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Prezentare de caz şi revederea literaturii Sex cord-stromal tumors of the ovary: granulosa-stromal cell tumors. Materials and method.

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This paper describes a case of granulosa tumor cell, juvenile type, in a young woman with secondary amenorrhea and primary infertility. Granulosa tumor cell, juvenile type, was suspicioned after clinical and paraclinical tests had been done, and MRI de­scribed the ovarian tumor.

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This case emphasizes the importance of multidisciplinary team approach, involving gynecologist, fertility specialist, oncologist, and radiologist. We have reviewed the available literature in this report.

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Although most cases are treated with surgery alone fol­lowing oncological safety principles as in epithelial ovarian cancer approach, it is important to discuss the follow-up ap­proach, taking into consideration that this patient par­ti­cularly wished to procreate, and fertility sparing surgery was performed.

Chemotherapy and radiotherapy were com­plementary treatments that were discussed in the multidisciplinary meeting, but as no adjuvant therapy was found to be effective, these adjuvant therapies are kept for recurrence and palliative care for advanced disease.

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Given the rarity of ovarian cancer natural treatments disease worldwide, it is important to raise ovarian cancer natural treatments amongst medical staff and educate the general population to seek medical attention early.

Keywords sex cord-stromal tumors of the ovary, granulosa tumor cell, juvenile granulosa tumor cells, fertility sparing surgery, ovarian cancer Rezumat Introducere.

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Materiale şi me­­to­­dă. Lu­crarea descrie un caz de tumoare de gra­nu­loasă de tip juvenil la o femeie tânără cu amenoree se­cun­dară şi infer­ti­­li­­tate primară.

Tumoarea de granuloasă de tip ju­­ve­nil a fost suspicionată după ce s-au ovarian cancer natural treatments investigaţiile cli­­ni­ce şi paraclinice, iar RMN-ul a descris o tumoare ovariană. Ca­zul prezentat arată im­por­tanţa abordării în echipă mul­ti­­dis­­ci­pli­nară care să in­clu­dă ginecologul, specialistul în re­pro­du­­ce­re medicală asis­ta­tă, oncologul medical şi spe­cia­lis­tul în ima­gis­tică.

Deşi tra­ta­mentul de bază îl reprezintă chi­rur­gia, cu res­pec­tarea prin­ci­piilor de siguranţă oncologică si­mi­lare celor din can­ce­rul epitelial ovarian, este importantă in­di­vi­dualizarea tra­­ta­­men­­tului la pacientele care doresc con­ser­va­rea fer­ti­li­tă­ţii, situaţie în care se recomandă o chirurgie adaptată aces­tui deziderat.

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Chimioterapia şi radioterapia sunt tra­ta­mente com­ple­mentare, recomandate în caz de recidivă sau paliaţie, în stadii avansate de boală. Datorită rarităţii acestor cazuri, ovarian cancer natural treatments necesară o continuă in­for­mare a po­pu­laţiei feminine şi a medicilor de familie de a so­li­cita opinia spe­cia­listului pentru o depistare precoce.

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Cuvinte cheie tumoare ovariană stromală de cordoane sexuale tumoare cu celule granuloase tumoare juvenilă cu celule granuloase chirurgie conservatoare a fertilităţii cancer ovarian Introduction Sex cord-stromal tumors of the ovary SCSTO is a group of ovarian tumors, either ovarian cancer natural treatments of malignant, that usually develop from the division of the cells which surround and support the oocytes, and they include cells that produce hormones. The majority of the malignant SCSTO have ovarian cancer natural treatments good prognosis, being diagnosed in an early stage, and they are low-grade malignancies compared with epithelial ovarian cancer.

Pre- or postmenopausal women account the same percentage of granulosa stromal cells tumors 2. Patients with these types of tumors usually have signs and symptoms of estrogen and androgen excess.

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Granulosa cell tumors are part of the group of sex cord-stromal tumors of the ovary, being the most common one and having a malignant potential 3. These tumors are large ovarian masses, up to 15 cm 4. The juvenile type is very rare, and this is specific for children, for women at puberty, or in high risk hpv no cancer early 20s.

This subtype seems to be more aggressive, with early recurrence compared with the adult subtype, that tends to have low risk of late recurrence 5. In postmenopausal women, estrogen secretion can be sufficient to induce the development of endometrial cancer. Very rare granulosa cell tumor could rupture and produce hemoperitoneum.

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Very rare granulosa cell tumor may produce androgens and induce virilization 8. The phenotype of the patient who develops granulosa tumor cell is non-white, obese patients with family history of ovarian cancer or breast cancer.

Smoking, parity and the use of contraceptive pills seem to have a protective role in developing these types of tumors 4. However, a gene mutation was found to be the constant in the adult type of granulosa cell tumor, and ovarian cancer natural treatments is mutant FOXL2 9but no family cases were found.

Surgical approach as a first-line treatment brought significant benefit on a long-term prognosis, since most of these tumors are confined with one ovary and they can be resected with oncological safety principles followed.

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Moreover, chemotherapy ovarian cancer natural treatments less needed, although recurrent disease usually responds poorly to chemotherapy. Taking into consideration that patients are in an early stage at diagnosis and surgery is usually ovarian cancer natural treatments with a curative approach, these bring excellent prognosis and outcome for these patients, but the real prognosis and the natural history are poorly known and understood since these tumors are very rare in the population.

Clinical and paraclinical investigations Early puberty, secondary amenorrhea and endocrinologic symptoms are the most common symptoms that brings the patients to medical advice and lead to early diagnosis Other nonspecific symptoms include abdominal pain and enlargement of the abdomen for the juvenile type.

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For the adult type, symptoms and signs include menometrorrhagia or postmenopausal bleeding, virilization, abdominal pain and a palpable mass Blood tests and hormonal profile should be included in the investigation panel in order to check for the level of testosterone and androstendione. Because these tumors are very rare, the hormonal profile is not evaluated currently preoperatively, therefore after surgery the levels of these hormones are normal.