Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 7, 2022; 10(1): 275-282
Published online Jan 7, 2022. doi: 10.12998/wjcc.v10.i1.275
Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report
Jiao Wang, Qing Yang, Ning-Ning Zhang, Dan-Dan Wang
Jiao Wang, Qing Yang, Ning-Ning Zhang, Dan-Dan Wang, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Author contributions: Wang J was responsible for the data collection and drafting of the manuscript; Yang Q carried out the study and is the surgeon of the patient; Zhang NN participated in providing knowledge of the disease etiology; Wang DD was responsible for critical revision of the manuscript; All authors read and approved the final manuscript.
Supported by National Natural Science Foundation of China, No. 81872125; and Local Technology and Development Key Program of Liaoning Province, No. 2019416020.
Informed consent statement: Informed consent to publish was obtained from the patient.
Conflict-of-interest statement: The authors declare no competing interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dan-Dan Wang, MD, PhD, Attending Doctor, Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, No. 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. dandan067603@163.com
Received: March 23, 2021
Peer-review started: March 23, 2021
First decision: September 1, 2021
Revised: September 9, 2021
Accepted: November 28, 2021
Article in press: November 28, 2021
Published online: January 7, 2022
Processing time: 282 Days and 4.5 Hours
Abstract
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.

Keywords: Postmenopausal bleeding; Endometrial hyperplasia; Estrogen excess; Ovarian cellular fibroma; Case report

Core Tip: This case demonstrates the necessity of considering the rare possibility of ovarian cellular fibroma as a precursor of postmenopausal bleeding.