Rare case of coexisting ovarian Brenner tumour and ovarian stromal hyperplasia presenting with persistent endometrial hyperplasia following treatment with levonorgestrel-intrauterine system.

A Rare Case of Coexisting Ovarian Tumors and Recurrent Endometrial Hyperplasia

Endometrial hyperplasia (EH), a condition characterized by an abnormal thickening of the lining of the uterus, is a precursor to endometrial cancer. EH arises in an environment of unopposed estrogen, making it essential to identify the underlying cause and address it effectively. This case report delves into a rare and complex case of a menopausal patient presenting with recurrent EH despite prior treatment with a levonorgestrel-intrauterine system (LNG-IUS), a common treatment for EH.

Unmasking the Hidden Oestrogenic Influences

The patient was found to have coexisting ovarian Brenner tumor and ovarian stromal hyperplasia, both of which can produce estrogen. This rare combination of tumors likely contributed to the recurrent EH, highlighting the importance of a thorough investigation when EH persists despite appropriate treatment. The patient ultimately underwent a hysterectomy and bilateral salpingo-oophorectomy (BSO) to address the underlying estrogen-producing tumors.

Navigating the Complexities of Endometrial Hyperplasia

This case underscores the need for a high index of suspicion for potential oestrogenic influences in cases of refractory EH, particularly in women who have undergone menopause. The findings emphasize the importance of considering BSO during hysterectomy in cases of unexplained EH to ensure complete removal of any potential oestrogenic foci.

Dr.Camel's Conclusion

This complex case is like a hidden oasis in the desert of gynecologic medicine, revealing the intricate interplay of hormones and tumor growth. It highlights the importance of a thorough investigation and careful consideration of all potential oestrogenic sources when addressing recurrent EH. This case reminds us that even in the seemingly arid landscape of menopause, unexpected oestrogenic influences can emerge, requiring a vigilant approach to ensure optimal patient care.