CASE REPORT: This 55-year-old woman presented with abdominal enlargement and no stool passage for about 2 weeks. she has suffered from occasional abdominal distention and constipation after an appendectomy 30 years ago. Postmenopausal irregular vaginal bleeding was also noted for one year after her menopause 4 years ago, but she didn't pay attention to it and regarded it as normal perimenopausal course. Physical exam showed a huge abdominal mass, about 30cm in size. The patient emphasized the mass growing in recent days after she drank several bowls of 四物湯. An ultrasound showed huge abdominal cystic mass, multiple septi and some solid portion. Minimal ascites was noted, too. The patient showed severe anemia with hemoglobin 6.5 g/dl. Other lab data shows below: CA125 : 131 U/ml; E2: 484 pg/ml; FSH: 0.06 mIU/ml. A surgery planned and revealed huge right adnexal cystic mass with massive intratumoral bloody fluid and clots. Right oophorectomy and hysterectomy were done.
CONCLUSION: Granulosa cell tumors have malignant potential. They are the most common type of malignant ovarian sex cord stromal tumors, and they comprise two to five percent of all ovarian cancers. Intratumoral hemorrhage occasionally occurs in these turmors. Whether the herb drugs, like 四物湯, trigger tumor bleeding needs more observation and study.
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