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Sun Y, Tian L, Meng C, Liu G. Ovarian steroid cell tumors, not otherwise specified: three case reports and literature review. Front Oncol 2024; 14:1400085. [PMID: 39026973 PMCID: PMC11254658 DOI: 10.3389/fonc.2024.1400085] [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: 03/13/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To provide a reference for the diagnosis and treatment of ovarian steroid cell tumors, not otherwise specified (SCTs-NOS). Methods We retrospectively analyzed the clinicopathological data of three patients with SCTs-NOS admitted to the Tianjin Medical University General Hospital from 2012 to 2022 and reviewed literature reports related to this disease. Results A total of 3 cases in our center and 70 cases searched in literature reports were included. The age at diagnosis ranged from 3 to 93 years (median, 34 years). The common clinical manifestations were hirsutism, acne, deepened voice, clitoromegaly, amenorrhea, and excessive weight gain. Tumor sizes ranged from 1.2 to 45 cm, with an average diameter of 6.5cm. Most of SCTs-NOS were benign, but some of them exhibited malignant behavior. Surgery was the main treatment and close follow-up was required. The follow up time of 73 cases ranged from 3 to 132 months (median, 21.3 months). Disease recurrence or progression occurred in 14 cases (19.2%). Three of the 73 patients had a successful pregnancy. Conclusion SCTs-NOS usually occur in women of reproductive age, which are mainly manifested as androgen excess symptoms. Surgery is an appropriate treatment for SCTs-NOS and should be individualized. Final diagnosis depends on pathology. SCTs-NOS have malignant potential, and the treatments for patients with malignant tumors and disease recurrence or progression were cytoreductive surgery, adjuvant chemotherapy, and gonadotrophin-releasing hormone agonists (GnRHa) therapy.
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Affiliation(s)
- Yue Sun
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Lina Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Meng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoyan Liu
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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Lin M, Bao K, Lu L, Xu S, Liang Y, Cheng X, Wang F. Ovarian steroid cell tumors, not otherwise specified: analysis of nine cases with a literature review. BMC Endocr Disord 2022; 22:265. [PMID: 36316664 PMCID: PMC9623933 DOI: 10.1186/s12902-022-01170-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS), are rare, with few large studies. The purpose of this study was to analyze the clinical features, prognosis, and treatment choices for these patients of different age groups. METHODS This was a retrospective study. We identified nine cases of ovarian steroid cell tumor, not otherwise specified, confirmed by post-operative histopathological examination, and analyzed clinical features, surgical procedures, and follow up outcomes. We also reviewed cases reports of ovarian steroid cell tumors, not otherwise specified. RESULTS A total of nine cases were included. The age range was 9-68 years (mean, 41.89 ± 19.72 years). Clinical features included virilization, amenorrhea, abdominal pain, vaginal bleeding, isosexual precocious puberty, Cushing's syndrome, and abnormal weight gain with elevated testosterone levels. The follow up interval ranged 5-53 months and no recurrence was observed. CONCLUSION Ovarian steroid cell tumors covered all age groups, with manifestations of androgen excess. Younger patients appeared to have a more favorable prognosis, which provided more opportunities for these patients to pursue treatment options that will preserve reproductive function.
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Affiliation(s)
- Mengyan Lin
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Kechun Bao
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Lingjia Lu
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Shuhang Xu
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Yun Liang
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaodong Cheng
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Fenfen Wang
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China.
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Jana B, Palus K, Meller K, Całka J. Porcine dorsal root ganglia ovarian neurons are affected by long lasting testosterone treatment. Physiol Res 2017; 65:1019-1030. [PMID: 27959574 DOI: 10.33549/physiolres.933342] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
We studied the effect of testosterone overdose on the number, distribution and chemical coding of ovarian neurons in the dorsal root ganglia (DRGs) in pigs. On day 3 of the estrous cycle, the ovaries of both the control and experimental gilts were injected with retrograde tracer Fast Blue. From day 4 of the estrous cycle to the expected day 20 of the second studied cycle, the experimental gilts were injected with testosterone, while the control gilts received oil. After the completion of the protocol the Th16-L5 DRGs were collected. Injections of testosterone increased the testosterone (~3.5 fold) and estradiol-17beta (~1.6 fold) levels in the peripheral blood, and reduced the following in the DRGs: the total number of the Fast Blue-positive perikarya, the population of perikarya in the L2-L4 ganglia, and the numbers of SP(+)/CGRP(+), SP(+)/PACAP(+), SP(+)/nNOS(+) and SP(-)/nNOS(+) perikarya. In the testosterone-injected gilts, the populations of SP(+)CGRP(-), small and large androgen receptors-expressing perikarya were increased. These results suggest that elevated androgen levels during pathological states may regulate the transmission of sensory modalities from the ovary to the spinal cord, and antidromic regulation of the ovarian functions.
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Affiliation(s)
- B Jana
- Division of Reproductive Biology, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Olsztyn, Poland.
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Sedhom R, Hu S, Ohri A, Infantino D, Lubitz S. Symptomatic Cushing's syndrome and hyperandrogenemia in a steroid cell ovarian neoplasm: a case report. J Med Case Rep 2016; 10:278. [PMID: 27729065 PMCID: PMC5059940 DOI: 10.1186/s13256-016-1061-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background Malignant steroid cell tumors of the ovary are rare and frequently associated with hormonal abnormalities. There are no guidelines on how to treat rapidly progressive Cushing’s syndrome, a medical emergency. Case presentation A 67-year-old white woman presented to our hospital with rapidly developing signs and symptoms of Cushing’s syndrome secondary to a steroid-secreting tumor. Her physical and biochemical manifestations of Cushing’s syndrome progressed, and she was not amenable to undergoing conventional chemotherapy secondary to the debilitating effects of high cortisol. Her rapidly progressive Cushing’s syndrome ultimately led to her death, despite aggressive medical management with spironolactone, ketoconazole, mitotane, and mifepristone. Conclusions We report an unusual and rare case of Cushing’s syndrome secondary to a malignant steroid cell tumor of the ovary. The case is highlighted to discuss the complications of rapidly progressive Cushing’s syndrome, an underreported and often unrecognized endocrine emergency, and the best available evidence for treatment.
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Affiliation(s)
- Ramy Sedhom
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Sophia Hu
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anupam Ohri
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dorian Infantino
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sara Lubitz
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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Jana B, Meller KA, Bulc M, Całka J. Long-term treatment with testosterone alters ovary innervation in adult pigs. J Ovarian Res 2016; 9:64. [PMID: 27724935 PMCID: PMC5057494 DOI: 10.1186/s13048-016-0273-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 09/23/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Intraovarian distribution and density of nerve fibres immunoreactive (IR) to protein gene product 9.5 (PGP 9.5) and containing dopamine-β-hydroxylase (DβH), neuropeptide Y (NPY), somatostatin (SOM), galanin (GAL) were determined. METHODS From day 4 of the first oestrous cycle to day 20 of the second studied cycle, experimental gilts (n = 3) were injected with testosterone (T), while control gilts (n = 3) received corn oil. RESULTS After T administration the numbers of fibres IR to PGP 9.5 and fibres IR to DβH, NPY and SOM were decreased. Fewer PGP 9.5- and DβH-IR terminals were observed within the ground plexus and around arteries and medullar veins, and medium tertiary follicles, and DβH-IR terminals in the vicinity of small tertiary follicles. T decreased the density of NPY-IR fibres in the medullar part of the ground plexus, and SOM-IR in the cortical part of the ground plexus. CONCLUSIONS The obtained data show that long-term T treatment of gilts decreases the total number of intraovarian fibres, including sympathetic ones. These results suggest that elevated T levels that occur during pathological states may affect the innervation pattern of ovaries, and their function(s).
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Affiliation(s)
- Barbara Jana
- Division of Biology Reproduction, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Olsztyn, 10-748 Poland
| | - Karolina A. Meller
- Division of Biology Reproduction, Institute of Animal Reproduction and Food Research of the Polish Academy of Sciences, Olsztyn, 10-748 Poland
| | - Michał Bulc
- Division of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Olsztyn, 10-718 Poland
| | - Jarosław Całka
- Division of Clinical Physiology, Faculty of Veterinary Medicine, University of Warmia and Mazury, Olsztyn, 10-718 Poland
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Sood N, Desai K, Chindris AM, Lewis J, Dinh TA. Symptomatic Ovarian Steroid Cell Tumor not Otherwise Specified in a Post-Menopausal Woman. Rare Tumors 2016; 8:6200. [PMID: 27441075 PMCID: PMC4935824 DOI: 10.4081/rt.2016.6200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/09/2015] [Accepted: 12/16/2015] [Indexed: 12/18/2022] Open
Abstract
Steroid cell tumor not otherwise specified (NOS) is a rare subtype of sex cord stromal tumor of the ovary and contributes less than 0.1% of all ovarian neoplasms. The majority of tumors occur in pre-menopausal women (mean age: 43 years), in which 56-77% of patients present with virilization due to excess testosterone. An 80-year-old woman with worsening alopecia and excessive growth of coarse hair on abdomen and genital area was found to have elevated serum testosterone level (462 ng/mL). Radiologic studies were consistent with bilateral adrenal adenomas. Bilateral adrenal venous sampling ruled out the adrenal gland as origin of hormone secretion. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS of the left ovary. Post-operatively, the patient had complete resolution of her symptoms and normalization of testosterone level. Our case emphasizes the importance of a clinical suspicion for an occult testosterone secreting ovarian tumor in a symptomatic patient without obvious ovarian mass on imaging.
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Affiliation(s)
- Neha Sood
- Department of Medical and Surgical Gynecology
| | | | | | - Jason Lewis
- Department of Pathology, Mayo Clinic , Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology
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Wan J, Chen X, Li X. Ovarian steroid cell tumor, not otherwise specified: A rare case of postmenopausal vaginal bleeding. Oncol Lett 2014; 8:1187-1189. [PMID: 25120684 PMCID: PMC4114601 DOI: 10.3892/ol.2014.2251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/20/2014] [Indexed: 12/11/2022] Open
Abstract
Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS) are particularly rare ovarian tumors, which are composed of steroid-hormone secreting cells. The majority of patients with this tumor produce excessive quantities of testosterone and virilization is common. The current report presents a rare case of SCT in a 59-year-old female who presented with postmenopausal vaginal bleeding. The patient had experienced irregular vaginal bleeding for two months, 12 years after menopause. Transvaginal ultrasound and magnetic resonance imaging identified a solid adnexal mass and the pathological result of diagnostic curettage showed a proliferative endometrium. The patient’s serum estrogen and testosterone levels were elevated (393.71 nmol/l and 22.28 nmol/l, respectively). The patient underwent an exploratory laparotomy, hysterectomy and bisalpingectomy. The neoplasm was well-circumscribed, solid, homogeneous and yellow in color. Microscopically, the tumor was predominantly composed of granular eosinophilic or vacuolated cytoplasm. Reinke’s crystals, prominent nucleoli and Call-Exner bodies were not observed, and there was no mitotic figure. Immunohistochemistry demonstrated that the tumor cells were strongly positive for inhibin. The present rare case aims to expand the current knowledge of this type of ovarian tumor.
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Affiliation(s)
- Jing Wan
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiaowei Chen
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiaomao Li
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
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