Young and Roth, with very few cases published after them. This is a neoplasm only described on postmenopausal women, with an average age of presentation of 68 year old, and they could suffer virilization symptoms in different degrees. Histologically, it is a well differentiated neoplasm, with a low malignancy degree, and good prognosis if it is confined to ovaries. In other way, the finding of this ovarian tumour getting together with an endometrioid adenocarcinoma is an extremely rare case.


Introduction
Sertoli cells tumours are neoplasms with a very low incidence, being sertoliform cystoadenoma extremely unusual.The first description of this tumor was made on 1982 by Young and Roth [1,2], with very few cases published after them.Sertoliform cystoadenoma is a neoplasm described only on postmenopausal women [3], with an average age of presentation of 68 year old, and has been related to virilization symptoms in different degrees, abdominal swelling, acute abdominal symptoms and postmenopausal metrorrhage [4].Histologically, it is a well differentiated neoplasm, with a low malignancy degree, and good prognosis if it is confined to ovaries [5].In other way, the finding of this ovarian tumour getting together with an endometrioid adenocarcinoma is an extremely rare case [6].
It has been described that postmenopausal women with epithelial ovarian tumours would be able to develop a potential to produce sex steroid hormones, mainly estrogens [7][8][9][10].However, the incidence of this overproduction still remains con-troversal [11].Moreover, the developing of endometrial endometrioid adenocarcinoma could be related with the estrogenic ovarian production from an ovarian tumour or could be just a synchronic presentation of both tumours.

Medical Case
A 66 year old woman, who attended our office relating postmenopausal metrorrhage, is presented.The patient had a medical history of diabetes mellitus type II, arterial hypertension, dyslipidemia, liver steatosis, glaucoma and appendectomy.She got three deliveries and had her menopause at the age of 53.
An outpatient hysteroscopy was carried on, finding three endometrial polyps, two of them appeared as normal, and the bigger one had a glandular appearance with atypical vascularization.The biopsy of this polyp was informed as endometrioid type adenocarcinoma with mucus-secreting pattern.
An abdominal total hysterectomy with double adnexectomy, was carried on, with intraoperative biopsy, informed as a borderline tumour.Due to this finding, the operation was completed with omentectomy, lymphadenectomy and peritoneal washing.
Last histological analysis identifies the ovarian tumour as sertoliform adenoma from rete ovarii, with hepatocyte multifocal metaplasia.This tumour is suspected of being estrogenic functioning one, probably was the inductor of low degree and moderatedly differentiated G2 endometrioid adenocarcinoma.There was no lymphatic or omental metastases.FIGO staging IA, TNM staging T1aN0M0.

Conclusions:
Sertoliform cystoadenoma is a very rare finding, with only few cases reported.It could be an estrogenic functioning tumour and due to this characteristic could induce endometrial hyperplasia, and at last, could be the reason for appearance of low malignancy degree endometrial neoplasms.

Section: international online Medical conference / obStetricS & GynecoloGy
Issn: 1755-7682 Ultrasoud scanning found an 2.5cm.adnexal left nodule with heterogeneous ultrasonic pattern, and endometrial 11mm thickening.Magnetic Resonance found that the adnexal left nodule, with heterogeneous signal pattern and significant contrast agent captation, was suggestive of malignancy.Serum Ca125 detected was 5 UI/ml.
An abdominal total hysterectomy with double adnexectomy was carried on, with intraoperative biopsy, informed as a borderline tumour.Due to this finding, the surgical intervention was completed with omentectomy, pelvic lymphadenectomy and peritoneal washing.(Figure 1 and 2).

Conclusions
Sertoliform cystoadenoma is a very rare finding, with only a few cases reported, and it could be an estrogenic functioning tumour [7][8][9][10][11].In other way, estrogenic overproduction has been related to endometrial hyperplasia and low malignancy degree endometrial neoplasms.In the present case, we suggest that endometrial carcinoma could be induced or related to the sertoliform cystoadenoma found in the ovary.However, it could be a synchronous presentation without causal relationship between them [6].
The reported case has the particularity of containing hepatocyte multifocal metaplasia, not described in other reported cases.
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Figure 5 :
Figure 5: Hepatocytes in ovarian sample.Figure 7: Presence of Inhibin in ovarian sample.

Figure 7 :
Figure 5: Hepatocytes in ovarian sample.Figure 7: Presence of Inhibin in ovarian sample.