Padrão histopatológico e incidência de carcinomatose peritoneal ao diagnóstico em mulheres com câncer de ovário / Histopathological pattern and incidence of peritoneal carcinomatosis at diagnosis in women with ovarian cancer

Objetivo: Descrever o padrão histopatológico e identificar a incidência de carcinomatose peritoneal no momento do diagnóstico de mulheres diagnosticadas com neoplasia de ovário. Métodos: Trata-se de um estudo transversal e descritivo, baseado na análise secundária de dados correspondentes aos prontuários de mulheres adultas com diagnóstico de neoplasia de ovário de um serviço de referência em oncologia clínica. Foram analisados 40 prontuários entre janeiro de 2007 e janeiro de 2017. Resultados: Ao estadiamento segundo o sistema da International Federation of Gynecology and Obstetrics, três mulheres (7,5%) apresentavam estadiamento clínico (EC) II, três (77,5%) estágio ECIII com carcinomatose peritoneal/invasão da pelve e seis (15%) estágio ECIV com metástases à distância, especialmente para pulmão e fígado. Em relação ao padrão histopatológico, 20 mulheres apresentaram adenocarcinoma seroso papilífero de alto grau (50%), 4 (10%) adenocarcinoma seroso papilífero de baixo grau, 3 (7,5%) adenocarcinoma endometrioide, 3 (7,5%) tumor de teca/granulosa, 3 (7,5%) carcinoma de células claras, 3 (7,5%) tumores não classificados, 2 (5%) disgerminoma e 2 (5%) com cistoadenocarcinoma mucinosos. Conclusão: É nítida a necessidade de mais estudos envolvendo essa patologia, de modo a favorecer o diagnóstico e a intervenção em estágios mais precoces e reduzir desfechos desfavoráveis. (AU)

Objective: To describe the histopathological pattern, and to identify the incidence of peritoneal carcinomatosis at the time of the diagnosis of women diagnosed with ovarian neoplasm. Methods: This is a cross-sectional and descriptive study, based on the secondary analysis of data corresponding to the medical records of adult women diagnosed with ovarian neoplasm in a reference service of clinical oncology. A total of 40 medical records were analyzed between January 2007 and January 2017. Results: At the staging (FIGO system) of the International Federation of Gynecology and Obstetrics, three women (7.5%) had clinical staging (EC) II staging, 31 (77.5%) were in the ECIII stage, with peritoneal carcinomatosis/pelvic invasion, six (15%) were in the ECIV stage, with metastases at a distance, especially to lung and liver. Regarding the histopathological pattern, twenty women had high-grade papillary serous adenocarcinoma (50%), 4 (10%) with low-grade papillary serous adenocarcinoma, 3 (7.5%) with endometrioid adenocarcinoma, 3 (7.5%) with granulosa-theca tumor, 3 (7.5%) with clear cell carcinoma, 3 (7.5%) with unclassified tumors, 2 (5%) with dysgerminoma, two (5%) with mucinous cystadenocarcinoma. Conclusions: There is a clear need for further studies involving this pathology, in order to favor diagnosis and intervention at earlier stages and to reduce unfavorable outcomes. (AU)

Bilateral Ovarian Collision Tumours: Serous Carcinomas and Fibrothecomas / Tumores de colisión ováricos bilaterales: carcinomas serosos y fibrotecomas

ABSTRACT A patient had both ovaries affected by clearly demarcated colliding tumour masses of different gross appearance, histological features and immunohistochemical profiles, corresponding to bilateral collision papillary serous high-grade adenocarcinoma and fibrothecoma. Despite the applied chemotherapy, it led to a lethal outcome for the patient nearly a year after the surgery. Bilateral ovarian tumours raise the question of whether they are primary tumours or metastases. Simultaneous bilateral occurrence of surface epithelial tumours with other types of ovarian tumours is rare. Therefore, it poses a great challenge in proper differential diagnostics.

RESUMEN Una paciente tenía ambos ovarios afectados por masas tumorales en colisión, claramente demarcadas. Las mismas mostraban diferente aspecto macroscópico, y diferentes rasgos histológicos y perfiles inmunohistoquímicos, correspondientes a fibrotecomas y adenocarcinomas serosos papilares bilaterales de alto grado en colisión. A pesar de la quimioterapia aplicada, la condición condujo a un resultado fatal para la paciente, casi un año después de realizada la cirugía. Los tumores ováricos bilaterales plantean la cuestión de si se trata de tumores primarios o metástasis. La ocurrencia bilateral simultánea de tumores epiteliales superficiales con otros tipos de tumores ováricos es rara, y por tanto, plantea un gran desafío a la hora de realizar un diagnóstico diferencial adecuado.

Fibrotecoma extraovárico gigante retroperitoneal / Giant Retroperitoneal Extraovarian Fibrothecoma

El fibrotecoma ovárico es una neoplasia poco frecuente y su localización extraovárica es más rara aún. Se observa generalmente como tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría, es benigno y puede ser funcionales o no. Actualmente solo se han reportado tres pacientes y solo una de ellas de localización retroperitoneal. Se presenta un caso de una paciente con fibrotecoma extraovárico gigante retroperitoneal. Se realizó a la paciente exéresis de la lesión sin complicaciones intra ni posoperatorias.

Ovarian fibrothecoma is a rare malignancy and its extraovarian location is even rarer. It is generally seen as unilateral solid tumor, of variable size, in premenopausal women. It is mostly benign and it can be functional or not. Currently only three patients have been reported and only one of retroperitoneal location. A case of a patient with giant retroperitoneal extraovarian fibrothecoma is presented in this paper. The patient underwent excision of the lesion showing no intraoperative or postoperative complications.

Postmenopausal Meigs' Syndrome in Elevated CA-125: A Case Report

Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated cancer antigen 125 (CA-125) in Meigs' syndrome is an unusual clinical condition reported in few cases. We report here on a 61-year-old woman who presented with dyspnea; in imaging assessment, a heterogeneous pelvic mass measuring 12 x 11 cm with ascitic fluid was reported. Pleural effusion was detected on Chest X-ray. Aspiration of pleural fluid showed no evidence of malignancy. CA-125 level was 347 IU/mL. The patient underwent laparotomy during which a mass measuring 12 x 11 cm was detected in her left adnexa. Histology showed ovarian thecoma. The mass was resected, and, after that, the symptoms disappeared and CA-125 level reached 19 IU/mL. The patient had experienced no problem after 12 months of follow up. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA-125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.

Unilateral ovarian fibrothecoma with menorrhagia

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 <35 kU/L). Total abdominal hysterectomy, left salpingo-oopherectomy and cystectomy were performed. On histopathology, the mass was proven to be an ovarian fibrothecoma. No signs of malignancy were noted on peritoneal fluid cytology. The LNG-IUS was found inside the uterus. Our case is reported on the basis of the rare incidence of ovarian fibrothecoma and the possible effect it may have on the efficacy of LNG-IUS causing menorrhagia.

rare case of bilateral pelvic mass

A case of 69- year-old woman with large pelvic mass and ascites is reported in this paper. With the exception of mild pelvic pain and a Pelvic mass in pelvic, shehad no symptom or sign. All routine and hormonal Lab tests and tumor marker's were normal. The MRI revealed a large mass in anterosuperior of uterus, and left ovary was situated in neighborhood of pelvic mass.Her Uterus normal, with a small cyst in the right ovary. The total abdominal hysterectomy and bilateral salpingo- oophorectomy revealed a large cream solid mass [16×8× 8 Cm, 1260 gr] in the left ovar. Nonetheless the right ovary had normal appearance with a cyst [3×2.5Cm]. There was some free fluid in the pelvic cavity. The ovarian mass was identified as fibrothecoma, the right ovarian cyst as serous cystadenoma, but no malignant cells found in free fluid. This case had interesting features, because first clinical features suggested a bilateral malignancy in pelvic, but she had two different tumors which were benign. Also, the occurrence of bilateral fibrothecoma and serous cystadenoma were rare. Furthermore, we did find no similar case in the literature

Sclerosing stromal tumors of the ovary occurred in various ages / 대한산부인과학회지

Sclerosing stromal tumor (SST) of the ovary is a rare, benign tumor. The most common clinical symptom is menstrual irregularity. Diagnosis of SST is often made by postoperative pathologic examination. The important differential diagnoses are other sex cord stromal tumors including fibroma, thecoma and etc. We present four cases of SST of the ovary during 10 years with a brief review of the literature.

Ovarian Thecoma with Virilizing Manifestations

A 29-year-old woman presented with secondary amenorrhea, primary infertility, and virilization, which had developed over the past 2 years was suspected to have a virilizing tumor at her left ovary. Her serum testosterone level was markedly elevated (380 ng/dL). Left salpingooophorectomy was performed, and histopathological examination revealed a thecoma of the left ovary. The postoperative serum testosterone level returned to 65 ng/dL. The patient did not have regression of virilism soon. However, the patient had a normal menstruation 29 days after surgery and gave birth to a baby 13 months after surgery.

A case of ovarian sclerosing stromal tumor with massive ascites and elevated CA 125 / 대한산부인과학회지

Sclerosing stromal tumor (SST) is an uncommon benign tumor of the ovary, representing 2~6% of all stromal ovarian tumors. It is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and steroid cell tumors. It presents most often with non-specific symptoms and tumor markers usually remain normal. However massive ascites is a rare symptom. We report a case of sclerosing stromal tumor with massive ascites and elevated CA 125 with brief review of literature.

A case of ovarian sclerosing stromal tumor with massive ascites and elevated CA 125 / 대한산부인과학회지

Sclerosing stromal tumor (SST) is an uncommon benign tumor of the ovary, representing 2~6% of all stromal ovarian tumors. It is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and steroid cell tumors. It presents most often with non-specific symptoms and tumor markers usually remain normal. However massive ascites is a rare symptom. We report a case of sclerosing stromal tumor with massive ascites and elevated CA 125 with brief review of literature.

Sclerosing peritonitis associated with luteinized thecoma and elevated serum CA 125 levels: case report / Peritonite esclerosante associada com tecoma tuteinizante e elevação do CA 125: relato de caso

CONTEXT: Thecomas are benign tumors that account for less than 1 percent of all ovarian neoplasms. The association of ovarian thecoma with sclerosing peritonitis is rare. CASE REPORT: We report the case of a 33-year-old woman, with a two-month history of increasing abdominal volume. Ultrasound showed a complex pelvic lesion and laboratory analysis detected elevated serum CA 125 levels. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and peritoneal biopsy. Histopathological analysis revealed the presence of luteinized thecoma of both ovaries associated with sclerosing peritonitis.

CONTEXTO: Os tecomas são tumores benignos e representam menos de 1 por cento das neoplasias ovarianas. A associação de tecoma de ovário com peritonite esclerosante é rara e caracteriza-se pela presença de múltiplos espessamentos nodulares fibróticos no peritôneo. RELATO DE CASO: Relatamos um caso de uma paciente de 33 anos de idade, com aumento de volume abdominal há dois meses. A ultra-sonografia mostrou uma lesão pélvica complexa e a dosagem de CA 125 mostrava-se elevada. A paciente submeteu-se a histerectomia abdominal total com ooforectomia bilateral e biópsia peritoneal. O exame histopatológico revelou a presença de tecoma luteinizado de ovário bilateral associado a peritonite esclerosante.

[Diagnostic value of immunohistochemistry in ovarian sex cord-stromal tumors]

The ovarian tumors' diagnosis is bused on biological and radiologic tests but only the histological examination associated to an immunohistochemical study allow best diagnosis. The purposes of this study is to examine inhibin and other markers immunoreactivity to ovarian sex cord-stromal tumors and their histological mimics and to discuss its value in the differential diagnosis. We report a retrospective study of 31 cases of ovarian sex cord-stromal tumors and review the clinical, pathologic and immunohistochimical features of these tumors. The average age of our patients was 51.3 years with an average size of 8,4 cm. Immunostaining for inhibin was positive in 66% of granulosa cell tumor, in 50% of Sertoli-Leydig cell tumor and in 54% of thecoma-fibroma group. Inhibin immunoreactivity was more important than with cytokeratin and epithelial membrane antigen, but less marked than with CD99, vimentin, smooth muscle actin, desmin and 5-100 protein. The results of this study show that although it is not complete specificity, inhibin, contrarily to the other markers, can be used to help in the distinction between ovarian sex cord-stromal neoplasms and the other primary and metastatic tumors

A case of huge sclerosing stromal tumor of the ovary weighing 10 kg in a 71-year-old postmenopausal woman / 부인종양

Sclerosing stromal tumor (SST) is a rare benign neoplasm of ovarian stromal origin and predominantly affects young women in the second and third decades. This tumor characteristically differentiates itself histologically and clinically from both thecomas and fibromas. We present a case of huge SST of the ovary weighing 10 kg in a 71-year-old postmenopausal woman with a brief review of the literature.

A case of huge sclerosing stromal tumor of the ovary weighing 10 kg in a 71-year-old postmenopausal woman / 부인종양

Sclerosing stromal tumor (SST) is a rare benign neoplasm of ovarian stromal origin and predominantly affects young women in the second and third decades. This tumor characteristically differentiates itself histologically and clinically from both thecomas and fibromas. We present a case of huge SST of the ovary weighing 10 kg in a 71-year-old postmenopausal woman with a brief review of the literature.

A case of thecoma causing precocious puberty at 6 years old age / 대한산부인과학회지

Thecomas make up only 0.5% to 1% of ovarian tumors. They occur in woman predominantly in the perimenopausal and menopausal years. The average patient's age is between 50 and 55 years.1-3 Thecomas only rarely occur in children.4 These tumors can be associated with estrogen production but not as frequently as are granulosa cell tumors. They are mostly unilateral and rarely malignant, so exicion of ovary is adequate treatment.5 Recently, we experienced thecoma, causing precocious puberty in 6 year old girl. and report with brief review of literatures.

Comparision of sonographic findings and pathological features in ovarian thecoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To compare the sonographic findings with pathological features of ovarian thecoma, and to analyze the relationship between them.</p><p><b>METHODS</b>The sonograms of 45 ovarian thecoma cases were reviewed retrospectively and categorized into three subtypes as sound attenuation pattern, homogeneous hypoechoic pattern and solid and cystic mixed pattern. The pathological findings were classified as theca cell-predominant, fibroblast-predominant and mixed thecoma according to the cellular composition of the tumors. Hyaline degeneration and luteinization of the tumors were recorded. The pathologic findings of each subtype based on sonography were compared.</p><p><b>RESULTS</b>Of the 45 patients, there were 34 (75.6%) solid ovarian lesions, 15 (33.3%) of those showed a sound-attenuation pattern with an anterior hypoechoic zone and posterior acoustic attenuation in sonography, the other 19 (42.2%) cases had homogeneous hypoechoic pattern with no posterior acoustic attenuation, and the remaining 11 (24.4%) cases presented as a solid and cystic mixed pattern. There were no significant differences in pathological cellular composition among the three sonographic subtypes. Five solid tumors containing hyaline degeneration and one with luteinization were found to have posterior acoustic attenuation. The solid and cystic mixed thecomas showed cystic degeneration and hemorrhage.</p><p><b>CONCLUSION</b>Solid ovarian thecomas usually have typical sonographic features, which may be associated with degeneration but not with cellular composition within the tumor.</p>

Ovarian steroid cell tumor, not otherwise specified: a clinicopathologic study / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the clinicopathologic features, diagnostic criteria, differential diagnosis and treatment options of ovarian steroid cell tumor, not otherwise specified (NOS).</p><p><b>METHODS</b>Light microscopy and immunohistochemical study was carried out in 8 cases of ovarian steroid cell tumor, NOS. The literature was reviewed.</p><p><b>RESULTS</b>The 7 cases of benign ovarian steroid cell tumor, NOS were composed mainly of polygonal cells with granular eosinophilic cytoplasm and larger cells with vacuolated cytoplasm. They resembled the architecture of normal adrenal gland, with formation of cell nests and trabeculae. The single case of malignant ovarian steroid cell tumor had evidence of significant cellular pleomorphism, haemorrhage and coagulative tumor necrosis. The mitotic count measured about 7 per 10 high-power fields. Immunohistochemical study showed that the tumor cells expressed calretinin and alpha-inhibin. Differential diagnosis included oxyphilic granulosa cell tumor, thecoma, Sertoli cell tumor and clear cell carcinoma. The treatment options of benign ovarian steroid cell tumor, NOS was local excision or ipsilateral salpingo-oophorectomy, while the malignant counterpart should be treated with a combination of surgery and chemotherapy, including administration of GnRH agonist.</p><p><b>CONCLUSIONS</b>Ovarian steroid cell tumor, NOS, is the most common type of ovarian steroid cell tumors. Most of which are associated with a benign clinical outcome. Immunohistochemistry is an important adjunct for diagnosis. The treatment options of ovarian steroid cell tumor, NOS depend on its malignant potential.</p>

A case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of bilateral ovary / 대한산부인과학회지

Fibrothecoma is mesenchymal tumor deriving from the ovarian stroma composed of theca-like elements and fibrous tissues. Fibroma is rarely associated with Meigs' syndrome which consists of an ovarian fibroma, ascites, and pleural effusion. And also, sclerosing peritonitis associated with thecoma of the ovary is a rare, but intriguing phenomenon characterized by striking peritoneal reactive fibrosis. We have experienced a case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of the bilateral ovaries in a 57-year-old woman. We report a case with brief review of literatures.

A Clinicopathological Study in patients with Granulosa Stromal Cell Tumor of the Ovary / 대한산부인과학회지

OBJECTIVE: The purpose of this study is to know the pathological and clinical characteristics of granulosa stromal cell tumor of the ovary. METHODS: From January 1996 to December 2005, patients with granulosa cell tumor of ovary and ones with thecoma, which are included in granulosa stromal cell tumor of the ovary, treated in the Obstetrics and Gynecology, College of Medicine, the Kyungpook National University Hospital of Korea were identified and reviewed retrospectively for patient profiles, mode of therapy, length of survival and so on. RESULTS: There were 14 granulosa cell tumors, and 55 thecomas. The mean age of patients with granulosa cell tumor was 46.8 years old, and 7 women (50.0%) were menopausal. Bilaterality was absent, and mean size of tumor was 11.1 cm. The chief complaints of patients were 3 cases (21.4%) of abdominal discomfort or pain, 3 cases (21.4%) of vaginal bleeding and 4 cases (28.6%) of no symptom. Of 14 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 5 cases (35.7%). Chemotherapy was performed in 5 cases (35.7%), and regimen was combination of BEP (bleomycin+etoposide+cisplatin). According to FIGO staging, 10 cases (71.4%) were stage I. Second look operation was done in one case (7.1%). Among 14 patients of follow-up, one patient (7.1%) was expired. Surgical staging was associated with survival rate of patients. The mean age of patients with thecoma was 49.6 years old, and 28 women (50.9%) were menopausal. Bilaterality was 3 cases (5.4%), and mean size of tumor was 8.5cm. The chief complaints of patients were 14 cases (25.4%) of abdominal discomfort or pain, and 19 cases (34.5%) of no symptom. Of 55 cases, total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed in 21 cases (38.2%). Among 55 patients of follow-up, all patients survived. CONCLUSION: Thecomas are regarded as benign tumors but granulosa cell tumors are characterized by a long natural history with a significant capacity to recur years after apparent clinical cure. The patients with granulosa cell tumor should be followed up indefinitely.

A Case of Pseudo-Meigs' Syndrome with Elevated Serum CA 125 levels / 대한산부인과학회지

Meigs' syndrome is defined by the presence of ascites and hydrothorax in association with an ovarian fibroma, which spontaneously resolve soon after the removal of the tumor. Pseudo-Meigs' syndrome refers to the same clinical features associated with other ovarian tumors; thecoma, granulosa cell tumor, Brenner tumor, struma ovarii, etc. Elevated serum CA 125 levels have a strong correlation with ovarian malignancy, but several benign ovarian tumors have been found to cause a rise in CA 125 levels. We present a case of Pseudo-Meigs' syndrome with an elevated CA 125 resulting from thecoma with a brief review of the literatures.