Increased Serum Inhibin Associated with Ovarian Fibroma Neoplasms

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. Kelly P. Copeland, Casey M. Cosgrove, Jeffrey M. Fowler and Larry J. Copeland* Department of Obstetrics and Gynecology, Ohio State University, USA Larry J. Copeland, et al. Clinics in Oncology Gynecological Cancers Remedy Publications LLC., | http://clinicsinoncology.com/ 2016 | Volume 1 | Article 1019 2 A gynecological exam included a normal vagina and cervix on speculum exam, uterus was normal shape and size on bimanual. Her adnexa on bimanual and rectovaginal examinations were noted to have fullness on the left side, there was no cul de sac nodularity noted. A pelvic ultrasound demonstrated a thickened endometrial lining (13.8 mm, normal <4 mm) and a complex left adnexal mass (7 x 5.3 x 5.9 cm). An endometrial biopsy was performed that was negative for malignancy or hyperplasia. Serum tumor markers were obtained and demonstrated an elevated Ca-125 (63.7, normal <35), elevated Inhibin B (277, normal < 10) and mildly elevated Inhibin A (7.7, normal < 6.9). She underwent a total abdominal hysterectomy, bilateral salpingooophorectomy with an intra-operative frozen section. Frozen section was consistent with an ovarian stromal tumor favoring fibroma and final pathology confirmed the diagnosis. Pathological exam included an 8.8 x 5.6 x 5.4 cm ovarian mass focally multinodular external appearance with whorled rubbery tissue and no hemorrhage or necrosis. No immunohistochemical testing was performed given the histological appearance of the specimen (Table 1). No further treatment was required. Four months post-op the patient had repeat Ca -125 and Inhibin B levels tested both of which had normalized 5 and <10, respectively.