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Revista de La Facultad de Ciencias... Jun 2021During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests...
During menopausal transition, mild clinical signs of hyperandrogenism may appear as part of the normal aging process, but the development of frank virilization suggests a specific source of androgen excess. In this context, androgen-secreting tumors at both adrenal and ovarian levels should be ruled out. We present the case of a 51-year-old postmenopausal woman with signs of 12 month period virilization, associated with personal history of type 2 diabetes and arterial hypertension, poorly managed in the past year. Laboratory tests showed elevation of serum androgen levels and hyperinsulinemia. Images were requested, revealing both enlarged homogeneous and solid ovaries, with preserved adrenal glands, which led to suspicion of a possible thecal hyperplasia of the ovarian stroma. Laparoscopic bilateral adnexectomy was performed and the pathological report confirmed the presumptive diagnosis. One month later after surgery, serum testosterone levels returned to values close to spected for a postmenopausal woman. Finding the source of virilization in postmenopausal women is challenging, and they are usually associated with rare pathologies. A detailed medical history is essential to differentiate the progressive development of virilization that characterizes benign causes from the rapid progression that characterizes malignant tumors. The adequate interpretation of laboratory tests with complementary images, as well as looking for the association of pathologies causing elevated cardiovascular risk such as diabetes and hypertension are essential to establish a right diagnosis and treatment.
Topics: Female; Humans; Hyperplasia; Metabolic Diseases; Postmenopause; Retrospective Studies; Virilism
PubMed: 34181829
DOI: 10.31053/1853.0605.v78.n2.32136 -
Journal of Ovarian Research Apr 2021Ovarian sex cord stromal tumours (OSCSTs) are rare ovarian tumours and include different histopathologic subtypes. This study aimed to analyse the clinical and...
BACKGROUND
Ovarian sex cord stromal tumours (OSCSTs) are rare ovarian tumours and include different histopathologic subtypes. This study aimed to analyse the clinical and sonographic characteristics of different histopathologic OSCST subtypes.
METHODS
A total of 63 patients with surgically proven OSCSTs were enrolled in this retrospective study to analyse their clinical and sonographic features. Ultrasound examinations and predictive models were performed before surgery. The clinical and sonographic findings were compared according to the type of OSCST based on the histopathological diagnosis.
RESULTS
The mean age of 63 patients was 52.17 years (range: 17-78 years). Eighteen patients experienced irregular vaginal bleeding (28.57% 18/63), 7 patients exhibited abnormal body hair (11.11%). 2 patients (3.17%) showed an increased level of CA125, and 25 patients (39.68%, 25/63) showed an increased level of testosterone. Forty-two patients had ovarian thecoma-fibroma groups (OTFGs). Six patients had Sertoli-Leydig cell tumours (S-LCTs), 4 patients had Leydig cell tumours (LCTs), 8 patients had ovarian granulosa cell tumours (OGCTs), 2 patients had ovarian steroid cell tumours, not otherwise specified (OSCTs-NOS), and one patient had sclerosing stromal tumours (SSTs). The mean diameter of the tumour was 47.9 mm (range: 10-258 mm). Forty-seven masses were hypoechoic (74.60%). Twenty-eight masses had posterior echo attenuation, 22 masses exhibited abundant Doppler flow signals (34.92%), and one patient had ascites (1.59%). The diagnostic accuracy of the Simple Rules (SR) and the Assessment of Different NEoplasias in the adneXa (ADNEX) model in distinguishing benign and malignant OSCSTs was 44% (30/63) and 84% (53/63), respectively. The diagnostic accuracy of the SR for OTFGs, S-LCTs & LCTs & OSCTs-NOS, OGCTs, and SSTs was 47.6% (20/42), 16.67% (2/12), 100% (8/8), and 0% (0/1), respectively. The diagnostic accuracy of the ADNEX model for OTFGs, S-LCTs & LCTs & OSCTs-NOS, OGCTs, and SSTs was 93% (31/42), 58.33% (7/12), 75% (6/8), and 100% (1/1), respectively.
CONCLUSIONS
OSCSTs generally appear as a solid mass on ultrasound. Posterior echo attenuation indicates an OTFG. A solid mass with abundant Doppler flow signals indicates an S-LCT, LCT, OSCT-NOS or OGCT. Current predictive models are not very effective, but symptoms, sonographic features and serum hormones are helpful for diagnosis.
Topics: Adolescent; Adult; Aged; Female; Humans; Middle Aged; Sex Cord-Gonadal Stromal Tumors; Ultrasonography; Young Adult
PubMed: 33865445
DOI: 10.1186/s13048-021-00805-0 -
Gynecologic Oncology Reports Nov 2020Elevated serum inhibin B is a classic marker of adult granulosa cell tumors. Here we discuss an extremely rare and informative case of elevated inhibin B associated with...
INTRODUCTION
Elevated serum inhibin B is a classic marker of adult granulosa cell tumors. Here we discuss an extremely rare and informative case of elevated inhibin B associated with an ovarian thecoma.
CASE
A 57 year-old postmenopausal female presented with recurrent bleeding and was found to have an adnexal mass with an elevated serum inhibin B level of 1,915 pg/mL (normal range 10-200 pg/mL). With a preoperative diagnosis of adult granulosa cell tumor, she underwent surgical management for what was ultimately a benign ovarian thecoma. The diagnosis of thecoma was confirmed by a pericellular pattern of reticulin staining and the lack of a mutation by molecular testing.
CONCLUSION
This case demonstrates that inhibin B lacks specificity as a tumor marker for adult granulosa cell tumor, even at very high levels. Knowledge of benign alternative explanations for this finding can facilitate improved preoperative patient counseling. Pertinent literature is reviewed, with an emphasis on proposed hypotheses for inhibin overproduction.
PubMed: 33204793
DOI: 10.1016/j.gore.2020.100658 -
Proceedings (Baylor University. Medical... Jul 2020Although rare, fibroepithelial polyp of the ureter is the most common type of benign urinary tract mesodermal tumor. It may cause symptoms such as hematuria, dysuria,...
Although rare, fibroepithelial polyp of the ureter is the most common type of benign urinary tract mesodermal tumor. It may cause symptoms such as hematuria, dysuria, and flank pain or be asymptomatic. Here we report incidental intraoperative detection of a left ureteral fibroepithelial polyp during an elective gyno-oncological surgery for left-sided ovarian thecoma.
PubMed: 33100571
DOI: 10.1080/08998280.2020.1783968 -
Medicine May 2020To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy.Retrospective analysis was performed on 45... (Observational Study)
Observational Study
To investigate the magnetic resonance imaging (MRI) findings in ovarian thecoma and improve preoperative diagnostic accuracy.Retrospective analysis was performed on 45 patients with surgically and pathologically confirmed ovarian thecoma. Patients were grouped into those with maximum lesion diameter ≥5 cm and <5 cm. Diagnostic scores (up to 6 points) were evaluated on the basis of MRI performance.The ≥5 cm group contained 36 cases (cystic necrosis, 32 cases) with the following findings: T1WI: isointense signal, 22 cases; slightly hypointense signal, 14 cases; T2WI: isointense signal, 6 cases; slightly hypointense signal, 21 cases; slightly hyperintense signal, 9 cases; Diffusion-weighted imaging (DWI): hyperintense signal, 23 cases; mixed hyperintense signal, 13 cases; slight enhancement on dynamic enhanced scans; pelvic fluid accumulation, 31 cases. The diagnostic score evaluations yielded 6 points in 31 cases, 5 points in 1 case, 4 points in 2 cases, and 3 points in 2 cases. The <5 cm group contained 9 cases (cystic necrosis, 3 cases) with the following findings: T1WI: isointense signal, 3 cases; slightly hypointense signal, 6 cases; T2WI: isointense signal, 2 cases; slightly hypointense signal, 4 cases; slightly hyperintense signal, 3 cases; DWI, hyperintense signal; slight enhancement in 8 cases and significant enhancement in 1 case; pelvic fluid accumulation, 4 cases. The diagnostic score evaluations yielded 6 points in 3 cases, 5 points in 1 case, 4 points in 4 cases, and 3 points in 1 case. (iii) Incidence of pelvic fluid accumulation and cystic necrosis differed depending on the size of the lesion (P = .007, .000).Larger lesions show hyperintense or mixed hyperintense signals on DWI along with pelvic fluid and cystic necrosis; whereas, smaller lesions show a hyperintense signal on DWI, cystic necrosis is rare. MRI characteristics along with the patient age and laboratory findings can improve the accuracy of preoperative diagnosis of these lesions.
Topics: Adult; Aged; China; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Ovarian Neoplasms; Radiology; Sensitivity and Specificity; Thecoma
PubMed: 32481327
DOI: 10.1097/MD.0000000000020358 -
Taiwanese Journal of Obstetrics &... Nov 2019
Topics: Diagnosis, Differential; Female; Humans; Laparoscopy; Laparotomy; Leiomyoma; Ovarian Neoplasms; Ovary; Thecoma; Unnecessary Procedures
PubMed: 31759556
DOI: 10.1016/j.tjog.2019.09.026 -
Skin Appendage Disorders Jun 2019
PubMed: 31367608
DOI: 10.1159/000494730 -
Gynecologic Oncology Reports May 2019Luteinized thecoma with sclerosing peritonitis (LTSP) is a very rare condition, and its clinical management is not evidence-based. Here we describe a case of long-term...
BACKGROUND
Luteinized thecoma with sclerosing peritonitis (LTSP) is a very rare condition, and its clinical management is not evidence-based. Here we describe a case of long-term disease control achieved with leuprorelin and tamoxifen therapy.
CASE PRESENTATION
A 18-year-old woman with acute abdomen underwent surgical removal of an ovarian mass and received diagnosis of LTSP. Treatment plan consisted of leuprorelin and tamoxifen, followed by a good instrumental response. After 5 years, leuprorelin was stopped, and the patient continued tamoxifen alone. Ten years after diagnosis, she is still disease free.
CONCLUSION
Even in the absence of solid evidence, the combination of leuprorelin and tamoxifen could be considered as a possible medical treatment of LTSP. Considering the limitations related to the rarity of disease, further studies are needed to improve its management.
PubMed: 30859116
DOI: 10.1016/j.gore.2019.02.004 -
European Journal of Radiology Open 2019Mucinous tumors are a common ovarian cystic tumor, having a characteristic finding on MR imaging, the so-called stained glass appearance. We report a rare case of a...
Mucinous tumors are a common ovarian cystic tumor, having a characteristic finding on MR imaging, the so-called stained glass appearance. We report a rare case of a solidified mucinous tumor of the ovary, which showed unique findings on MR images. The tumor demonstrated hypointensity on T2-weighted images, not stained glass appearance, mimicking ovarian fibrous tumor such as thecoma-fibroma. Histopathological examination confirmed solidified contents of the tumor with numerous septa and diagnosed mucinous borderline tumor/atypical proliferative tumor.
PubMed: 30723755
DOI: 10.1016/j.ejro.2019.01.005 -
Archives of Pathology & Laboratory... Dec 2018This year being the 60th anniversary of the publication of the excellent book Endocrine Pathology of the Ovary by John McLean Morris, MD, and Robert E. Scully, MD, the... (Review)
Review
Ovarian Sex Cord-Stromal Tumors: Reflections on a 40-Year Experience With a Fascinating Group of Tumors, Including Comments on the Seminal Observations of Robert E. Scully, MD.
CONTEXT.—
This year being the 60th anniversary of the publication of the excellent book Endocrine Pathology of the Ovary by John McLean Morris, MD, and Robert E. Scully, MD, the writer reflects on that work and in particular the remarkable contributions of its second author to our knowledge in this area.
OBJECTIVE.—
To review ovarian sex cord-stromal tumors.
DATA SOURCES.—
Literature and personal experience.
CONCLUSIONS.—
The essay begins with remarks on the oftentimes straightforward stromal tumors of the ovary because the commonest of them, the fibroma, dominates from the viewpoint of case numbers. Then, the sclerosing stromal tumor and the peculiar so-called luteinized thecomas of the type associated with sclerosing peritonitis are discussed in greater detail and their wide spectrum is illustrated. Brief mention is made of 2 rare neoplasms: the ovarian myxoma and signet-ring stromal tumor. Discussion then turns to the more recently recognized intriguing tumor tentatively designated microcystic stromal tumor and the commonest malignant tumor in this entire family, the so-called adult granulosa cell tumor, which despite its name may occasionally be seen in young individuals. The second variant of granulosa cell tumor-that which usually, but not always, occurs in the young-the so-called juvenile granulosa cell tumor, is then discussed. In the section of Sertoli-Leydig cell tumors, particular attention is focused on unusual tumors with heterologous elements and the remarkable so-called retiform tumors, which have a predilection for the young, often have distinctive gross features, and exhibit slitlike spaces and papillae. The essay concludes with consideration of the sex cord tumor with annular tubules.
Topics: Female; Granulosa Cell Tumor; Humans; Ovarian Neoplasms; Ovary; Sex Cord-Gonadal Stromal Tumors
PubMed: 30500284
DOI: 10.5858/arpa.2018-0291-RA