Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 11-1972

Hormonally Functional Ovarian Neoplasms

Hormonally functional ovarian neoplasms are those tumors that secrete one or more hormones that are clinically manifested in the patient. The hormone production may have implications for the diagnosis, management or treatment of the patient. Hormonally functional ovarian neoplasms include tumors that belong to various histologic categories and produce a variety of hormonal effects. Functional ovarian tumors most commonly produce steroid hormones, and such tumors frequently belong in the sex cord-stromal and steroid cell categories. In addition, a wide variety of peptide hormones may be produced by ovarian tumors. Although in most instances the neoplastic cells themselves produce the hormones, a wide variety of tumors may induce their stroma to produce steroid hormones. The stroma of ovarian tumors is derived from the ovarian stroma and may, on occasion, resemble specialized ovarian stroma and its derivatives. Cells resembling luteinized stromal cells or luteinized theca cells may be present and appear to be responsible for the resultant hormone secretion.

Krukenberg tumors of the ovary. Ultrastructural, histochemical and immunohistochemical studies of 15 cases

The ultrastructural, histochemical, and immunohistochemical characteristics of 12 classical signet ring cell Krukenberg tumors (CKT) and three tubular Krukenberg tumors (TKT) were evaluated and related to their possible influence on the ovarian stroma. In CKT, single signet ring cells predominated over lumen-forming cells and contained ultrastructural and histochemical characteristics similar to goblet cells in colonic and ovarian mucinous adenocarcinomas. In TKT, lumen-forming nonsecretory and secretory signet ring cells were prominent. Rare argentaffin cells were found in TKT but not in CKT. Cells in both CKT and TKT produced neutral and sialomucins. The stroma contained extracellular mucin, hypertrophied stromal fibroblasts and myofibroblasts, and in two cases stromal lutein cells with steroidogenic type ultrastructure. It appears that Krukenberg tumors are made up exclusively of intestinal type cells. Based on cell differentiation, TKT is better differentiated than CKT. Hypertrophy and hyperplasia of ovarian stromal cells may occur in response to malignant growth and/or the extracellular mucinous products of malignant cells and may play a role in the control of tumor invasiveness. None of the 15 cases were immunohistochemically positive for chorionic gonadotropin, placental lactogen, or luteinizing hormone. These hormones are suspected to be related to stromal luteinization in KT.

Dysgerminoma with syncytiotrophoblastic giant cells presenting as a hydatidiform mole

There have been a total of 11 cases of pure dysgerminoma with syncytiotrophoblastic giant cells (SGC) previously reported in the literature as of June 1981. All were Stage IA, all were treated with unilateral salpingo-oophorectomy, and the preoperative serum human chorionic beta-gonadotropin (beta-hCG) titers ranged from 2000 to 3160 mlU/ml. A recent case at William Beaumont Army Medical Center involved a 20-year-old Hispanic female who presented with a 20 weeks' size pelvic-abdominal mass which was sonographically consistent with a hydatidiform mole. An initial preoperative serum beta subunit hCG was 193,000 mlU/ml. At the time of surgery a Stage IC dysgerminoma of the right ovary was discovered and right salpingo-oophorectomy performed. In reviewing all 11 previously reported cases, not only is this case the first Stage IC reported, but it also is the first to present as a hydatidiform mole, has the highest ever reported preoperative beta-hCG, and provides the first ultrastructural study of this tumor type. The unusual clinical presentation and management of this case are discussed and a brief review of the clinical and pathological features of this unusual tumor is given.