卵巢顆粒細胞瘤與腫瘤繼發血液高雄性素之案例報告報告

Ovarian granulosa cell tumor with secondary hyperandrogenism: a case report

卵巢顆粒細胞瘤佔所有卵巢腫瘤的不到5%和超過70%的卵巢性索間質腫瘤，成人顆粒細胞瘤通常見於接近停經期和停經後婦女，發病高峰期為50-55歲。幼年型顆粒細胞瘤是罕見的腫瘤，佔所有卵巢顆粒細胞腫瘤的5%，且主要發生在初潮前的女孩和年輕30歲以下的女性。若以症狀表現頻率來看，腫瘤的症狀97-98%是由於雌激素分泌過多，2-3%是因為雄激素過多。臨床產生雌激素的腫瘤常表現停經、異常子宮出血、子宮增大、平滑肌瘤、子宮內膜增生或子宮內膜癌；罕見男性化的症狀包括原發性或繼發性閉經、多毛症、陰蒂肥大、聲音低沉、肌肉發達、痤瘡等。在已停經或接近停經的婦女中，顆粒細胞卵巢腫瘤不一定會有典型高性激素導致之症狀，受限於正常生理分泌的賀爾蒙，在生化血液檢驗上也不一定會呈現不正常的雌激素濃度，高雄性素也有可能單純於血液檢驗中表現，因此卵巢腫瘤合併性激素值異常或有相關賀爾蒙異常導致的相關症狀，在診斷上都應考慮卵巢顆粒細胞瘤存在的可能性。

Ovarian granulosa cell tumors account for less than 5% of all ovarian tumors and more than 70% of ovarian sex cord stromal tumors. Adult granulosa cell tumors usually occur in peri-menopausal and postmenopausal women, with a peak incidence in 50-55 years of age. Juvenile granulosa cell tumors are rare tumors that account for 5% of all ovarian granulosa cell tumors and occur primarily in premenarchal girls and women younger than 30 years of age. Judging from the frequency of symptom manifestations, 97-98% of tumor symptoms are due to excessive estrogen secretion, and 2-3% are due to excessive androgen. Clinically, estrogen-producing tumors often present with amenorrhea, abnormal uterine bleeding, uterine enlargement, leiomyomas, endometrial hyperplasia, or endometrial cancer; rare virilizing symptoms include primary or secondary amenorrhea, hirsutism, clitoral hypertrophy, deep voice, muscular development, acne. In women who have already menopause or perimenopause, granulosa cell ovarian tumors may not necessarily have the typical symptoms caused by high sex hormones. They are limited by the normal physiological secretion of hormones and may not show abnormal estrogen symptoms in biochemical blood tests. Hormone concentration and high androgen may also be manifested simply in blood tests. Therefore, when ovarian tumors are combined with abnormal sex hormone values or have related symptoms caused by related hormonal abnormalities, the possibility of ovarian granulosa cell tumors should be considered in the diagnosis.