Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report  

作　　者：Jiao Wang Qing Yang Ning-Ning Zhang Dan-Dan Wang 

机构地区：[1]Department of Obstetrics and Gynecology,Shengjing Hospital of China Medical University,Shenyang 110004,Liaoning Province,China

出　　处：《World Journal of Clinical Cases》2022年第1期275-282,共8页世界临床病例杂志

基　　金：National Natural Science Foundation of China,No.81872125;Local Technology and Development Key Program of Liaoning Province,No.2019416020.

摘　　要：BACKGROUND Postmenopausal bleeding(PMB)is a common gynecologic complaint among elderly women,and endometrial hyperplasia is a common cause of this bleeding.Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor(SCST).They arise from non-functioning stroma,rarely show estrogenic activity,and stimulate endometrial hyperplasia,causing abnormal vaginal bleeding.CASE SUMMARY We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB.A sex hormone test revealed that her estrogen level was significantly higher than normal,and other causes of hyperestrogenism had been excluded.The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia.The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.CONCLUSION Ovarian cellular fibromas occur insidiously,and some may have endocrine functions.Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium.If the estrogen level remains elevated,the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely,even if the imaging results do not indicate ovarian tumors.Once the tumor is found,it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation.More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels,despite the auxiliary examination results not indicating ovarian mass.The physical and psychological burden caused by repeated curettage could be prevented using this technique.

关 键 词：Postmenopausal bleeding Endometrial hyperplasia Estrogen excess Ovarian cellular fibroma Case report 

分 类 号：R737.31[医药卫生—肿瘤]