Dados do Trabalho

Title

Conservative treatment in a young patient with a rare uterine tumor similar ovarian sex cord tumor diagnosed in IVF/ICSI treatment.

Objective

Uterine tumors similar to ovarian sex cord tumors (UTROSCT) are divided into two groups: endometrial stromal tumors with sexual cord-like elements (Group I), which have a poor prognosis; and UTROSCT itself (group II), with more than 40% of differentiation similar to sexual cords and a smaller endometrial component, biologically less aggressive than tumors of the other group.. We report the case of a woman with UTROSCT treated by minimally invasive hysteroscopic surgery prior to embryo transfer.

Methods

A 31-year-old woman with a same-sex relationship undergoing in vitro fertilization (IVF) treatment, asymptomatic from the gynecological point of view, and normal previous transvaginal ultrasound examinations was submitted to outpatient diagnostic video hysteroscopy prior to embryo transfer.
The examination identified a small tumor, 0,5 x 0,5 cm, suggestive of hysteroscopic level 1 submucous leiomyoma in the left anterolateral wall of the uterine cavity. Despite the minimum size, resection by surgical videohysteroscopy under sedation was indicated.

Results

The histopathological report was compatible with a uterine tumor similar to an ovarian sex cord tumor (UTROSCT). The immunohistochemical panel was positive for AE1/AE3, CK7, WT1, CD10, CD56 and CD 99, with a low cell proliferation index ( ki67). Smooth muscle actin, Inhibin and Calretinin were negative. The morphological and immunohistochemical findings were favorable to the diagnosis of UTROSCT. Two months after surgery, reassessment by hysteroscopy and endometrial biopsy revealed no residual endometrial disease. In three months she had an artificial cycle to prepare the embryo transfer. She received one day 5 blastocyst with no PGT-A previous study, from other 14 cryopreserved embryos ( 8 day-3, 3 other day-5 and 3 day-6 blastocysts). It resulted in a twin pregnancy and a full-term c-section of two healthy boys.

Conclusion

Due to the uncertain malignant potential of UTROSCTs and based on the scarce data available in the current literature, fertility-sparing surgery in young patients seems safe. However, a long-term follow-up is necessary and a quick conclusion of a patient's desire to become pregnant was advisable.

Keywords

Fertility preservation;  Uterine cancer; Sex cord tumor;  Uterine tumor similar to ovarian cord tumor, conservative surgery