Full Text Available Hyperandrogenism is a common disorder among women in the reproductive age group. One of the rare causes for androgen excess is sex cord- stromal tumors of the ovary. These are usually unilateral. Here we report case of a 48 year old woman who presented with hyperandrogenism due to bilateral ovarian thecoma. Androgen levels normalized following resection of the tumor. This, to the best of our knowledge, is the first case of bilateral thecoma presenting as hirsutism in a premenopausal woman.
Full Text Available Uterine lipomas are very uncommon with symptoms that are similar to leiomyomas. Their diagnosis is always histological although some radiological methods may suggest their existence prior to surgery. They are sometimes associated with endometrial pathology, but there are no previous reported cases related to ovarian thecoma. Their prognosis is excellent. Clinical, radiological, morphologic, and immunohistochemical findings are shown which correspond to uterine lipoma associated with endometrial polyps and ovarian thecoma.
Donovan, Lois E; Brain, Philippa H; Duggan, Máire A
To review the diagnostic possibilities that exists when the workup of amenorrhea reveals an isolated LH elevation; and to examine the effect of inhibin B on LH levels in vivo. Case report. University hospital. A 20-year-old woman presented with secondary amenorrhea. Her FSH measurement was low, and the LH level was elevated. The recognition that this was an unusual pattern led to the diagnosis of a rare but very treatable inhibin B-producing thecoma, despite the fact that results on the initial pelvic ultrasound examination performed 10 months after presentation of amenorrhea were relatively unremarkable. Surgical removal of an ovarian thecoma. Gonadotropins, E2, inhibin B, menstrual bleeding, and fertility. Removal of the ovarian thecoma resulted in a normalization of FSH, LH, and inhibin B levels and a return of spontaneous menses 28 days later. Pregnancy occurred with the third postoperative menstrual cycle, followed by the delivery of a healthy full-term girl. Inhibin B-producing sex cord granolosa-stromal cell tumors should be considered in women who present with amenorrhea with isolated LH elevations, even in the setting of a previously normal pelvic ultrasound report. Diagnostic considerations that arise in the workup of amenorrhea when there is an isolated elevation in LH that is accompanied by normal or low FSH levels are reviewed. This rare clinical presentation provides the opportunity to observe the impact of inhibin B on gonadotropins in vivo. Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.
Conclusion: Meigs syndrome is not uncommon in gynecology. The clinical signs and symptoms, and imaging and laboratory findings may not sufficiently differentiate Meigs syndrome from malignancy. An exploratory laparotomy is essential for the final diagnosis of this syndrome.
calciﬁcations and cerebellar medulloblastomas. Female patients with Gorlin's syndrome are susceptible to develop ovarian ﬁbromas; infact, the presence of the fibroma may be the ﬁrst sign of the presence of the syndrome(8-10). Ovarian fibromas can extensively calcify as seen in this case as compared to thecomas which ...
Kwon, Yang Sook; Kim, Soo Han; Kim, Seung Hyup; Shin, Hyun Ja [Korea Veterans Hospital, Seoul (Korea, Republic of)
The ultrasound is easily available and noninvasive diagnostic method without radiation hazard. We can approach to differential diagnosis of ovarian tumors by gray scale ultrasound which can display the detailed structure of soft tissue. In department of radiology, Korea Veterans Hospital, 27 cases of histologically confirmed ovarian tumors collected from March 1984 to February 1986 were analyzed. The results were as follows: 1. The age distribution was from 13 to 72 years. 2. The histologic diagnosis of ovarian tumors (27 cases) are as follows; teratoma (14), mucinous cystadenoma (8), mucinous cystadenocarcinoma (1), serous cystadenoma (2), Krukenburg tumor (1) and malignant thecoma (1). 3. The long diameter of ovarian tumors ranges from 4 cm to 28 cm. In these, mucinous cystadenoma is the largest and their size are as follows; less than 10 cm; 25%, 11-15 cm; 12%, 16-20 cm; 25% and more than 20 cm; 38%. 4. The ultrasonographic findings of teratoma (14) were mainly cystic (8) or echogenic (6). There were echogenic solid components showing distal acoustic shadowing or fat-fluid level within cystic masses. Echogenecity of solid masses was heterogenous. 5. The ultrasonographic findings of mucinous cystadenoma and cystadenocarcinoma (9) were unilocular cystic (3) or multilocular cystic (6). There were variable amount of echogenic component within cystic masses. 6. Those of serous cystadenoma (2) were unilocular cystic (1) or multilocular cystic (1). 7. Krukenburg tumor (1) and Malignant thecoma (1) were heterogenously echogenic.
Lewisch, E; Reifinger, M; Schmidt, P; El-Matbouli, M
Although ovarian tumour in the koi (Cyprinus carpio) does not appear to be an uncommon condition, its occurrence and therapy has rarely been reported. In the present case, the decision for surgery was based on clinical and sonographic findings of an intracoelomic mass. We used tricaine methansulfonate for the anaesthesia. Laparotomy was performed by ventral access and an ovarian tumour of 12-cm diameter was removed. The wound was sutured in two layers using Vicryl®. In addition to the application of an analgesic, an antibiotic and vitamins, the postoperative conditions the patient was kept under were adapted to support wound healing. The fish recovered uneventfully and was clinically healthy during the 16-month observation period. Based on the histological findings, the tumour was diagnosed as a thecoma. Investigations using antibodies against vimentin, cytokeratin, S 100 and glial fibrillary acidic protein (GFAP) failed to provide reliable results.
Blake, Erin A; Carter, Charelle M; Kashani, Banafsheh N; Kodama, Michiko; Mabuchi, Seiji; Yoshino, Kiyoshi; Matsuo, Koji
Sex-cord stromal tumors (SCSTs) are rare ovarian cancers and their behavior during pregnancy is not well understood. To evaluate the maternal and fetal outcomes of pregnancy complicated by ovarian SCST, a systematic literature search was conducted in PubMed/MEDLINE using entry key words "pregnancy" and each type of ovarian SCST ("sex cord stromal tumor," "granulosa cell tumor," "thecoma," "Sertoli-Leydig cell tumor," or "gynandroblastoma") between 1955 and 2012 that identified 46 cases eligible for the analysis. Clinical characteristics, pregnancy outcome, tumor characteristics, and survival outcomes were evaluated. Serious adverse events were defined as complications related to the SCST that resulted in severe morbidity or mortality for mother, fetus, or both. The most common histology was granulosa cell tumor (22.0%), followed by thecoma (18.6%) and Sertoli-Leydig cell tumor (8.5%). Abdomino-pelvic pain (45.7%), palpable mass (30.4%), and virilization (26.1%) were the three most common symptoms. The majority were stage I (76.1%), tumor size complication (13.0%). Logistic regression test identified younger age (pregnancy was comparable to ovarian SCST not related to pregnancy (5-year rate, stages I and II-IV, 100% and 70.0%, respectively). In conclusion, although the majority of cases resulted in live birth, ovarian SCST-complicated pregnancy falls into the category of high-risk pregnancy. Risk factors for SAE identified in our study will help to guide strategic management of pregnancy complicated by ovarian SCST. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Full Text Available AIM: GATA proteins are a family of zinc finger transcription factors regulating gene expression, differentiation and proliferation in various tissues. The expression of GATA-4 and FOG-2, one of its modulators, was studied in pediatric Sex Cord-Stromal tumors of the ovary, in order to evaluate their potential role as diagnostic markers and prognostic factors. MATERIALS AND METHODS: Clinical and histological data of 15 patients, enrolled into the TREP Project since 2000 were evaluated. When available, immunostaines for FOG-2, GATA-4, α-Inhibin, Vimentin and Pancytokeratin were also analyzed. RESULTS: In our series there were 6 Juvenile Granulosa Cell Tumors (JGCT, 6 Sertoli-Leydig Cell Tumors (SLCT, 1 Cellular Fibroma, 1 Theca Cell Tumor and 1 Stromal Sclerosing Tumor (SST. Thirteen patients obtained a complete remission (CR, 1 reached a second CR after the removal of a metachronous tumor and 1 died of disease. Inhibin was detectable in 11/15, Vimentin in 13/15, Pancytokeratin in 6/15, GATA-4 in 5/13 and FOG-2 in 11/15. FOG-2 was highly expressed in 5/6 JGCT, while GATA-4 was weakly detectable only in 1 of the cases. SLCT expressed diffusely FOG-2 (4/6 and GATA-4 (3/5. GATA-4 and FOG-2 were detected in fibroma and thecoma but not in the SST. CONCLUSIONS: Pediatric granulosa tumors appear to express a FOG-2/GATA-4 phenotype in keeping with primordial ovarian follicles. High expression of GATA-4 does not correlate with aggressive behaviour as seen in adults, but it is probably involved in cell proliferation its absence can be associated with the better outcome of JGCT. SLCTs replicate the phenotype of Sertoli cells during embryogenesis in normal testis. In this group, the lack of expression of FOG-2 in tumors in advanced stages might reveal a hypothetical role in inhibiting GATA-4 cell proliferation pathway. In fibroma/thecoma group GATA-4 and FOG-2 point out the abnormal activation of GATA pathway and might be involved in the onset of these tumors.
Krishnan, Danendran; Kumar, Komal; Thomas, Anitha Ann
Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumour that has mixed features of both fibroma and thecoma. The prevalence of ovarian fibrothecoma tumours is very rare and is reported to be about 1.2% of all ovarian tumours. We report a case of a 32-year-old woman who presented with acute menorrhagia with no previous medical, surgical or gynecological history. She was amenorrhic for four years after the insertion of a levonorgestrelreleasing intrauterine system (LNG-IUS) for contraception. The efficacy and location of LNG-IUS was reflected due to the sudden onset of menorrhagia. On pelvic examination and ultrasound the LNG-IUS could not be visualized and a uterine fibroid was noted. A diagnostic laparoscopy was done to identify the LNG-IUS, which revealed an incidental large ovarian mass on the left ovary. CA-125 level was elevated to 45 kU/L (Normal range menorrhagia.
José de Arimatéia Batista Araújo Filho
Full Text Available Sclerosing encapsulating peritonitis (SEP, also called encapsulating peritonitis, is a rare and benign cause of intestinal obstruction of unknown etiology. Its onset may be acute or subacute although there are some reports with a two-month history. More commonly, this entity is secondary to chronic peritoneal dialysis, ventriculoperitoneal and peritoneovenous shunting, the use of β-blockers and systemic lupus erythematous. Recurrent episodes of bacterial peritonitis, intestinal tuberculosis, sarcoidosis, familial Mediterranean fever, gastrointestinal cancer, liver transplantation, intra-abdominal fibrogenic foreign bodies, and luteinized ovarian thecomas are also related to SEP. The idiopathic presentation is more rare. Abdominal pain, nausea, vomiting, weight loss, malnutrition, and clinically palpable mass characterize the clinical features. Diagnosis is frequently made with gross findings during surgery, imaging workup and histopathology. The authors report the case of a 36-yearold male patient with a 10-day history of abdominal pain that was operated on because of intestinal obstruction. Diagnosis was made preoperatively and confirmed by the intraoperative findings and histopathology.
Park, Cheol Keun; Kim, Hyun-Soo
A sclerosing stromal tumor is a very rare benign sex cord-stromal tumor of the ovary. Because its clinical presentation and imaging findings are similar to those of borderline or malignant epithelial tumors and other sex cord-stromal tumors, accurate preoperative clinical diagnosis can be difficult. The aim of this study was to analyze the clinicopathological characteristics of SSTs and examine the immunohistochemical expression TFE3, which has not been studied in SSTs. Our study cohort consisted of 9 patients diagnosed as having SST; the median age was 36 years. Radiologically, SSTs presented as multiseptated cystic masses, mixed echoic masses, pseudolobular masses, solid pelvic masses, or uterine subserosal nodules. In 4 of the 9 cases, the preoperative clinical impression was a borderline or malignant ovarian tumor. SSTs displayed the following histopathological features: 1) relatively well-circumscribed cellular nodules that were randomly distributed in the fibrous or edematous stroma; 2) a characteristic alternating pattern of hypercellular and hypocellular areas; 3) a hemangiopericytoma-like vascular growth pattern in the cellular nodules; 4) bland-looking spindle-shaped cells and round or polygonal cells densely clustered around blood vessels; and 5) red blood cell-containing intracytoplasmic vacuole-like spaces in the tumor cell cytoplasm, possibly indicating epithelioid hemangioendothelioma. Immunohistochemically, the tumor cells exhibited diffuse and moderate-to-strong TFE3 expression in 7 of the 9 SSTs. TFE3 was strongly expressed in the nuclei of round or polygonal cells and lutein cells. In contrast, neither luteinized thecomas nor fibromas appreciably expressed TFE3. In summary, our study describes characteristic histopathological features that may be useful for differentiating SSTs from other sex-cord stromal tumors and demonstrates for the first time that SSTs show strong TFE3 expression. Further investigations are necessary to clarify the role of
Preoperative assessment of asymptomatic adnexal masses by positron emission tomography and F-18-fluorodeoxyglucose; Praeoperative Dignitaetsbeurteilung asymptomatischer Adnextumoren mittels Positronen-Emissions-Tomographie und F-18-Fluordeoxyglukose
Fenchel, S.; Kotzerke, J.; Reske, S.N. [Ulm Univ. (Germany). Abt. Nuklearmedizin; Stoehr, I.; Grab, D.; Kreienberg, R. [Ulm Univ. (Germany). Frauenklinik; Nuessle, K.; Rieber, A.; Brambs, H.J. [Ulm Univ. (Germany). Abt. Radiologie 1 (Roentgendiagnostik)
Aim: To evaluate use of F-18-FDG-PET in assessment of dignity of asymptomatic adnexal masses. Methods: 85 asymptomatic patients with suspicious, asymptomatic adnexal masses were evaluated. Static FDG-PET (Exact HR+ or ECAT 931) imaging of the abdomen was performed following application of 222-555 MBq F-18-FDG. Iterative reconstruction was applied. PET data were analysed visually, at first without and second together with MRT images. Final diagnosis was made by histopathology. Results: FDG-PET allowed correct identification of 4 of 8 malignant adnexal tumors. False negative results were obtained in 2 adenocarcinomas stage pT1a and 2 borderline-tumors. In 60 out of 77 benign adnexal masses malignancy could be excluded. False positive FDG-uptake, partly because of misinterpretation of gastrointestinal activity, was found in 3 inflammatory processes, 1 teratoma, 1 benign schwannoma, 1 dermoid cyst, 1 benign thecoma, 1 serous cyst, 1 serous cystadenoma, 2 mucinous cystadenomas, 2 corpus luteum cysts, 3 endometriosic cysts and 1 sactosalpinx. The overall sensitivity and specifity of FDG-PET alone were 50% and 78%. Evaluation together with MRT images showed a sensitivity of 50% and a specifity of 86%. (orig.) [Deutsch] Ziel: Es wurde untersucht, ob die FDG-PET zu einer Verbesserung der Dignitaetsbeurteilung asymptomatischer, sonographisch malignomsuspekter Ovarialtumoren beitragen kann. Methode: 85 Patientinnen mit malignomsuspekten, asymptomatischen Adnextumoren unterzogen sich einer FDG-PET Untersuchung. Emissionsaufnahmen des Abdomens wurden ca. 1 h nach i.v. Injektion von 222-555 MBq F-18-FDG angefertigt (Exact HR + bzw. ECAT 931). Die Bildrekonstruktion erfolgte iterativ. Die PET-Aufnahmen wurden visuell ausgewertet, zum einen ohne andere bildgebende Verfahren, zum anderen zusammen mit der Kernspintomographie. Die Validierung erfolgte mittels Histologie. Ergebnisse: Histologisch fanden sich 8 Malignome, von denen 4 mittels FDG-PET als richtig positiv erkannt wurden
Young, Robert H
as neuroblastoma. Consideration of the gross and microscopic features, and differential diagnosis, of individual neoplasms follows the introductory remarks and emphasizes the importance of gross pathology. An example of the latter is the marked difference in most cases between a dermoid cyst and an immature teratoma, the former being dominantly cystic and the latter dominantly solid, and the latter on average twice as large as the former. Caution should be exercised in entertaining a diagnosis of immature teratoma if a lesion is grossly a typical dermoid cyst. The treacherous shared gross characteristics and age distribution of the dysgerminoma and small cell carcinoma of hypercalcemic type are noted. The rarity of monodermal teratomas and malignant neoplasms such as squamous cell carcinoma arising in dermoid cysts in the first three decades is noted. The distinctive features of two recently described stromal neoplasms, microcystic stromal tumor and luteinized thecomas of the type associated with sclerosing peritonitis, are emphasized as is the varied differential diagnosis of the juvenile granulosa cell tumor and Sertoli-Leydig cell tumor. Sections on ovarian tumors and tumor-like lesions in pregnant patients and tumor-like lesions overall conclude the article. Copyright © 2014 Elsevier Inc. All rights reserved.
Irving, Julie A; Young, Robert H
We have encountered 16 ovarian neoplasms of probable stromal origin whose most distinctive feature is microcystic change, which is usually conspicuous. On the basis of our extensive experience with ovarian tumors, the neoplasm is unique and warrants separate categorization; we have elected to designate it "microcystic stromal tumor" because of its most striking feature. The patients ranged from 26 to 63 (mean 45) years of age and typically presented with a pelvic mass. Hormonal manifestations were possibly present in only 2. All tumors were unilateral with a mean size of 8.7 (range: 2 to 27) cm and none had evidence of extraovarian spread. The tumors were solid-cystic (11 cases), solid (3 cases), or predominantly cystic (2 cases). The solid component was usually firm and tan or white-tan, but in 1 case was yellowish; soft foci were present in 3 cases and small foci of hemorrhage, necrosis, or both, in 3. On microscopic examination the appearance of the tumors varied according to the relative prominence of their 3 fundamental components: microcysts, solid cellular regions, and fibrous stroma. Microcysts dominated in 9 cases, were roughly equal to noncystic morphology in 5 cases and were minor in 2. The microcystic pattern was characterized by small rounded to oval cystic spaces, in areas coalescing to larger irregular channels; intracytoplasmic vacuoles were also frequently present. The solid cellular areas were usually focally intersected by fibrous bands and hyaline plaques reminiscent of thecoma. The cells contained moderately conspicuous finely granular, lightly eosinophilic cytoplasm, with generally bland, round to oval or spindle-shaped nuclei with fine chromatin and small indistinct nucleoli. Foci of bizarre nuclei were, however, present in 10 cases. Mitotic rate was low in all cases, ranging from 0 to 2 mitoses/10 high-power fields. Immunohistochemical results were as follows: CD10, 16/16 cases positive; vimentin, 16/16 cases positive; inhibin, 1/16 cases