Abnormal Uterine Bleeding Asociated to Actinomices Endometritis in Perimenarcheal Adolescent

Abstract

Laboratory findings included: A pelvic ultrasound showed a normal uterus and ovaries. A CT scan of the abdomen and pelvis revealed a 2.9 cm solid mass in the left ovary. Laparoscopy revealed a solid yellow-orange, spongy mass in the left ovary. Frozen section was indeterminate. The mass was removed. The pathology "show ovarian tissue .(with) steroid appearing cells with round nuclei and clear/vacuolated cytoplasm.The tumor cells are positive for calretinin and inhibin." The mitotic index was low (<1 per high power field) and pelvic washings were negative. The final diagnosis was sex cord stromal tumor, steroid cell NOS. Her testosterone level was 28 ng/dl postop. A CT scan of the chest, abdomen and pelvis showed fatty liver. She subsequently underwent a laparoscopic left salpingo-oophorectomy. No residual tumor was detected. Planned surveillance includes serial CT scans and labs every 3 months the first year, then every 6 months for a year, and then annually for 5 years. Comments: Sex cord stromal tumor, steroid cell NOS is a rare tumor that accounts for <0.1% of ovarian tumors with the largest series from Hayes and Scully 1. In that series 56% of patients had evidence of androgen excess and 43% were malignant. Characteristics suggestive of malignancy include size > 7 cm (78%), necrosis (86%) and hemorrhage (77%), grade 2-3 nuclear atypia (64%), and a mitotic count of two or more per 10 HPF (92%) 1. The literature suggests that in a young patient with stage IA disease, a unilateral salpingo-oophorectomy is appropriate in this age group as only 6% are bilateral 1. Close follow up is necessary given the limited long-term data on these tumors.