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Fadare O, Fard EV, Bhargava R, Desouki MM, Hanley KZ, Ip PPC, Li JJX, Lu B, Medeiros F, Ng JHY, Parkash V, Pinto A, Quick CM, Skala SL, Tokuyama M, Turashvili G, Wei CH, Xing D, Zheng W, Soong TR, Howitt BE. The Malignant Potential of Ovarian Steroid Cell Tumors Revisited: A Multi-institutional Clinicopathologic Analysis of 115 Cases. Am J Surg Pathol 2024; 48:570-580. [PMID: 38512100 DOI: 10.1097/pas.0000000000002201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024]
Abstract
Steroid cell tumors (SCTs) of the ovary are rare and understudied, and as such, uncertainties remain about their malignant potential, as well as clinicopathologic predictors of patient outcome. Based on a multi-institutional cohort of cases, we present findings from the largest study of SCT reported to date. Clinicopathologic data were documented on 115 cases of SCT that were assembled from 17 institutions. The median patient age was 55 years (range: 9 to 84). When measured, preoperative androgen levels were elevated in 84.2% (48/57) of patients. A total of 111 (96.5%) cases were classified as stage I (103 stage IA; 2 stage IB; 6 stage IC). The stage distribution for the remaining 4 patients was as follows: stage II (n = 1), III (n = 3; 1 IIIA, 1 IIIB, 1 IIIC). The median tumor size was 3 cm (range: 0.2 to 22). Cytologic atypia, microscopic tumor necrosis, microscopic tumor hemorrhage, and a mitotic index of >1 mitotic figure/10 high-power fields were present in 52% (60/115), 9.6% (11/115), 37% (43/115), and 19% (22/115) of cases, respectively. Of 115 patients, 7 (6.1%) recurred postexcision, 4 (3.5%) ultimately died of disease, and 10 (8.7%) either recurred, died of disease, or were advanced stage at presentation. The median duration to recurrence postresection was 33 months (range: 23 to 180). Four of the 7 recurrences were stage IA at baseline. Tumor size >4 cm, International Federation of Gynecology and Obstetrics (FIGO) stage ≥IB, tumor necrosis, and tumor hemorrhage were each significantly associated with reduced recurrence-free survival in log-rank tests and univariable Cox models, with age older than 65 years being of marginal significance (hazard ratio [HR]: 5.4, 95% CI: 1.0-30.0, P = 0.05). Multivariable analyses suggested that FIGO stage ≥IB (HR: 27.5, 95% CI: 2.6-290.5), and age older than >65 years (HR: 21.8, 95% CI: 1.6-303.9) were the only parameters that were independently associated with recurrence. Cross-section analyses showed that tumor necrosis, tumor hemorrhage, and larger tumor size were significantly associated with a FIGO stage ≥IB status, which bolstered the conclusion that they are not independent predictors of recurrence. In summary, <10% of SCTs are clinically malignant, a substantially lower frequency than has previously been reported in the literature. Clinicopathologic predictors of patient outcomes that are prospectively applicable in practice could not be definitively established. Recurrences may occur many years (up to 15 y in this study) after primary resection, even in stage IA cases.
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Affiliation(s)
- Oluwole Fadare
- Department of Pathology, University of California San Diego
| | | | - Rohit Bhargava
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women's Hospital, Pittsburgh, PA
| | | | - Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
| | - Philip P C Ip
- Department of Pathology, The University of Hong Kong, Queen Mary Hospital
| | - Joshua J X Li
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong
| | - Bingjian Lu
- Department of Surgical Pathology and Center for Uterine Cancer Diagnosis and Therapy Research of Zhejiang Province, Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Fabiola Medeiros
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles
| | - Joshua Hoi Yan Ng
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | - Vinita Parkash
- Departments of Pathology and Obstetrics and Gynecology, Yale School of Medicine, New Haven, CT
| | - Andre Pinto
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL
| | - Charles M Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR
| | | | - Minami Tokuyama
- Department of Pathology, Stanford University School of Medicine, Stanford
| | - Gulisa Turashvili
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, GA
| | - Christina H Wei
- Department of Pathology, City of Hope Medical Center, Duarte, CA
| | - Deyin Xing
- Departments of Pathology, Gynecology and Obstetrics, and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Wenxin Zheng
- Departments of Pathology and Obstetrics and Gynecology, University of Texas Southwestern Medical Center, Dallas, TX
| | - T Rinda Soong
- Department of Pathology, University of Pittsburgh Medical Center Magee-Women's Hospital, Pittsburgh, PA
| | - Brooke E Howitt
- Department of Pathology, Stanford University School of Medicine, Stanford
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Wei CH, Fadare O. Ovarian steroid cell tumors: what do we know so far? Front Oncol 2024; 14:1331903. [PMID: 38352891 PMCID: PMC10861727 DOI: 10.3389/fonc.2024.1331903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Steroid cell tumors (SCT) of the ovary are rare, which has limited advances in the understanding of this enigmatic neoplasm. In this review, we summarize currently known clinicopathologic information on SCT. SCT are frequently hormonally active, leading to elevated serum and/or urine levels of androgenic hormones or their metabolites, and associated symptomatology, including virilization. The reported age at diagnosis is broad and has ranged from as young as 1 year old to 93 years old, although most patients were between ages 20 and 40 years. Most tumors are stage I and unilateral. The tumors are usually well circumscribed with a solid or solid to cystic cut surface. The tumors in one series reportedly ranged in size from 1.2 to 45 cm (average 8.4 cm). MRI is a useful imaging modality, typically showing a well delineated mass with contrast enhancement and lipid content on T2 and T1 weighted images, respectively. Microscopically, SCT display polygonal to epithelioid cells with abundant eosinophilic to vacuolated/clear cytoplasm and display an immunoprofile that is consistent with sex cord-stromal differentiation. Most cases are benign, without any recurrences after primary resection, but a subset - probably less than 20% of cases -are clinically malignant. Pathologic criteria that can specifically predict patient outcomes remain elusive, although features that correlate with adverse outcomes have been proposed based on retrospective studies. The molecular characteristics of SCTs are similarly under characterized, although there is some evidence of an enrichment for hypoxia-signaling gene mutations in SCT. In malignant SCT, the tumors generally show greater global genomic instability, copy number gains in oncogenes, and occasional BAP1 mutation. Future studies involving multi-institutional cohort and unbiased molecular profiling using whole exome/transcriptome sequencing are needed to help advance our molecular understanding of SCTs.
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Affiliation(s)
- Christina H. Wei
- Department of Anatomic Pathology, City of Hope National Medical Center, Duarte, CA, United States
| | - Oluwole Fadare
- Department of Pathology, University of California, San Diego, La Jolla, CA, United States
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Bala NM, Aragüés JM, Guerra S, Brito D, Valadas C. Ovarian Leydig Cell Tumor: Cause of Virilization in a Postmenopausal Woman. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e933126. [PMID: 34449760 PMCID: PMC8409458 DOI: 10.12659/ajcr.933126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/15/2021] [Accepted: 07/10/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Only 0.5% of all ovarian tumors are Leydig cell tumors and they are generally benign and unilateral. These androgen-secreting tumors lead to virilizing symptoms, most often in postmenopausal women. Because Leydig cell tumors are typically small, diagnosing them accurately can be challenging. CASE REPORT We report the case of a 77-year-old woman who was referred to our Endocrinology Clinic because of a 5-year history of hirsutism (Ferriman-Gallwey score of 11) with no discernible cause. The patient had high levels of serum testosterone and a normal level of dehydroepiandrosterone sulfate. Imaging, including transvaginal ultrasound and pelvic magnetic resonance, revealed a 16-mm uterine nodule, which was suspected to be a submucous leiomyoma, but no adrenal or ovarian lesions. Despite the lack of findings on imaging and because of the high suspicion for an androgen-secreting ovarian tumor, bilateral laparoscopic oophorectomy was performed. Histological examination of the specimen revealed a non-hilar Leydig cell tumor that measured 8 mm in its largest axis. After the surgery, the patient had significant clinical improvement and her laboratory test results normalized. Her sister had the same symptoms and laboratory findings at a similar age, which raised the suspicion of a possible familial genetic syndrome. No genetic testing was performed, however, because the patient's sister declined further diagnostic investigation. CONCLUSIONS Leydig cell tumors are rare, and even when they are small, they can cause symptoms related to androgen excess. As a result, diagnosing them often is challenging.
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Affiliation(s)
| | | | - Sílvia Guerra
- Department of Endocrinology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Delfina Brito
- Department of Pathology, Hospital Beatriz Ângelo, Loures, Portugal
| | - Cristina Valadas
- Department of Endocrinology, Hospital Beatriz Ângelo, Loures, Portugal
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Patil VS, VemiReddy PR, Taqdees A, Arakeri SU. Steroid Cell Tumor of the Ovary - A Rare Case Report and Review of Literature. Int J Appl Basic Med Res 2019; 9:185-187. [PMID: 31392185 DOI: 10.4103/ijabmr.ijabmr_299_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Steroid cell tumors of the ovary are extremely rare, accounting for only 0.1% of all ovarian tumors. Most steroid cell tumors secrete steroid hormones, and only about 10%-15% of patients are asymptomatic. The clinical presentation may take many forms, including abdominal pain, distention, irregular menstrual cycles, and hirsutism. Here, we present a case of a 60-year-old postmenopausal patient who presented with complaints of bleeding per vagina and abdominal pain for 4 months. Ultrasonography (USG) revealed a hypoechoic left adnexal mass measuring 65 mm × 40 mm × 30 mm. Based on these USG findings, the diagnosis of cystic lesion of the left ovary was made. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done, and the specimen was sent for histopathological analysis. On histopathology, diagnosis of steroid cell tumor-not otherwise specified was offered. This case is reported due to its rarity and its unusual presentation, together with a brief review of the literature of the same.
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Affiliation(s)
- Vijayalaxmi S Patil
- Department of Pathology, BLDE (DU) Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India
| | - Poojitha Ram VemiReddy
- Department of Pathology, BLDE (DU) Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India
| | - Afra Taqdees
- Department of Pathology, BLDE (DU) Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India
| | - Surekha U Arakeri
- Department of Pathology, BLDE (DU) Shri B. M. Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India
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Ajith S, Beena G, Mathew NM, Omana EK. Postmenopausal hyperandrogenism of ovarian origin: A clinicopathologic study of five cases. J Midlife Health 2017; 7:189-192. [PMID: 28096644 PMCID: PMC5192990 DOI: 10.4103/0976-7800.195699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In postmenopausal women presenting with virilization and elevated testosterone levels, laparoscopic salpingo-oophorectomy should be considered after exclusion of adrenal causes. A clinicopathological study was conducted among those women who presented with features of hyperandrogenism in our postmenopausal clinic over a period of 2 years. Relevant past medical and surgical histories were elicited. Basic hormonal evaluation and radiological imaging were done. Laparoscopic bilateral salpingo-oophorectomy was done. Six weeks postoperatively, serum testosterone was undetectable with significant clinical improvement. There was no recurrence of symptoms during the follow-up period of 2 years. Treatment of postmenopausal women with hyperandrogenism and virilization with laparoscopic bilateral salpingo-oophorectomy is effective if she has no pronounced ovarian enlargement or adrenal tumor on imaging. An extensive endocrine testing and a detailed search for metastatic disease may be unnecessary.
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Affiliation(s)
- S Ajith
- Department of Obstetrics and Gynaecology, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India
| | - George Beena
- Department of Obstetrics and Gynaecology, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India
| | - Nitu Mariam Mathew
- Department of Obstetrics and Gynaecology, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India
| | - E K Omana
- Department of Obstetrics and Gynaecology, Academy of Medical Sciences, Pariyaram, Kannur, Kerala, India
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Bhagat R, Bodal VK, Gupta N, Garg P. Steroid Cell Tumour of Ovary - A Rare Case Report. J Clin Diagn Res 2016; 10:ED06-ED07. [PMID: 27790445 DOI: 10.7860/jcdr/2016/15767.8556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 07/04/2016] [Indexed: 11/24/2022]
Abstract
Steroid cell tumours of the ovary are uncommon sex- hormone secreting tumours characterized by a steroid cell proliferation. The incidence of steroid cell tumour of the ovary is only 0.1% of all ovarian tumours. As far as steroid cell tumours, not otherwise specified (NOS) is concerned; it constitutes about 56% of all steroid cell tumours. Here we present a case of 55-year-old, postmenopausal patient who presented with complaints of bleeding per vaginum and abdominal pain for last 3-4 months, with history of excessive hair growth since 3-4 years. Ultrasonography revealed a solid right ovarian mass with a possibility of ovarian sex cord tumour. Histopathology confirmed the diagnosis of steroid cell tumour NOS type with no cytological atypia.
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Affiliation(s)
- Ranjeev Bhagat
- Assistant Professor, Department of Pathology, Government Medical College and Hospital , Chandigarh, India
| | - Vijay Kumar Bodal
- Associate Professor, Department of Pathology, Government Medical College , Patiala, Punjab, India
| | - Nishit Gupta
- Junior Resident, Department of Pathology, Government Medical College , Patiala, Punjab, India
| | - Pooja Garg
- Junior Resident, Department of Pathology, Government Medical College , Patiala, Punjab, India
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8
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Affiliation(s)
- Esther Oliva
- James Homer Wright Pathology Laboratories, Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA,
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9
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Lalwani N, Patel S, Ha KY, Shanbhogue AK, Nagar AM, Chintapalli KN, Prasad SR. Miscellaneous tumour-like lesions of the ovary: cross-sectional imaging review. Br J Radiol 2012; 85:477-86. [PMID: 22253351 DOI: 10.1259/bjr/92819127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Miscellaneous tumour-like ovarian lesions are histobiologically diverse, and are often mistaken for the more common ovarian cancers, leading to aggressive management. Knowledge of characteristic clinical, laboratory and imaging findings of these select non-neoplastic ovarian entities allows correct diagnoses and permits optimal management.
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Affiliation(s)
- N Lalwani
- Department of Radiology, University of Texas Health Science Center, San Antonio, USA
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Ichimura R, Shibutani M, Mizukami S, Suzuki T, Shimada Y, Mitsumori K. A case report of an uncommon sex-cord stromal tumor consisted of luteal and sertoli cells in a spayed bitch. J Vet Med Sci 2009; 72:229-34. [PMID: 19940389 DOI: 10.1292/jvms.09-0235] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
We report a rare case of benign sex cord-stromal tumor consisted largely of luteoma with minor portion of Sertoli cell tumor located at the position of the left ovary excision in an 11-year-old ovariectomized bitch. Granulosa cell component was lacking, and both luteal and Sertoli cell portions were entirely positive for inhibin alpha and neuron-specific enolase, whereas luteoma portion alone was positive for Wilms' tumor-1 (WT1), immunohistochemically. The results suggest that this tumor is a possible complication of incomplete ovarian excision at the time of ovariectomy and consisted of uncommon hybrid of luteal and Sertoli cells to be diagnosed as an unclassified sex cord-stromal tumor if applied in human cases. WT1-expression pattern suggested the signature of the difference in the phenotype of these cell types.
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Affiliation(s)
- Ryohei Ichimura
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, 3-5-8 Saiwai-cho, Fuchu-shi, Tokyo 183-8509, Japan
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Stromal luteoma and nodular hyperthecosis of the bilateral ovaries associated with atypical endometrial hyperplasia of the uterus. Pathol Int 2009; 59:831-3. [DOI: 10.1111/j.1440-1827.2009.02454.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dhingra KK, Sharma P, Khurana N, Chaturvedi KU. Ovarian stromal luteoma in a patient with endometrial carcinoma. J Obstet Gynaecol Res 2008; 34:283-5. [DOI: 10.1111/j.1447-0756.2008.00772.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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13
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Affiliation(s)
- H D McClamrock
- Department of Obstetrics and Gynecology, University of Maryland School of Medicine, Baltimore 21201
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Young RH, Clement PB. An appreciation of Robert E. Scully, MD, and an introduction to a symposium in his honor on recent advances in gynecologic pathology. Hum Pathol 1991; 22:737-46. [PMID: 1869259 DOI: 10.1016/0046-8177(91)90202-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- R H Young
- Department of Pathology, Harvard Medical School, Boston, MA
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Paoletti M, Pridjian G, Okagaki T, Talerman A. A stromal Leydig cell tumor of the ovary occurring in a pregnant 15-year-old girl. Ultrastructural findings. Cancer 1987; 60:2806-10. [PMID: 2824014 DOI: 10.1002/1097-0142(19871201)60:11<2806::aid-cncr2820601135>3.0.co;2-e] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The first case of stromal Leydig cell tumor of the ovary occurring during pregnancy is reported. A 15-year-old girl presented in labor at 36.5 weeks of gestation. The tumor mass was obstructing labor and the patient had to be delivered by cesarean section. Unique features of this case included the young age of the patient, the large size of the tumor, and the associated pregnancy. The tumor was encapsulated and showed the typical histologic and ultrastructural features of ovarian stromal Leydig cell tumor. The literature is reviewed, and the differential diagnosis is discussed.
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Affiliation(s)
- M Paoletti
- Department of Gynecologic Pathology, Universities of Chicago, IL 60637
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Abstract
An ovarian tumour of mixed thecomatous and lipid cell structure is described and the clinical and pathological features of this and eleven previously reported cases are reviewed. Functionally the tumours resemble lipid cell tumours in being mainly androgenic and are similar in size range and age incidence to the 'adrenal' type. Three tumours however contained hilus (Leydig) cells with Reinke crystalloids. The tumours furnish additional evidence of the stromal origin of lipid cell tumours and the term 'lipid cell thecoma' is proposed for them as indicating their main morphological affinities. It is suggested that fibromas, fibrothecomas, thecomas, lipid cell thecomas and lipid cell tumours form a series of related stromatogenous tumours of relatively simple structure with functional correlations as one moves from left to right.
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Abstract
The partly luteinized theca cell tumor is a variant of the theca cell tumor in which extensive foci of luteinization occur. This neoplasm belongs to a set of tumors, which includes the theca cell tumor, that is believed to be derived from mature ovarian stroma. This tumor can be classified as a tumor of specialized gonadal stroma of "ovarian cell type" intermediate between the theca cell tumor and the stromal luteoma. Two patients were virilized, and one had evidence of endometrial hyperplasia, whereas in the fourth no endocrine function was evident. None of the patients were pregnant at the time of discovery of the tumor. On gross examination these tumors consisted of a mixture of firm gray-white and yellow tissue. The presence of multiple yellow nodules in two tumors distinguished it from the usual theca cell tumor. A third tumor was distinctly lobulated. The tumor in only one of the cases arose in a background of ovarian stromal hyperplasia. Although the number of cases reported up to now is small and variability exists, the tumors tend to occur in patients in the early reproductive age group, often produce significant quantities of steroid hormones, and the clinical course has been benign.
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Abstract
The secure deduction of tumor histogenesis in vivo is notoriously difficult, owing to the retrospective form of the inquiry, which implies that no histogenetic theory makes certain-enough predictions. Deduction of a tumor's parent tissue currently relies on 1) its location relative to that of small early tumors, 2) correlation of its relative availability with tumor frequency, 3) its resemblance to the tumor tissue in various respects, and 4) its microscopic continuity with the tumor through transitional forms. Each of these criteria has pitfalls, owing to possible failure of the relevant factor to persist or to subsequent mimicry of it by other processes. This makes reliance on only one or two criteria undesirable. The application of these criteria to teratomas shows that there are no convincing data provided by the fourth. A dysgerminoma containing multiple small teratoid foci, which was studied in detail, is described, and the origin of the second tissue from the first is argued. The apparently somatic origin of some of the mesenchyma and the role of the mesenchyma in promoting teratoma development and segregation are discussed.
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Honoré LH, O'Hara KE. Subcapsular adipocytic infiltration of the human ovary: a clinicopathologic study of eight cases. Eur J Obstet Gynecol Reprod Biol 1980; 10:13-20. [PMID: 7189156 DOI: 10.1016/0028-2243(80)90032-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A systematic pathologic study of excised ovaries uncovered 8 cases of microscopic adipocytic infiltration of the subcapsular ovarian cortical stroma among 449 patients subjected to unilateral or bilateral oophorectomy with or without hysterectomy for common gynecologic disorders. As this process was only detected in the routine paraffin sections, no fresh tissue was available for ultrastructural, histochemical and biochemical investigations. Its differential diagnosis is presented, and the possible role of obesity is discussed in its causation.
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Abstract
Most functional ovarian tumors are of specific stromal or sex cord origin, capable of differentiating in either a female direction or, less commonly, a male direction. Tumors of stromal origin such as thecoma, stromal luteoma, and Leydig cell tumors are for all practical purposes benign, and evolve from mature ovarian stroma, recapitulating common non-neoplastic transformations such as stromal changes associated with follicle development and nodular stromal hyperplasia. Sex cord tumors of granulosa or Sertoli cell types are generally of a low order of malignancy, tending to late recurrence, occasional peritoneal seeding, and only rarely to distant metastasis. Nonfunctional tumors of the ovary may trigger hormone production from adjacent reactive stroma. Massive edema of the ovary due to partial torsion may simulate neoplasm and may produce hormonal syndromes by an unknown mechanism.
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Abstract
An ovarian lipid cell tumor without Reinke's crystalloids in a woman with secondary amenorrhea, minimal hirsutism, and elevated 17-ketosteroid excretion was studied by light and electron microscopy. Tumor cells were found in small clumps or scattered singly within a collagenous matrix. The cytoplasm of the tumor cells contained abundant smooth endoplasmic reticula, numerous mitochondria with tubular cristae, lipid droplets, lysosomal dense bodies, and concentric membranous whorls, characteristic of steroidogenic cells. In addition, "peripheral canalicular systems" were found at the outer margins of the nests of the tumor cells. These "peripheral canalicular systems" were bordered by the cell membranes and the surrounding collagenous stroma into which microvilli projected. Since the intercellular canalicular system present between the tumor cells was continuous with the "peripheral canalicular system," both systems probably have a common function related to steroid metabolism. The intercellular and "peripheral" canalicular systems and cytoplasmic microfilaments found in this tumor suggest that this ovarian lipid cell tumor was derived from the ovarian stroma.
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Abstract
A peculiar primary ovarian neoplasm occurring in a 28-year-old woman is presented. The tumor cells showed extensive cytoplasmic vacuolation, resulting in a "signet-ring" appearance similar to what was described in Krukenberg tumors. The tumor was studied histochemically, as well as by light and electron microscopy. The cells appeared to be uniform. A moderately electron-dense flocculent material was present in the cytoplasmic vacuoles. similar material was seen in the intercellular matrix with some fibrillary structures suggesting a protein structure. This, coupled with the lack of any basement membrane material around the tumor cells, indicates a mesenchymal tumor that is probably derived from the multipotent ovarian stromal cell. The features that help to differentiate this tumor from other ovarian tumors with clear or vacuolated cells are discussed. Because of its gross and microscopic appearance, the tumor is expected to behave in a benign fashion.
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Sternberg WH, Roth LM. Ovarian stromal tumors containing Leydig cells. I. Stromal-Leydig cell tumor and non-neoplastic transformation of ovarian stroma to Leydig cells. Cancer 1973; 32:940-51. [PMID: 4751924 DOI: 10.1002/1097-0142(197310)32:4<940::aid-cncr2820320428>3.0.co;2-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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FIENBERG R, COHEN RB. A comparative histochemical study of the ovarian stromal lipid band, stromal theca cell, and normal ovarian follicular apparatus. Am J Obstet Gynecol 1965; 92:958-69. [PMID: 14321112 DOI: 10.1016/0002-9378(65)90729-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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