Severe hemoperitoneum from spontaneous rupture of uterine tumor resembling ovarian sex-cord tumor: A very rare case

A case of uterine tumor resembling ovarian sex‐cord tumor with an unfamiliar presentation. Management was performed based on the clinical findings and the literature recommendations.

Ovarian steroid cell tumor (not otherwise specified) with subsequent spontaneous pregnancy after tumor removal: a case report and literature review

Steroid cell tumors not otherwise specified are rare sex cord-stromal tumors of the ovary that may produce various steroids and are associated with hirsutism and virilization. We report a rare case of ovarian steroid cell tumor with subsequent spontaneous pregnancy after tumor removal. A 31-year-old woman presented with secondary amenorrhea, hirsutism, and inability to conceive. Clinical and diagnostic evaluations revealed a left adnexal mass and elevated serum total testosterone and 17α-hydroxyprogesterone levels. She underwent a left salpingo-oophorectomy, and histopathological examination confirmed the diagnosis of a steroid cell tumor not otherwise specified. Her serum total testosterone and 17α-hydroxyprogesterone normalized one month after surgery. Her menses resumed spontaneously one month after the operation. She spontaneously conceived 12 months after the surgery. The patient had an uncomplicated pregnancy and delivered a healthy male infant. In addition, we reviewed the literature on steroid cell tumors not otherwise specified with subsequent spontaneous pregnancies after surgery and data regarding pregnancy outcomes.

Hypoxia-associated genetic signature in ovarian steroid cell tumor NOS

Steroid cell tumors, not otherwise specified (SCT-NOS), are uncommon ovarian neoplasms accompanied by virilization symptoms due to hyperandrogenism, which are malignant in approximately one-third of the cases. Given the rarity of SCT-NOS, their molecular underpinnings have not yet been studied in depth. In this case series, we performed the first comprehensive analysis of the genetic landscape of this rare ovarian tumor. A detailed clinicopathological description of an index case is also provided. Over a 20-year period, a total of eight patients were seen at our institution. Total nucleic acids (RNA and DNA) were extracted from evaluable formalin-fixed, paraffin-embedded tumor specimens (n = 7) and subjected to TruSight Oncology 500 testing and/or exome sequencing. The results identified pathogenic variants in several hypoxia-related genes - including HIF1A, VHL, SDHB, SRC, IDH2, and FOXO4. As the first comprehensive genetic analysis of SCT-NOS, this study shows that dysregulation in the hypoxia signaling pathway is a key molecular feature of this rare tumor. Clinically, long-term follow-up with periodic measurements of androgen levels should be pursued in all cases since recurrences may occur several years after the initial diagnosis.

Fibrothecoma of broad ligament with minor sex cord elements: Case report and brief literature review

RATIONALE

Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease.

PATIENT CONCERNS

A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass.

DIAGNOSIS

Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements.

INTERVENTIONS

This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm.

OUTCOMES

Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination.

CONCLUSION

The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients.

Ovarian steroid cell tumor causing isosexual pseudoprecocious puberty in a young girl: an instructive case and literature review

BACKGROUND

Steroid cell tumors (SCTs) are very rare sex cord-stromal tumors and account only for less than 0.1% of ovarian neoplasms. SCTs might comprise diverse steroid-secreting cells; hence, the characteristic clinical features were affected by their propensity to secrete a variety of hormones rather than mass effect resulting in compression symptoms and signs. To date, ovarian SCTs have seldom been reported in children, particularly very young children; and pseudoprecocious puberty (PPP) as its unique principal manifestation should be reiterated.

CASE PRESENTATION

We reported a 1-year-8-month-old girl presenting with rapid bilateral breast and pubic hair development within a 2-month period. Undetectable levels of LH and FSH along with excessively high estradiol after stimulation with gonadotropin-releasing hormone (GnRH), as well as a heterogeneous mass inside left ovary shown in pelvic sonography indicate isosexual PPP. Her gonadal hormones returned remarkably to the prepubertal range the day after surgery, and histology of the ovary mass demonstrated SCTs containing abundant luteinized stromal cells.

CONCLUSION

The case highlighted that SCTs causing isosexual PPP should be taken into consideration in any young children coexistent with rapidly progressive puberty given a remarkable secretion of sex hormones. This article also reviewed thoroughly relevant reported cases to enrich the clinical experience of SCTs in the pediatric group.

Ovarian steroid cell tumour (NOS) causing Cushing's syndrome in an extremely young girl: A case report

Steroid cell tumours are rare type of sex cord-stromal tumour of the ovary, with the average age at diagnosis during the fourth decade of life. A 2-year-old girl presented with virilisation, precocious pseudopuberty and Cushing syndrome. Her morning cortisol level was elevated and there was left lower abdominal mass found in radiological examination. An explorative laparotomy followed by a left salpingo-oophorectomy was performed. Histopathological examination revealed an encapsulated solid yellow-tan tumour composed of polygonal cells arranged in nests/lobes, containing numerous vascular channels, with abundant, clear-to-granular eosinophilic cytoplasm, severe nuclear pleomorphism and no Reinke crystals present consistent with an ovarian steroid cell tumour (NOS). The tumours cells were diffusely positive with calretinin, weak focal positive for inhibin, melan-A, pankeratin, chromogranin and negative for AFP, HMB-45 and androgen receptors. Following the tumour removal, blood pressure regressed to normal. The patient was discharged and advised for outpatient care.

Multicentric adrenocorticotropic hormone -producing steroid cell tumor of the fallopian tube & broad ligament in a 15 year old girl

Steroid cell tumors occur usually in the ovaries with very few reported cases of extra-ovarian origin. Our patient was a fifteen year old female, complaining from secondary amenorrhea and voice deepening. Values of serum cortisol, DHEA, FSH & LH were normal. Serum Testosterone was elevated while ACTH-pm was markedly elevated. MRI described bilateral solid para-ovarian masses. Exploration revealed two bilateral tubal extraluminal cysts & a right broad ligament cyst which were all excised. Pathological examination led to the diagnosis of steroid cell tumor. Serum testosterone & ACTH returned to normal levels after surgery with subsequent regression of the virilizing symptoms. We can conclude that extra-ovarian steroid cell tumors are extremely rare. They are usually presented with virilizing symptoms and hormonal abnormalities. Surgery is the main line of treatment.

Ovarian steroid cell tumor as an example of severe hyperandrogenism in 45-year-old woman

Approximately, 5% of ovarian tumors have hormonal activity. Steroid cell tumors (SCTs) represent about 0.1% of all ovarian tumors. They cause hyperandrogenism associated with typical virilization. In this case report, we present 45-year-old women with unmalignant ovarian SCT-producing androgens which cause severe virilization and secondary amenorrhea lasting two years. Transvaginal ultrasound, computed tomography of adrenal glands, magnetic resonance imaging of small pelvis, laboratory tests (including serum concentration of FSH, LH, testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), as well as ROMA index) were performed. During hormonal evaluation, elevated concentrations of serum T - on admission 1.72 ng/ml and one month later 3.75 ng/ml (normal range 0.08-0.82 ng/ml) and A - 24.90 ng/ml (normal range 0.40-3.40 ng/ml) were found. The ROMA index was within the normal range. Enlargement of the left ovary by solid mass 56 × 43 mm was found during ultrasound examination. Based on small pelvis MRI scan and hormonal finding, patient was qualified for laparotomy. During this procedure, the left salpingo-oophorectomy with removal of the tumor was performed. The histopathological examination identified SCT. During follow-up examination, one day after surgery, we found serum testosterone levels within normal ranges - 0.74 ng/ml (normal range 0.08-0.82 ng/ml). This case shows that hormone-producing ovarian tumors are rare but very important clinical causes of severe hyperandrogenism.

Canine ovarian gonadoblastoma with dysgerminoma overgrowth: a case study and literature review

BACKGROUND

Gonadoblastoma (GB) is a rare mixed germ cell-sex cord-stromal tumour, first described in humans, commonly found in dysgenetic gonads of intersex patients that have a Y chromosome. However, this entity in not recognized in the WHO classification of tumours of genital system of domestic animals. Herein, we describe a case of ovarian gonadoblastoma with proliferation of dysgerminoma and sex cord-stromal tumour components, in a phenotypically and cytogenetically normal bitch.

CASE PRESENTATION

A 17-year-old cross-breed bitch had a firm, grey-white multinodular mass in the left ovary. The tumour was submitted to histopathological examination and Y chromosome detected through karyotype analysis and PCR studies. Microscopically, the ovary was almost replaced by an irregular neoplasm composed of three distinct, intermixed elements: dysgerminoma, mixed germ cell-sex cord-stromal tumour resembling human GB and a proliferative sex cord-stromal tumour component. The germ cells of gonadoblastoma and dysgerminoma components were immunoreactive for c-KIT. Sex cord-stromal cells of gonadoblastoma were immunoreactive for α-inhibin. The sex cord-stromal tumour was immunoreactive for AE1/AE3, occasionally for α-inhibin and negative for epithelial membrane antigen (EMA). The karyotype was 78, XX and PCR analysis confirmed the absence of the Y chromosome.

CONCLUSION

Based on these findings, a diagnosis of gonadoblastoma with proliferation of dysgerminoma and sex cord-stromal tumour was made. This is the first case of ovarian gonadoblastoma in a female dog.

The clinical features and reproductive prognosis of ovarian neoplasms with hyperandrogenemia: a retrospective analysis of 33 cases

The aim of this study is to review the natural course, clinical features, and reproductive prognosis of ovarian tumors associated with hyperandrogenemia. We retrospect 33 patients of ovarian tumors with hyperandrogenemia. Thirty cases (91%) were sex cord-stromal tumors. Sertoli-Leydig cell tumors, Leydig cell tumors, and steroid cell tumors were the most common types. It is not possible, to predict the pathological subtypes based on androgen levels alone. Most of these tumors were solid masses, with an average diameter of 3.9 cm. These tumors are soft or fragile, no clear boundary with normal tissue, thus excision is superior to exfoliation. The average disease course of the top three tumors was 32.6, 35.4, and 67.7 months, respectively. Among 11 married women with a desire to get pregnant, nine cases resumed menstrual periods after surgery and became pregnant naturally. Hyperandrogenemia might predict a better prognosis. The asynchronism of hyperandrogenemia and undetectable tumor may cause irreversible change and emotional depress, the methods of early diagnosis need further study.

Case report: an identical twin with Sertoli-Leydig cell tumor

Our report details the workup and management of a 43-year-old woman with an identical twin who presented with 2 years of virilization and secondary amenorrhea. Serum total testosterone was elevated. An MRI did not identify adnexal or adrenal pathology. Subsequent ovarian vein sampling demonstrated unilateral testosterone elevation. The patient underwent laparoscopic unilateral oophorectomy resulting in the diagnosis of Sertoli-Leydig cell tumor (SLCT). Although SLCT is a rare sex-cord ovarian tumor, it is associated with endometrial hyperplasia and malignancy. Our goals are to review the workup of androgen-secreting tumors and discuss the clinical importance of the DICER1 mutation in the context of SLCT. In this case, an identical twin underwent DICER1 testing which was one of the essential steps in her clinical management.

Accessory ovarian steroid cell tumor producing testosterone and cortisol: A case report

RATIONALE

An accessory ovary is a rare structure containing normal ovarian tissue, which has a direct or ligamentous connection with a normal and eutopic ovary.

PATIENT CONCERNS

In the study, we reported a 46-year-old woman presented with secondary amenorrhea and virilization symptoms for 1 year.

DIAGNOSES

Endocrine evaluation revealed slightly elevated serum cortisol, extremely elevated 24-hour urinary-free cortisol and serum testosterone. Clinical assessment exhibited a large solid mass with heterogeneous enhancement in the left adnexauteri compounded with hypercortisolism and hyperandrogenemia. An accessory ovarian tumor attached to the infundibulum of the left fallopian tube was found, and a separate normal ovary was present on the same side.

INTERVENTIONS

The patient underwent a left adnexectomy.

OUTCOMES

During surgery, a 12 cm × 8 cm, gray-red, and well-circumscribed solid mass was be identified. The tumor had ligamentous attachment with the infundibulum of left fallopian tube. The sectioned surface was gray-brown, lobulated and did not exhibit either significant necrosis or hemorrhage. Pathological findings demonstrated that tumor cells had small round nuclei, mild atypia, no mitosis were arranged in a diffuse pattern of columns or nests separated by a rich vascular network and no crystals of Reinke were found. It was diagnosis ovarian steroid cell tumor (NOS) without malignant behavior by immunohistochemical staining. The patient was finally diagnosed as accessory ovarian steroid. The patient was discharged from the hospital on the seventeenth day after surgery. During postoperative follow-up, the first postoperative menstrual flow recovered and blood pressure regained 1 month after surgery. Furthermore, her Cushing syndrome regressed and hirsutism disappeared completely 4 months after surgery cell tumor.

LESSONS

It is vitally important to establish a final diagnosis according to the clinical manifestations and laboratory values in addition to imaging studies and laparoscopic examination of a rare coexistence of hyperandrogenemia and Cushing syndrome based on the accessory ovarian pathology.

Gynandroblastoma with a Juvenile Granulosa Cell Component in an Adolescent: Case Report and Literature Review

BACKGROUND

Gynandroblastoma is an extremely rare ovarian sex cord tumor with malignant potential.

CASE

An 18-year-old adolescent experienced intermittent vaginal bleeding. A year later, a right adnexal mass with a heterogeneous imaging appearance was identified. Laparoendoscopic single-site ovarian tumorectomy was performed. A histopathological examination showed gynandroblastoma composed of juvenile granulosa and Sertoli-Leydig cells. Because the tumor was upstaged to stage Ic because of cyst rupture during surgery, three cycles of adjuvant chemotherapy with carboplatin and paclitaxel were added. Three years after surgery, no signs of recurrence have been noted.

SUMMARY AND CONCLUSION

The present findings can help clinicians make an accurate preoperative imaging diagnosis of gynandroblastoma with a juvenile granulosa cell component and plan an adequate treatment strategy for this rare, potentially malignant neoplasm.

Sclerosing stromal tumour of the ovary in a postmenopausal woman presenting with virilization

Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. To date, fewer than 200 cases have been described in the literature and most patients have menstrual irregularities and pelvic pain. Sclerosing stromal tumours were reported in which the inactive tumours did not represent endocrine clinical symptoms; however, currently according to several reports, it is the active tumour that produce hormones. Only a few cases of virilizing sclerosing stromal tumours of the ovary have been described in the literature and in this report first describes sclerosing stromal tumour of the ovary in a postmenopausal woman presenting with virilization.

A case of postmenopausal androgen excess

Ovarian steroid cell tumors are very rare but potentially life-threatening neoplasms. They represent less than 0.1% of all ovarian tumors, typically present in premenopausal women and frequently manifest with virilization. Signs of hyperandrogenism may appear in postmenopausal women due to tumorοus and non-tumorοus adrenal and ovarian causes as well due to the normal aging process. In any case, steroid cell tumor should be suspected in postmenopausal women who present with rapid progressive androgen excess symptoms. This report describes a case of a 67-year-old postmenopausal woman with signs of hyperandrogenism, where an ovarian steroid cell tumor was diagnosed and treated by laparoscopic bilateral salpingo-oophorectomy and synchronous hysterectomy.

Preservation of fertility in non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules

We report the successful conservative management of a non-Peutz-Jegher syndrome-associated ovarian sex cord tumour with annular tubules in a 32-year-old patient. The patient underwent a unilateral salpingo-oophorectomy by laparoscopy, and conceived spontaneously approximately 6 months after the diagnosis. After a normal term pregnancy, she underwent a contralateral laparoscopic salpingo-oophorectomy with hysterectomy. The patient is now on hormone replacement therapy and, after 30 months of follow-up, continues to present no sign of disease recurrence.

Metastatic ovarian sex-cord stromal tumor with annular tubules in a patient without Peutz-Jeghers syndrome

Sex-cord stromal tumors (SCSTs) with annular tubules (SCTATs) are a small class of ovarian lesions that possess histologic features of both Sertoli and granulosa cells. Approximately one-third of patients with SCTAT also have Peutz-Jaghers syndreome, which makes these cases especially rare. Patients with non-PJS-associated SCTAT make up the remaining two-thirds; 20% of these cases have a metastatic presentation. Metastasis of these tumors to the head and neck region has only been reported in a few instances. In this article we report a case of a 25-year-old woman who presented with "a lump in her throat" and was ultimately diagnosed with SCTAT. We also discuss the current protocols in the diagnosis and treatment of this entity.

Steroid cell tumor of the ovary in a pregnant woman whose androgenic symptoms were masked by pregnancy

INTRODUCTION

Ovarian steroid cell tumors are very rare sex cord-stromal tumors, and most of them are unilateral and almost one-third of the cases are malignant.

CASE REPORT

Here, we present a pregnant woman, who diagnosed with steroid cell tumor of the ovary and underwent surgical staging.

DISCUSSION

We will discuss the clinical presentation of the case, management options and follow-up strategies.

Gynandroblastoma: a rare ovarian tumour with an unusual clinical presentation

Gynandroblastoma is a rare ovarian mixed sex cord stromal tumour with very few cases reported in literature. These tumours are considered to be potentially malignant. Here a case of gynandroblastoma occurring in a 30-year female is reported who gave history of irregular menstrual bleeding and pain abdomen, there were no signs of virilisation. Computed tomography scan showed a left adnexal mixed density pelvic mass suggesting malignant ovarian tumour. Histological study revealed, the tumour was composed of mixed sex cord elements with predominantly intermediate differentiated Sertoli-Leydig cell component and a second adult type granulosa cell component.

Hyperandrogenism produced by ovarian tumors in women at different life stages

OBJECTIVE

to evaluate the different presentations of hyperandrogenism produced by ovarian tumors in women at different life stages

DESIGN

case report.

SETTING

academic institutions.

PATIENT(S)

3 patients at different life stages, with increased androgen levels.

INTERVENTION(S)

review of hospital records.

MAIN OUTCOME MEASURE(S)

clinical and biochemical features, treatment and follow-up.

RESULT(S)

a 10 year-old girl with Leydig cell tumor presented with hyperandrogenemia, virilization and changes in social behavior. Another patient, at reproductive age, with a tumor>10 cm, presented with signs of virilization and abdominal mass, whose pathologic analysis disclosed a carcinoid tumor of the ovary associated with stromal hyperplasia. The third patient was a postmenopausal woman with severe alopecia, who presented a steroid cell tumor, rare at that age.

CONCLUSION(S)

the evaluation of women with signs and symptoms of virilization should include a detailed clinical record, thorough physical examination and an appropriate hormonal dosage, especially when images are inconclusive.

Specific features of the stromal ovarian tumors

AIM OF THE STUDY

Establishing a characteristic pattern for the stromal ovarian tumors.

MATERIAL AND METHODS

We realized the clinical-statistics analyze of 27 stromal tumors (lot B) from a total of 498 patients with ovarian tumors (lot A), diagnosed and treated between 1999 - 2008 in Elena Doamna Hospital of Obstetrics and Gynecology, lasi. We used the clinical files of these patients, operatory protocols and anatomopathological results.

RESULTS

we analyzed a large number of parameters: age, location, first diagnoses, symptoms, anatomopathological diagnose, imunohistochemical diagnose, etc. When we compared the two lots of patients we pointed out significant differences for the following parameters: most affected group of age, first diagnose, and associated diseases, anatomopathological and imunohistochemical differences, and prognostic factors.

CONCLUSIONS

stromal ovarian tumors are a less studied entity, with particular anatomopathological and imunohistochemical features which differentiates them from the rest of the ovarian tumors.

Giant multilocular sex cord tumor with annular tubules associated with precocious puberty

We report a case of sex cord tumor with annular tubules featuring a giant multilocular cyst, grossly similar to cystadenoma, in the ovary of an 8.5 year old girl. Estrogen-related symptoms, including precocious puberty and irregular uterine bleeding, immediately improved after tumor resection.

Refractory hypertension and isosexual pseudoprecocious puberty associated with renin-secreting ovarian steroid cell tumor in a girl

Steroid cell tumor, not otherwise specified (NOS), are rare ovarian tumor, in addition, it is more rare in children. The majority of these tumors produce several steroid hormones, particularly testosterone. Estrogen also secreted by steroid cell tumor, NOS, but it is uncommon. Furthermore, hypertension is an infrequent sign in steroid cell tumor, NOS. An 8.5-yr-old girl with hypertension and frequent vaginal spotting visited at our clinic. On laboratory evaluation, secondary hypertension due to an elevated plasma renin level and isosexual pseudoprecocious puberty was diagnosed. Right solid ovarian mass was detected in radiologic tests. She underwent a right ooporectomy and it revealed renin and progesterone receptor positive steroid cell tumor, NOS. After operation, her blood pressure returned to normal level and vaginal bleeding disappeared. Even though this case is very rare, when hypertension coincides with virilization or feminization, a renin-secreting ovarian steroid cell tumor, NOS, should be considered.

Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumour, not otherwise specified: our experience of a rare case with female virilisation and review of the literature

INTRODUCTION

Ovarian steroid cell tumours, not otherwise specified (NOS) are rare sex cord-stromal tumours of the ovary. These tumours should be considered a cause of isosexual precocious puberty in children and virilisation in adults.

CASE

We report a case of 40-year-old woman with mental handicap who presented with 3 years of amenorrhea and progressive virilisation. Pelvic ultrasonography identified a 6.19 × 6.15 cm well-defined echogenic-multilobular mass arising from the left ovary. Fluid in the cul-de-sac was noted. Colour Doppler examination with endovaginal ultrasonography showed high vascularity of the tumour with low resistance to flow. A computed tomography (CT) scan of the upper and lower abdomen showed a lobular mass with diaphragms in the left adnexal structure and fluid in the cul-de-sac; no adrenal gland enlargement or additional tumour was detected. Laboratory analysis revealed increased levels of serum total testosterone. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histological examination showed a benign steroid cell tumour, NOS without evidence of necrosis, haemorrhage or invasion. The immunohistochemical study showed that the tumour cells were positive for inhibin, CD 99, Melan A and vimentin and negative to CK AE1, CK AE3, progesterone and estrogen receptors.

CONCLUSION

Careful medical history, physical examination, laboratory serum values and imaging studies are helpful in making the pre-operative diagnosis. Steroid cell tumours, NOS are usually benign, unilateral and characterised by the composition of two similar-appearing polygonal cell types. They differ from Leydig cell tumours in the lack of crystals of Reinke in their cytoplasm.

Endometrial carcinoma and ovarian sex cord tumor with annular tubules in a patient with history of Peutz-Jeghers syndrome and multiple malignancies

Peutz-Jeghers syndrome is a rare syndrome which is inherited in a dominant manner. It is characterized by hamartomatous polyps of the gastrointestinal tract, hyperpigmented macules of the oral mucosa and an increased risk of developing neoplasms in the gastrointestinal tract, pancreas, breast and genital system. Women with Peutz-Jeughers syndrome often develop an ovarian sex cord tumor and cervical adenocarcinoma of minimal deviation adenoma malignum type. A case of a 58-year-old patient with Peutz-Jeghers syndrome and history of multiple malignancies (thyroid, breast and colon cancer) who presented with metrorrhagia is reported. The dilatation and curettage revealed endometrial adenocarcinoma. The patient underwent total abdominal hysterectomy with bilateral oophorectomy. The histologic examination showed an endometrioid endometrial adenocarcinoma that developed in atypical endometrial hyperplasia. The histologic examination of the right ovary revealed a sex cord tumor with annular tubules, measuring 3 cm. Sex cord tumors with annular tubules in patients with Peutz-Jeghers syndrome are usually small, bilateral tumors of the ovaries which have common characteristics with granulosa cell tumor and Sertoli cell tumor. Hyperestrogenism is a rather common finding with development of estrogen-dependent lesions.

Gynandroblastoma with the symptoms of infertility and secondary amenorrhea: a case report

The case of a female patient who failed to get pregnant due to delayed menstruation is reported. Gynecological examination showed that the patient had a male pubic distribution, hypertrophic clitoris, unobstructed vagina and hypertrophic cervices with smooth and medium texture. B ultrasonic examination detected a 42 x 30 mm in size medium echo mass. This mass had irregular shape, smooth surface, relatively clear boundary and hard texture. Examination with paraffin-embedded section indicated that the tumor was composed of supporting cells and to a lesser amount of interstitial components. Some regions had particle-like cell differentiation. These results suggested that the tumor was gynandroblastoma. We found that the increased level of serum testosterone in the patient was the reason for amenorrhea and infertility. The diagnosis and treatment for patients with gynandroblastoma is also discussed.

Ultrasound of ovarian sex-cord tumor with annular tubules

Sex-cord tumors with annular tubules (SCTAT) have been extensively reported in the literature with great emphasis on the cytologic and histologic appearance. The association of Peutz-Jeghers syndrome (PJS) with bilateral benign, typically multifocal, small, and sometimes calcified SCTAT has also been reported. We present and describe the sonographic findings of bilateral SCTAT in a patient with PJS.

Lipid cell tumor in an adolescent girl: a case report

BACKGROUND

Lipid cell tumors of the ovary are rare sex cord neoplasms and account for < 0.1% of ovarian tumors.

CASE

A 16-year-old girl sought medical advice because of amenorrhea and virilization, manifested as facial hirsutism and temporal balding. Her total testosterone level was increased in comparison with normal values. Ultrasonography revealed an echogenic left adnexal tumor about 5.7 x 6.3 x 5.5 cm. The patient underwent laparoscopic ovarian cystectomy, and pathology showed a lipid cell tumor. Postoperatively, the serum testosterone level returned to normal.

CONCLUSION

The tumor appeared to be the source of hyperandrogenism in this woman.

An ovarian steroid cell tumor causing virilization and massive ascites

Steroid cell tumors, not otherwise specified (NOS), are rare ovarian sex cord-stromal tumors with malignant potential. The majority of these tumors produce several steroids, particularly testosterone. Various virilizing symptoms such as hirsutism, temporal balding, and amenorrhea are common in these patients; however massive ascites is an infrequent symptom. A 52-year-old woman with the sudden onset of virilization and massive ascites presented for treatment at Severance Hospital. After clinical evaluation, the patient underwent an exploratory laparotomy and a complete surgical staging procedure. She recovered from the surgery uneventfully and was discharged from the hospital five days after surgery. We present here an unusual case of an ovarian steroid cell tumor, NOS, and a brief review of the literature regarding these types of tumors.

Hypothyroidism and hyperlipidemia with a virilizing ovarian steroid cell tumor, not otherwise specified

Steroid cell tumors, not otherwise specified, are rare ovarian sex cord-stromal tumors with malignant potential. The majority of these tumors produce steroids, with testosterone being the most common. A 44-year-old woman with hypothyroidism and hyperlipidemia presented with abrupt onset of oligomenorrhea, progressive virilization as acne, hirsutism and clitoromegaly, and a non-palpable pelvic mass. The preoperatively elevated serum testosterone level returned to normal after salpingo-oophorectomy, and then menstrual flow became regular.

Ovarian sclerosing stromal tumor presenting as Meigs' syndrome with elevated CA-125

Meigs' syndrome caused by sclerosing stromal tumor is extremely rare and only two cases have been reported to date. An elevated serum level of CA-125 is also unusual and it has been thought that it is the consequence of physical irritation and inflammation. In this report, we present the case of a 50-year-old postmenopausal woman with a sclerosing stromal tumor presenting with Meigs' syndrome and an elevated CA-125 level (1476.8 IU/mL). This case highlights the difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy and it should be considered in the differential diagnosis in postmenopausal patients with pelvic mass, ascites, pleural effusions and elevated serum CA-125.

Peutz-Jeghers Syndrome with multiple genital tract tumors and breast cancer: a case report with a review of literatures

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.

Pediatric sex cord-stromal tumor with composite morphology: a case report

A 12-year-old female with developmental delay/mental retardation and a family history of gynecologic cancers presented with nonspecific abdominal complaints and was found to have a 4.5-kg, 25- x 23- x 15-cm pelvic mass with solid and cystic components and associated retroperitoneal and mesenteric lymphadenopathy. Laboratory studies revealed increased serum levels of CA-125 and inhibin B. Histologically, the tumor exhibited several different morphologic appearances including adult granulosa cell tumor, juvenile granulosa cell tumor (with areas of marked atypia), and Sertoli cell tumor. Immunohistochemically, the tumor was positive for calretinin, MIC-2 (CD99), S100 protein, PGP 9.5, and neuron-specific enolase. Electron microscopy of the Sertoli cell tumor-like areas showed Charcot-Bottcher filaments, a distinguishing feature of Sertoli cells. Together, these findings supported a diagnosis of mixed sex cord-stromal tumor including granulosa cell tumor of adult and juvenile types and intermediate- to high-grade Sertoli cell tumor, with large areas of markedly atypical sex cord-stromal tumor.

Ovarian sex cord-stromal tumor, unclassified: case report of endocrinologic findings and review of the literature

Endocrinologic findings and a successful pregnancy in a 39-year-old woman with significant androgen excess due to a biologically active, virilizing ovarian sex cord-stromal tumor, unclassified, are described. She had secondary amenorrhea, infertility, and hirsutism. Her basal plasma testosterone level was high at 187 ng/mL (normal range: 10-85 ng/mL). Tumor resection resulted in resumption of ovulation, pregnancy, and delivery.

Testicular tumour with features of sex cord tumor with annular tubules associated with cryptorchidism and infertility--a case report

Sex cord tumor with annular tubules (SCTAT) is a rare tumor seen in the ovary usually associated with Peutz-Jeghers syndrome. Testicular SCTAT are more infrequent and only four such cases have been reported in the literature. A 28-year-male presented with infertiliy. He had a history of orchiopexy 10 years back for right-sided inguinal testes. A right testicular biopsy done to investigate the cause of infertility revealed testicular atrophy with a focus suspicious of SCTAT. The right-sided orchiectomy revealed two firm nodules of 0.5 and 0.2 cms of SCTAT and sertoli cell nodule (SCN) respectively on microscopy. He did not have any features of Peutz-Jeghers or any other dysgenetic syndrome. He is asymptomatic after follow up of 26 months. This is the fifth case of testicular SCTAT and the first with SCN.

Colonic adenocarcinoma and bilateral malignant ovarian sex cord tumor with annular tubules in Peutz-Jeghers syndrome

Peutz-Jeghers syndrome is characterized by multiple polyps throughout the gastrointestinal tract in association with mucocutaneous pigmentation. Although Peutz-Jeghers syndrome polyps are hamartomas, frequent association of this syndrome with both gastrointestinal and non-gastrointestinal tumours had led to reassessment of the cancer risk in this hereditary disorder. The most common gynaecological tumors in this syndrome are adenoma malignum of the uterine cervix and ovarian sex cord tumor, particularly sex cord tumor with annular tubules. The question of malignant change in a polyp or of the association of gastro intestinal carcinomas still discuss. The authors report a case of Peutz-Jeghers syndrome in a young patient who developed a colonic adenocarcinoma in a hamartomatous polyp together with an incidentally discovered bilateral malignant sex cord tumours. We discuss its association with certain benign and malignant tumors and the risk of rare complications of these hamartomatous polyps. Although malignant tumors are increasingly reported in association with the Peutz-Jeghers syndrome, to our knowledge, there have been no previous reports of such an association in the literature.

Sclerosing stromal tumor of the ovary associated with Meigs' syndrome: a case report

Sclerosing stromal tumors of the ovary are distinct, but rare benign neoplasms. These tumors appear solid and are very vascular giving the impression of malignant tumors. They occur mostly in young women. Morphologically they have distinct characteristics which differentiate them from other stromal tumors. Benign ovarian tumors associated with Meigs' syndrome are rare. In this article a case of ovarian sclerosing stromal tumor associated with Meigs' syndrome in a 17-year-old women is described and the differential diagnosis is also discussed.

Fibrosarcoma of the ovary arising in a fibrothecomatous tumor with minor sex cord elements. A Case report and review of the literature

We report the case of a 69-year-old woman who presented with postmenopausal bleeding. Endometrial curettings showed complex atypical hyperplasia with focal well-differentiated adenocarcinoma. A computed tomographic scan of the abdomen revealed a right ovarian mass. Histologically, the right ovarian tumor was a fibrothecoma with minor sex cord elements showing focal fibrosarcomatous change. Fibrosarcoma of the ovary is a rare tumor that is considered to arise de novo or secondary to benign fibromatous tumors. Fibrothecoma of the ovary with minor sex cord elements is also a rare entity. To the best of our knowledge, this is the first reported case of a fibrosarcoma arising in a fibrothecoma with minor sex cord elements.

Sclerosing stromal tumor of the ovary: a case report and review of the literature

Sclerosing stromal ovarian tumor is an extremely rare neoplasm occurring predominantly in the second and third decades of life. It presents most often with non-specific symptoms. We describe a new case occurring in a young woman presenting with infertility and irregular menses. Ultrasound examination showed a left heterogenous ovarian mass without focal calcifications. Histological features included a pseudolobular pattern with focal areas of sclerosis, prominent vascularity and a two-cell population of spindled and polygonal cells. Immunohistochemical analysis for actin, vimentin, laminin, vascular epidermal growth factor (VEGF), oestrogen and progesterone receptors using formalin-fixed and paraffin-embedded materials showed predominant positivity for a-smooth muscle actin and consistent positivity for laminin and vimentin. The epidermal VEGF demonstrated rich tumor vascularity. Oestrogen and progesterone receptors were not expressed. suggesting hormonally independent development. Menstrual cycle disturbances, however, were corrected following extirpation of the tumor, indicating some endocrine involvement. In addition, the patient became pregnant ten months after the operation. The differential diagnosis is discussed.

Ovarian sex cord tumor with annular tubules in a woman with premature ovarian failure

OBJECTIVE

To report a case of premature ovarian failure (POF) associated with an ovarian sex cord tumor with annular tubules.

DESIGN

Case report.

SETTING

Reproductive endocrinology unit in a tertiary academic center.

PATIENT(S)

A 20-year-old woman with POF.

INTERVENTION(S)

Biopsy of the rudimentary ovary by laparoscopy.

MAIN OUTCOME MEASURE(S)

Protocol for POF investigation and histological study of the ovarian sample.

RESULT(S)

An ovarian sex cord tumor with annular tubules was detected in the rudimentary right ovary.

CONCLUSION(S)

The rare ovarian sex cord tumor with annular tubules, which may be hormonally active, was detected in a case of POF.

Androgen-secreting steroid cell tumor of the ovary

We present the case of a 93-year-old virilized woman with an androgen-secreting ovarian tumor. This rare ovarian sex cord stromal tumor behaved in a malignant fashion. Various aspects of the presentation, diagnosis, and treatment of these tumors are discussed.

Virilizing tumors of the ovary: imaging features

AIM

Virilizing tumors of the ovary are an uncommon cause of a common clinical problem. The reported imaging features of these tumors are based on case reports. The purpose of this study was to determine the spectrum of imaging characteristics of these tumors based on a larger referral population.

PATIENTS AND METHODS

Case records from the Armed Forces Institute of Pathology were searched for clinical evidence of virilization as a presentation of an excised sex cord-stromal and steroid cell ovarian tumor. Records and imaging studies on 14 patients with virilizing tumors were found. All available imaging studies (ultrasound studies of the pelvis (11 patients), CT scans of the pelvis (five patients), MRI examinations of the pelvis (two patients), and plain films of the pelvis (four patients) were reviewed by three radiologists independently for ascites, calcification, percent solid portion, echogenicity and attenuation.

RESULTS

On CT and/or ultrasound most (69%) of the tumors appeared to be solid or mostly solid. The amount of solid tissue varied with the tumor type, granulosa cell tumors were predominantly cystic. The masses were isoechoic (82%) or hypoechoic (18%). Ascites was an infrequent (23%) finding. Only a minority of these tumors (14%) were calcified on imaging studies. Six tumors were 5.0 cm or less in mean size, and two less than 3.0 cm in size. All cases were stage I tumors at presentation.

CONCLUSION

The majority of virilizing tumors of the ovary are typically solid, noncalcified, confined to the ovary at presentation, and not associated with ascites. Variability in appearance depends in part on tumor type. Many are small and may be difficult to recognize as a mass morphologically.

Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report

The majority of ovarian sex cord tumors with annular tubules (SCTAT) are benign neoplasms that arise sporadically. In patients who have Peutz-Jeghers syndrome (PJS), ovarian SCTAT is often an incidental finding. Malignant behavior in SCTAT has heretofore been reported only in sporadic cases. We report a case of bilateral, malignant SCTAT developing in a 47-year-old woman who had PJS, originally diagnosed as adenocarcinoma on cervicovaginal cytology. Cervicovaginal and peritoneal fluid cytologic preparations were characterized by pseudopapillary clusters and three-dimensional tubes of tumor cells with scanty cytoplasm and high nuclear: cytoplasmic ratio. Examination of surgical resection specimens revealed bilateral, solid ovarian tumors composed of simple and complex annular tubules with hyaline cores, typical of SCTAT. Tumor emboli were present within salpingeal lymphovascular spaces and in both right and left pelvic lymph nodes. Flow cytometry of tumor cells demonstrated a diploid phenotype. This case represents the first documented example of bilateral, malignant SCTAT arising in a patient who had PJS, presenting with an atypical cervicovaginal smear.

Somatic mutations in the STK11/LKB1 gene are uncommon in rare gynecological tumor types associated with Peutz-Jegher's syndrome

Peutz-Jegher's syndrome (PJS) is a rare autosomal dominant disorder characterized by mucocutaneous pigmentation, hamartomatous polyposis, and predisposition to benign and malignant tumors of the gastrointestinal tract, breast, ovary, uterine cervix, and testis. Germline-inactivating mutations in one allele of the STK11/LKB1 gene at chromosome 19p13.3 have been found in most PJS patients. Although ovarian sex cord tumors with annular tubules (SCTATs) and minimal deviation adenocarcinomas (MDAs) of the uterine cervix are very rare in the general population, both tumor types occur with increased frequency in women with PJS. An earlier report indicated that the 19p13.3 region containing the STK11 gene was affected by loss of heterozygosity (LOH) in nearly 50% of MDAs of the uterine cervix. We investigated the role of STK11 mutations and LOH of the 19p13.3 region in two PJS-associated SCTATs and in five SCTATs and eight MDAs of the uterine cervix, which occurred in patients lacking features of PJS (referred to here as "sporadic" cases). Germline mutations in the STK11 gene, accompanied by LOH of markers near the wild-type STK11 allele, were found in the two PJS-associated SCTATs. Somatic mutations in the coding region of STK11 were not found in any of the sporadic SCTATs or MDAs studied, although LOH of the 19p13.3 region was seen in three of eight MDAs. Our findings indicate that STK11, like other tumor suppressor genes, is affected by biallelic inactivation in gynecological tumors of PJS patients. In addition, although LOH of the 19p13.3 region was seen in sporadic MDAs, somatic STK11 mutations are rare. A yet-to-be-defined tumor suppressor gene in the 19p13.3 region may be the specific target of inactivation in these tumors.

Masculinizing sclerosing stromal cell tumor in pregnancy: report of a case and review of the literature

PURPOSE

To report a case of sclerosing stromal cell tumor of the ovary in pregnancy and to review the literature of this rare ovarian tumor.

METHODS

The patient's office record and hospital record were reviewed. Gross and microscopic pathology were reviewed by one gynecologic pathologist. A Medline literature search and literature review were performed.

RESULTS

Over eighty cases of sclerosing stromal cell tumor of the ovary have been reported in the literature since the definition of this pathologic condition in 1973. Only five cases have been reported during pregnancy and only two of these resulted in maternal virilization. This report describes severe maternal virilization with birth of a non-virilized female infant.

CONCLUSION

Sclerosing stromal cell tumor of the ovary can result in severe virilization via androgen production. Surgery with removal of the involved ovary is required for diagnosis and cure. Prognosis is excellent.