ARRHENOBLASTOMA OF THE OVARY

Malignant Ovarian Neoplasms in Childhood

From 1962 to 1976, 15 children up to the age of 15 years with malignant neoplasms of the ovary were observed at the Istituto Nazionale Tumori of Milan. 13 patients had a germ cell tumor and 2 a stromal tumor. Natural history and treatment results are reported. Out of 7 patients with dysgerminoma, 3 at stage IA, 2 at stage III retroperitoneal and 1 with recurrent disease are alive and disease free 38+, 20+, 36+, 16+, 23+, 156+ months after the histologic diagnosis; the last case with stage III peritoneal disease died 2 months after the diagnosis. Four children had immature malignant teratoma: 2 patients are alive and disease free 19+ and 51+ months, 1 is alive with disease 20+ months and 1 died 16 months after histologic diagnosis. Two patients with extra-embryonal teratoma died 7 and 12 months after diagnosis. One patient, treated by surgery plus chemotherapy for granulosa cell tumor at stage III, is alive 43+ months later. The child with arrhenoblastoma at stage III treated by surgery plus radiochemotherapy died 6 months after diagnosis. Through a close scrutiny of the literature and by drawing on experience gained in the treatment of the same tumors in adults, a rational approach to the diagnosis and treatment of each childhood ovarian tumor histotype is worked out.

Fertility-sparing management and obstetric outcomes in a 20-year-old patient with a Sertoli-Leydig cell tumor of the ovary: A case report and review of the literature

Sertoli-Leydig cell tumors (SLCTs) are an uncommon subtype of sex-cord stromal tumors of the ovary, which most commonly arise in women of reproductive age, creating an issue with regard to the preservation of fertility. The clinical manifestation of SLCTs varies widely, ranging from an asymptomatic clinical profile to extreme virilization. Correct diagnosis of SLCT is crucial and is primarily based on histopathological results. The current study presents the case of a 20-year-old woman who underwent unilateral salpingo-oophorectomy and adjuvant chemotherapy due to the diagnosis of an SLCT of the left ovary. Almost 2 years after the initial surgery, during the follow-up period, the patient conceived normally. Pregnancy was uneventful and the patient vaginally delivered a healthy infant at 38 weeks of gestation. A total of 1 year after delivery (3 years after the initial diagnosis), follow-up of the patient did not reveal any disease recurrence. In conclusion, SLCTs may be adequately treated by fertility-sparing surgery and chemotherapy in young women who wish to preserve their fertility. Natural conception, an uncomplicated pregnancy and a vaginal delivery are possible.

Weight reduction and pioglitazone ameliorate polycystic ovary syndrome after removal of a Sertoli-stromal cell tumor

This report presents an unusual case of Sertoli-stromal cell tumor and polycystic ovary syndrome successfully treated with weight reduction and an insulin-sensitizing agent. A 22-year-old woman, gravida 0, para 0, visited our hospital for the first time with a 12-year history of secondary amenorrhea and hypertrichosis. Transvaginal ultrasonography revealed a solid tumor in the right ovary. Right salpingo-oophorectomy was performed and pathological examination confirmed a Sertoli-stromal cell tumor. The patient's serum androgen levels declined postoperatively, but remained above normal. Pioglitazone treatment for 6 months also significantly reduced serum androgen levels, but they still remained above normal. However, after losing 12 kg of body weight, the patient's serum androgen levels declined to normal, and spontaneous menstruation became regular. Weight reduction with pioglitazone is an effective means of treating hyperandrogenism.

[The use of ultrasonographic 3D power Doppler to describe an ovarian Sertoli-Leydig cell tumor]

We report one case of unilateral ovarian Sertoli-Leydig tumor with intermediate grade and heterologous element, in a young woman with clinical and biological typical presentation. We discuss 2D and 3D ultrasonographic and doppler features.

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 cancer

Prevention, early detection, morbidity, and survival issues continue to challenge health professionals involved in the care of women with ovarian cancer. While advances in diagnosis, staging, and treatment have been made, survival rates remain grim. Continuing research in the areas of screening, diagnosis, and treatment is the key to improved survival. The hope of new drug therapy, such as cisplatin-taxol regimens, intraperitoneal therapy, immunotherapy, and bone marrow transplantation, needs further investigation to become reality. As new and potentially more toxic regimens are developed, the nurse must be knowledgeable about the therapies and adverse effects, and maintain a high level of clinical expertise in order to teach the patient, reinforce information, clarify misconceptions, and provide the patient with supportive physical and emotional care.

Bilateral Sertoli-Leydig cell tumor with heterologous elements: report of an unusual case and review of the literature

A case of bilateral ovarian Sertoli-Leydig cell tumor with heterologous elements is reported in an 18-yr-old girl with marked virilization. Panhysterectomy was performed, yet the tumor recurred shortly after the intervention. The microscopic picture was one of intermediate to poor differentiation. Despite chemotherapy, the postoperative course was rapidly malignant, and the patient died 4 wk later.

Basement membrane structures in tumors of the ovary

The location and amount of the basement membrane (BM) components collagen IV and laminin were studied in ovarian epithelial, sex cord-stromal and germ cell tumors. BM structures were found in the epithelial stromal interface of benign surface epithelial tumors and, though discontinuous, around well-differentiated tumor islets, being less well developed in invasive undifferentiated neoplasms. The stromal components in Müllerian mixed tumors had less distinct BM structures, a finding useful for the classification of these neoplasms. Thecomas and fibromas had scanty collagen IV and laminin; granulosa cell tumors contained large amounts of BM material. A fine diffuse BM-positive pattern occurred in dysgerminomas and endodermal sinus tumors; BM structures in cystic teratomas were distinct. Collagen IV and laminin were well-developed in benign and slow-growing tumors with epithelial components and in their metastases, but less distinct in stromal tumors and highly malignant undifferentiated tumors, showing the usefulness of this method for the clinical and biological classification of such tumors.

Serum testosterone concentrations in the evaluation of androgen-producing tumors

During a 5-year study period 18 women with a serum testosterone concentrations of greater than 2 ng/ml were evaluated for a possible androgen-producing tumor. All subjects were hirsute and had menstrual irregularities, with the exception of one postmenopausal woman. The majority of the women were obese and 72% were greater than 50% over ideal body weight. Only two of 11 women undergoing operative and histologic evaluation of the ovaries were found to have an androgen-producing neoplasm. Seven additional women with serum testosterone concentration of greater than 2 ng/ml have been followed for over 1 year with no additional evidence of an androgen-producing neoplasm. The poor predictive value of a serum concentration of greater than 2 ng/ml in identification of an androgen-producing neoplasm is partially explained by the apparent prevalence of high testosterone concentrations in chronically anovulatory, hyperandrogenic obese women and by the large coefficient of variation observed in this study when analyzing testosterone concentrations were analyzed over an 8-hour interval (range, 3% to 42%). In the absence of an adnexal mass or rapidly progressive virilization, it is suggested that the use of venography or operative exploration to diagnose an androgen-producing neoplasm be reserved for women with a mean testosterone concentration derived from three daily samples that is at least 2.5 times greater than the upper range of normal in the given laboratory.

AFP-producing Sertoli-Leydig cell tumor of the ovary

A tumor of the right ovary in a 21-year-old single woman is reported. Secondary amenorrhea, hirsutism, acne and deepening of the voice were associated with the tumor. Light and electron microscopic examinations showed that the tumor was composed of cells resembling Sertoli and Leydig cells of the testis in their cytology features and growth patterns. High levels of circulating dehydroepiandrosterone, androstenedione, testosterone and alpha-fetoprotein (AFP) were found preoperatively. Preoperative estrogen and progesterone levels were all slightly above the upper limits of normal for females. These hormone and AFP levels fell to within the normal range after removal of the tumor. Direct hormone and AFP production of this tumor was confirmed by immunohistochemical techniques and long-term cell cultures in vitro. This is possibly the first report on a Sertoli-Leydig cell tumor in which AFP has been identified in the patient's plasma, in part of the tumor cells and the culture fluid.

Sex cord-stromal tumours of the ovary

The aim of this review is to give a reasonably concise resumé of our knowledge of the sex cord-stromal tumours of the ovary. Lipoid cell tumours of the ovary are often included within this broad category but this poorly defined and heterogenous group of neoplasms will not be considered here. This review is a selective one and no attempt is made to cover all aspects of sex cord-stromal tumours or to provide a complete bibliography. The histological features of many of the neoplasms in this group, particularly those which have been recently defined, are discussed but a consideration of differential histological diagnosis is excluded. The ultrastructural characteristics of the various neoplasms are considered only in terms of their relevance to histogenesis or metabolic activity.

Sertoli-Leydig cell tumor of the ovary with heterologous elements and carcinoid: an immunohistochemical and ultrastructural study

A Sertoli-Leydig cell tumor of the ovary is described in which there were heterologous elements consisting of enteric cysts and an evolving carcinoid. Endocrine cells in the cysts and carcinoid were found to contain gastrin and other polypeptide hormones. Aspects of the organization of the enteric epithelium, its histogenesis, and the possible relationship of this tumor to other cystic ovarian neoplasms are discussed.

Recurrence of a gonadal stromal cell tumor (Sertoli Leydig cell with heterologous elements) in a teenager

An unusual case of a moderately well-differentiated, encapsulated, Sertoli Leydig cell tumor with heterologous elements recurring 3 years after a conservative unilateral oophorectomy in a 15-year-old female is reported. This is the first case report of a metastatic Sertoli Leydig cell tumor with mucinous heterologous elements. A relative lack of uniformly accepted histological criteria of these tumors makes prognosis difficult to access. The optimal therapy for recurrent Sertoli Leydig cell tumor is unknown. Initial plans of management of this rare neoplasm, follow-up, and current concepts of treatment of recurrences will be discussed.

Ovarian Sertoli-Leydig cell tumors with heterologous elements. I. Gastrointestinal epithelium and carcinoid: a clinicopathologic analysis of thirty-six cases

Thirty-six ovarian Sertoli-Leydig cell tumors containing heterologous elements in the form of gastrointestinal-type epithelium are described. Eight of the cases contained microscopic foci of insular carcinoid; in two of these cases of foci of goblet cell carcinoid were also present. The patients' ages ranged from 4-67 years (average, 23 years). The presenting manifestations were androgenic changes (18 cases), abdominal swelling (15 cases), acute abdominal symptoms (one case), menstrual irregularities (one case), and postmenopausal bleeding (two cases). All of the tumors were unilateral. The surface of the tumor was intact in 32 cases, ruptured in three, and adherent to the diaphragm in one. The tumors usually had both cystic and solid components and averaged 15.0 cm in diameter; mucinous fluid was noted on gross examination in 12 cases. On microscopic examination, the gastrointestinal epithelium contained mucinous cells, columnar cells and argentaffin cells; rarely Paneth cells were seen. It was cytologically benign in 29 cases, of borderline malignancy in five and malignant in two. Follow-up information, available for 31 patients, revealed that 29 were alive without evidence of disease from 1-17 years (average, six years) postoperatively. One patient, who had a poorly differentiated tumor, died of recurrent disease six years after the initial operation.

Plasma androstenedione and oestrone levels before and after the menopause. II. Non-endocrine ovarian tumours and cysts

Plasma androstenedione (A) and oestrone (E1) levels were measured by radioimmunoassay in 45 hospitalized patients who had non-endocrine benign or malignant ovarian tumours or cysts. The findings of these measurements were compared with the findings of the mean steroid levels which we determined previously (see previous article) in 135 healthy women, around the menopause, of similar weight. Of the total number of patients, 26 had non-endocrine benign ovarian tumours and cysts and were in the reproductive and pre-menopausal ages. The mean plasma A level was found to be significantly higher than the normal value (P less than 0.001). However, the plasma E1 level was not different from the norm. The remaining 19 patients, all around the menopause, had non-endocrine malignant epithelial ovarian tumours. The mean plasma levels of both A and E1 were found to be significantly higher (P less than 0.001) than the normal values. Since increased plasma A levels are associated with non-endocrine ovarian tumours and cysts, it seems likely that the measurement of plasma A may be used as an endocrine detector of non-endocrine ovarian tumours.

Sertoli-Leydig cell tumors: a clinicopathologic study of 34 cases

Thirty-four cases of Sertoli-Leydig cell tumor were studied. All tumors were limited to the ovary at the time of initial surgery. Eight tumors were well differentiated, 15 were of intermediate differentiation, and 11 were poorly differentiated. Six cases contained heterologous elements. The less differentiated tumors occurred in patients with a lower median age and were more likely to produce androgenic manifestations. Follow-up of one year or longer was obtained in 15 patients, with an average follow-up in these patients of 6.1 years. Only one patient, who had a poorly differentiated tumor, died of the neoplasm in this series. Although follow-up was limited in this study, our findings suggest that the better differentiated tumors have a relatively favorable prognosis. This neoplasm is composed of sex-cord and stromal elements, and its components have the capacity to a greater or lesser extent to recapitulate the cells of the testis at different stages of development.

The hormone pattern in a case of arrhenoblastoma

A case of ovarian arrhenoblastoma in a 14-year-old girl is reported. The patient presented with primary amenorrhea, severe diffuse hirsutism, moderate clitorial enlargement and slight decrease in breast size. Hormonal examinations revealed high plasma testosterone and androstenedione levels, normal plasma prolactin, drhydroepiandrosterone-sulphate, 17-alpha-hydroxyprogesterone, urinary 17 beta oestradiol, oestrone, FSH and LH. Androgen concentrations decreased under dexamethasone suppression test. Following tumor ablation menses occurred spontaneously and normal hormone patterns were observed.

Composite mucinous ovarian neoplasms associated with Sertoli-Leydig and carcinoid tumors

The authors describe two mucinous ovarian tumors that were hormonally active due to Sertoli-Leydig elements within the septal stroma. Carcinoid was also present in each case. The mesenchymal stromal cells within the septa of the mucinous tumors have undergone neoplastic proliferation with the Sertoli and Leydig differentiations, leading to the formation of arrhenoblastoma. The carcinoid component of these tumors is thought to have originated from argentaffin cells of the "intestinal" mucinous epithelium.

The pathological assessment of ovarian neoplasms. IV: The sex cord-stromal tumours

All neoplasms of the ovary encountered in a 25-yr study period at the King George V Memorial Hospital were classified according to the World Health Organisation (WHO) Histological Classification of Ovarian Tumours. Of just less than 1700 tumours, 168 fell into the category designated as sex cord-stromal tumours, this report analysing their major clinical and pathological correlates. A detailed histological assessment is then presented, including 4 cases of the recently separated subcategory of sclerosing stromal tumour of the ovary.

Ovarian Sertoli-Leydig cell tumor with hyperoestrinism

This report concerns a very rare case of ovarian Sertoli-Leydig cell tumor associated with an evident hyperoestrinism, that occurred in a 67-year-old woman. The clinical and pathological data are presented and discussed.

Ovarian Sertoli-Leydig cell tumors. A clinical, pathological and ultrastructural study with particular reference to the histogenesis of these tumors

Ovarian Sertoli-Leydig cell tumors are rare, most of them being endocrinologically active and causing virilization. Their histogenesis and nomenclature are still under discussion. Six such tumors were identified in the Laboratory for Histopathology of the University Women's Hospital, Zürich. The clinical data as well as the macroscopic, microscopic and ultrastructural features of these tumors are analysed and discussed. In an attempt to clarify their histogenesis, the ultrastructural features of these tumors have been compared with those of two granulosa cell tumors as well as with those of a testis in a patient with testicular feminization. Our own results and a study of published data suggest that Sertoli-Leydig cell tumors arise from ovarian stroma. Because of their obvious morphological similarities to testicular structures they should be termed "gonadal stromal tumors of android type".

Treatment of ovarian stromal tumors

Fifty-one patients with granulosa-cell tumors and nine patients with Sertoli-Leydig-cell tumors have been treated at the M. D. Anderson Hospital. The most important prognostic finding was the stage of the tumor when first seen. Conservative surgery was utilized in young patients with lesions confined to one ovary. More advanced tumors were treated with maximal tumor resection and postoperative treatment with either irradiation or chemotherapy. Postoperative radiation was given when the tumor capsule had ruptured or residual tumor less than 2 cm. in diameter was present after surgery. Single-agent chemotherapy was ineffective in ovarian stromal tumors, but combination chemotherapy was found to be effective in advanced or recurrent stromal tumors. Actinomycin-D, 5-fluorouracil, and cyclophosphamide were effective in granulosa-cell tumors. Vincristine, actinomycin-D, and cyclophosphamide were effective in Sertoli-Leydig--cell tumors.