Kelly P. Copeland, Casey M. Cosgrove, Jeffrey M. Fowler and Larry J. Copeland*
Department of Obstetrics and Gynecology, Ohio State University, USAFulltext PDF
Background: Clinicians are commonly tasked to evaluate adnexal masses. Both radiography and serum markers are useful in the counseling of patients regarding management options. Inhibin is one of several tumor markers used in the evaluation of adnexal masses given its known association with sex cord stromal tumors, specifically granulosa cell tumors. Case 1: 68 year old G6P6 Caucasian female who initially presented to her provider with postmenopausal bleeding; work up demonstrated a complex adnexal mass and a serum Inhibin B level of 277 (normal < 10). She underwent a hysterectomy and bilateral salpingo-oophorectomy with final pathology returning as a benign fibroma. Case 2: 38 year old G2P1011 African American female who presented to the emergency department for abdominal pain; a pelvic ultrasound demonstrated a complex left adnexal mass. Serum tumor markers included an Inhibin B of 719 (normal <139). An ovarian cystectomy was performed and pathology returned as a cystadenofibroma.
Discussion: In these two patients, granulosa cell tumor was suspected initially as both had markedly elevated inhibin B levels in the setting of an adnexal mass. Both patients were counseled on the need for surgery and possibility of surgical staging. However, for each patient, frozen section demonstrated benign fibromas. In Case 2, we were able to preserve ovarian tissue given the desire for future fertility. Both cases demonstrate that while tumor markers can be helpful in providing additional information in the evaluation of adnexal masses, they are not diagnostic tests and surgical management is the only means for a diagnosis.
Copeland KP, Cosgrove CM, Fowler JM, Copeland LJ. Increased Serum Inhibin Associated with Ovarian Fibroma Neoplasms. Clin Oncol. 2016; 1: 1019.