Ultrastructure of a virilizing ovarian Leydig-cell-tumor. Hilar cell tumor

Human fetal ovary development involves the spatiotemporal expression of p450c17 protein

OBJECTIVE

The purpose of this research was to characterize the spatiotemporal expression of P450c17 in the human fetal ovary.

DESIGN

P450c17 protein was visualized in sections of control and anencephalic ovaries using immunohistochemistry.

SUBJECTS

Subjects included control (nonanencephalic) and anencephalic human fetal ovaries during the second and third trimesters.

RESULTS

In second-trimester control ovaries, P450c17 was highly expressed in primary interstitial cells (PIC) located between the ovigerous cords near the cortical-medullary border where meiosis and primordial follicle formation were occurring. Morphometric analysis revealed a progressive decrease in the number of PIC during the second trimester, suggesting that PIC might have a finite lifetime. Between 25 and 32 wk, relatively few cells stained positive for P450c17; however, after 33 wk, P450c17 was strongly expressed in theca interstitial cells (TIC) bordering developing follicles. Surprisingly, the TIC appeared remarkably early during folliculogenesis, e.g. as early as the primary-to-secondary transition, and exhibited notable hyperplasia throughout preantral and early antral follicle growth. Owing to large numbers of developing preantral follicles, the third trimester was characterized by an increased abundance of P450c17-positive TIC. During this time period, P450c17 was strongly expressed in the hilus interstitial cells juxtaposed to the rete ovarii. Studies of ovaries of anencephalic fetuses revealed a similar spatiotemporal pattern of P450c17 expression in the PIC, TIC, and hilus interstitial cells, consistent with the possibility that pituitary hormones may not be involved in P450c17 expression in fetal ovaries.

CONCLUSION

We identified three different classes of P450c17-expressing interstitial cells in the human fetal ovary, each having a different spatiotemporal pattern of P450c17 expression and, presumably, a different set of physiological functions.

Testosterone-secreting adrenal adenoma that contained crystalloids of Reinke in an adult female patient

We describe a testosterone-secreting adrenal adenoma that contained crystalloids characteristic of Leydig cells in a 55-year-old woman with virilization, in whom results of a steroid biochemical profile were normal except for a substantially increased serum testosterone level. After right adrenalectomy, the serum testosterone level returned to normal and has remained within the normal range 2 years postoperatively. Histologic examination confirmed the diagnosis of a testosterone-secreting adrenal adenoma with crystalloids of Reinke specific for Leydig cells. The exact pathogenesis of these testosterone-secreting adrenal adenomas is still unclear. Although crystalloids of Reinke have been identified in only three cases, their absence does not exclude a Leydig cell character in the rest of the reported cases. Our case provides additional support for the hypothesis that Leydig cells are present in the adrenal gland and may have an active role in the pathogenesis of testosterone-secreting adrenal tumors; thus, such cells should be sought in every case.

Tumors of the endocrine/neuroendocrine system: an overview

For the sake of discussion, the markedly diversified tumors of the endocrine/neuroendocrine system are classified as those originating in classic epithelial endocrine organs (eg, adrenal cortical adenomas), from the diffuse endocrine cells (eg, jejunal carcinoid tumors), or from clusters of these cells (eg, islet cell tumors); and those arising from neurosecretory neurons (eg, neuroblastoma) or paraganglia (eg, carotid body tumor). Although traditional transmission electron microscopy is useful for identifying neurosecretory or endosecretory granules as such, with few exceptions (eg, insulin-containing granules with a complex paracrystalline core) it is not possible to ascribe a granule type (size, shape, or ultrastructure) to a distinct nosologic entity or secretory product because of their overlapping fine structures in different cell types. Immunoelectron microscopy methods utilizing colloidal gold-labeled secondary antibodies can be used to localize virtually any antigen (peptide or neuroamine) to a specific neurosecretory or endosecretory granule or other cell structure. General endocrine/neuroendocrine cell markers such as neuron-specific enolase, the chromogranins, and synaptophysin are useful in identifying neuroendocrine differentiation in a neoplasm using routine immunohistochemical procedures. The current relevance of the APUD concept of Pearse as well as the biologic importance of endocrine/neuroendocrine secretory products such as bombesin and insulinlike growth factors also are discussed.

A testosterone-producing tumour in the mesovarium

An androgen-secreting adnexal tumour is presented. The tumour was a steroid cell tumour of the mesovarium, without crystals of Reinke, hence the diagnosis was a steroid cell tumour (lipid cell tumour), not otherwise specified (in this case, because of its location in the mesovarium, an adrenal rest tumour). The clinical presentation, diagnosis, prognosis and differential diagnosis of virilizing adnexal tumours are discussed.

Hormone-producing tumors of the ovary

The ovary is an endocrine organ that gives rise to a wide variety of neoplastic and tumorlike nonneoplastic conditions, some of which are associated with endocrine activity. The hormones produced may be steroidal or nonsteroidal. The ovary is unique among endocrine organs in reacting to the presence of nonendocrine tumors within it by abnormal or inappropriate production of sex steroidal hormones. A classification of hormone-producing ovarian lesions is proposed based on the World Health Organization's histologicai typing of ovarian tumors.

Ovarian androblastoma metastatic to tonsil

Structural pattern of a tonsillar tumor found in a 67-year-old female was similar to a small ovarian androblastoma diagnosed histologically 6 1/2 years earlier. Electron microscopic study of the tonsillar mass revealed crystalloid structures suggestive of the Leydig cell origin of the tumor. After tonsillectomy, there was no local recurrence of the tumor, but the patient died a year later of multiple metastases. There appeared to be no previous reports of ovarian tumors metastatic to tonsil, and malignant androblastomas of the Leydig cell type are extremely rare.