Synchronous uterine serous carcinoma and ovarian sex cord stromal tumor (thecoma)–A rare first case report

Synchronous endometrial and ovarian carcinoma is a rare instance and it accounts for 50 to 70% of all synchronous female genital tract tumors. However, it is very rare to find synchronous endometrial carcinoma and ovarian sex cord–stromal tumor (thecoma). The present case is a 75-year-old woman with a complaint of post-menopausal vaginal bleeding. Radiologically, the magnetic resonance imaging (MRI) pelvis revealed altered signal intensity mass in the uterus. Frozen section and routine histopathological examination were done on radical hysterectomy. Microscopically, serous carcinoma involving uterine corpus and left Fallopian tube was identified along with the unusual finding of contralateral ovarian sex cord–stromal tumor (thecoma), which was confirmed on immunohistochemical examination. It is a very rare association and is first reported in the present study after a thorough search of the published literature. Their relationship based on a high level of estrogen produced by the hyperactive ovary is controversial as serous carcinomas are less hormone-dependent.

Clinical laboratory features of Meigs' syndrome: a retrospective study from 2009 to 2018 / 医学前沿

Meigs' syndrome (MS), a rare complication of benign ovarian tumors, is easily misdiagnosed as ovarian cancer (OC). We retrospectively reviewed the clinical laboratory data of patients diagnosed with MS from 2009 to 2018. Serum carbohydrate antigen 125 and HE4 levels were higher in the MS group than in the ovarian thecoma-fibroma (OTF) and healthy control groups (all P < 0.05). However, the serum HE4 levels were lower in the MS group than in the OC group (P < 0.001). A routine blood test showed that the absolute counts and percentages of lymphocytes were significantly lower in the MS group than in the OTF and control groups (all P < 0.05). However, these variables were higher in the MS group than in the OC group (both P < 0.05). The neutrophil-to-lymphocyte ratio (NLR) was also significantly lower, whereas the lymphocyte-to-monocyte ratio was higher in the MS group than in the OC group (both P < 0.05). The NLR, platelet-to-lymphocyte ratio, and systemic immune index were significantly higher in the MS group than in the OTF and control groups (all P < 0.05). The hypoxia-inducible factor-1 mRNA levels were also significantly higher, whereas the glucose transporter 1, lactate dehydrogenase, and enolase 1 mRNA levels were lower in peripheral CD4

Ovarian thecoma: Ultrasonic findings and causes of missed and misdiagnosis / 中国医学影像技术

Objective: To observe the ultrasonic findings of ovarian thecoma (OT), and to analyze causes of missed and misdiagnosis. Methods: Data of 17 OT patients diagnosed by pathology were retrospectively analyzed, and the shape, border, internal echo, blood signal, posterior echo and ultrasonic diagnosis of OT lesions were observed. Results: There were 18 OT lesions in 17 patients, 16 case with unilateral single lesion and 1 case with bilateral single lesions, 2 (2/18, 11.11%) lesions grew outward of ovary and 16 (16/18, 88.89%) in the ovary. Fifteen lesions were found with preoperative ultrasound and 3 were missed. Among 15 OT lesions detected with ultrasound, the shape of 8 were regular and 7 were lobed, the border of 14 lesions were clear and of 1 obscure, 12 were solid, 2 were cystic and solid and 1 was cystic,11 were homogeneous hypoecho while 4 were uneven hypoecho, when CDFI found few blood signal in 9 and no blood signal in rest 6 lesions. Liquefaction was found in 3 lesions, while 12 had no liquefaction. All 15 OT lesions had no calcification, while 2 lesions had posterior echo attenuation and 13 had no attenuation. Among these 15 lesions, preoperative ultrasound only correctly diagnosed 1 lesion as OT. In the rest 14 lesions, preoperative ultrasound could not locate and quantitate 1 lesion, while located 6 lesions as ovarian source tumors, the nature of the tumor was not clear, miss diagnosed 5 as ovarian malignancy or ovarian teratoma, 2 as subserous myoma of uterus/broad ligament myoma. Conclusion: Ultrasonic findings of OT are lack of specificity, easy to be missed when relative small OT coexisting with other large ovarian lesions, or misdiagnosed as subserous myoma of uterus, broad ligament myoma and other ovarian tumors.

The value of MRI in differentiating diagnosis of ovarian thecoma-fibroma and adult-type ovarian granulosa cell tumor / 实用放射学杂志

Objective To compare the MRI features of ovarian thecoma-fibroma and adult-type ovarian granulosa cell tumor (OGCT),and to investigate the differential value of MRI.Methods 13 patients (8 cases of ovarian thecoma-fibroma,5 cases of adult-type OGCT)confirmed by pathology were collected,in which MRI findings were analyzed retrospectively.Results 13 lesions were all unilateral.The shape of more lesions appeared round or oval,and huge lesions were lobulated.Most tumors were dominant solid and well-defined borders.The length-diameter of ovarian thecoma-fibromas ranged from 23 to 268 mm,with the mean diameter of (124±84)mm;on T1WI the solid part of tumors showed equal signal in 5 cases,slight lower signal in 3 cases,on T2WI all tumors were heterogeneous signal,6 lesions appeared equal signal with obscure nebulous high signal;all of 8 lesions were enhanced slightly;4 cases were accompanied with pelvic effusion and other type tumors of the ovarian.The length-diameter of adult-type OGCT tumors ranged from 27 to 110 mm, with the mean diameter of (84±33)mm;the solid part of lesions showed slight lower signal on T1WI and high signal on T2WI,the honeycomb and fissure cystic areas were found in all tumors,4 cases were accompanied with hemorrhage;all tumors were enhanced from moderately to highly,and delay contrast enhancement;the cases were accompanied with endometrial hyperplasia in 3 cases,endometrial carcinoma in 1 case.The non-enhanced cystic areas of two groups of tumors showed lower signal on T1WI and high signal on T2WI. Conclusion There are different characteristics between ovarian thecoma-fibroma and adult-type OGCT on MRI findings,which are helpful to the differential diagnosis.

Correlation between imaging characteristics and histopathology in the ovarian thecoma-fibroma / 中国医师进修杂志

Objective To explore the imaging characteristics of the ovarian thecoma-fibroma.Methods The clinical imaging characteristics of 25 patients with thecoma-fibroma were retrospectively analyzed. Results A total of 27 lesions were seen in 25 patients, and the maximum diameter of the tumors was 1.2 - 15.0 cm, with an average diameter of 6.9 cm. The tumors whose maximum diameter larger than 6 cm were mainly as cysticsolid. Twenty-six lesions were well-defined margin, and 14 lesions were round and oval masses, 9 lesions were lobulated masses, 3 lesions were irregular masses, and 1 lesion presented with unclear boundary. A total of 10 lesions in 9 cases were performed with CT scan, and the density was similar to uterine muscle density. In MRI scan of a total of 17 lesions of 16 cases, all lesions showed hypointensity on T1WI. On T2WI, 8 lesions showed slightly hyperintensity, 7 lesions appeared slight hypointensity, and 2 lesions appeared significantly hypointense. Eight lesions showed slit hyperintensity. Enhancement scanning was performed in seven cases. Five cases showed mild to moderate enhancement, 1 case was enhanced obviously, and 1 case was not strengthened. Conclusions The imaging findings of the ovarian thecoma-fibroma have somewhat features and can indirectly reflect pathology of tumor. Combined with the clinical data, imaging characteristics are is helpful to the diagnosis and differential diagnosis of the disease.

Diagnosis and differential diagnosis of ovarian thecoma-fibroma in multi-slice CT / 实用放射学杂志

Objective To analyze the imaging features of ovarian thecoma-fibroma in multi-slice CT (MSCT )and improve the di-agnostic level.Methods CT features of 26 patients with 28 pathologically confirmed lesions were analyzed retrospectively.Correla-tion between tumor length and ascites and menopause was analyzed.Results Of 26 patients (28 lesions),24 patients were unilateral, 2 patients were bilateral.Of 28 lesions,there were 18 ovarian thecoma,6 fibrothecoma and 4 fibroma.The longest diameter of tumor ranged from 34.74 mm to 227.64 mm (mean value 101.06 mm±42.25 mm).The longest diameter of tumor in the group of ascites (n=1 7)was larger than that of without ascites.All the tumors had well-defined border,with 24 of them round or oval in shape,4 lobulated;with 22 of them solid in composition,4 mixed,2 cystic;with 20 of them inhomogeneous in density.The tumors showed no or mild enhancement,0-5 HU added CT value in 1 1,5-10 HU in 1 1,10 -20 HU in 6,with 4 cases showing multiple slim blood vessels during the arterial phase.Conclusion The typical imaging features of ovarian thecoma-fibroma were unilateral,oval,solid mass with well-defined border,no or mild enhancement (less than 20 HU)and accompanied by ascites.These characteristics will be helpful in the diagnosis and differential diagnosis of ovarian thecoma-fibroma.

Value of combined CA125, CT and MRI in diagnosing the ovarian thecoma / 中国综合临床

Objective To discusses the value of combined CA125 and CT/MR/ in diagnosing the ovarian thecoma.Methods Forty cases of patients with ovarian thecoma were retrospectively analyzed.The results of CA125 and the appearance of CT and MRI were recorded,the value of CA125 changes and CT/MRI features was analysed in the diagnosis of ovarian thecoma.Results The value of CA125 elevated in 17 cases of ovarian thecoma,and showed statistical significance in the ratio((12/35 vs.5/5;x2=2.274,P=0.046) and the levels of the value of CA125 ((90.24 ± 18.56) U/ml vs.(243.35 ± 20.45) U/ml;t =7.780,P =0.002).Compared with 40 cases of control group,elevated CA125 level showed no obviously statistical significance (t =5.348,P=0.22).Forty patients in CT and MRI were all single lesion,30 cases were solid neoplasm,the rest were cystic-solidary lesions or priority of cystic component,75％ lesions were more than 5 cm,9 cases of lesions contains calcification.In pre-enhanced CT and MR/scan the lesions showed iso-density or signal-intensity,mildly enhanced;Twenty-two patients with ascites and 11 cases with symptoms in the elevating of estrogen.Combined the results of CA125 and the apperaance of CT and MR/,the accuracy of the diagnosis in ovarian thecoma was 85％.Conclusion CT and MR/imaging combining with CA125 can improve the diagnosis accuracy of ovarian thecoma.which should be given priorities.

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.

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.

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.

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.

The comparative study of MRI appearances of ovarian thecoma with pathologic findings / 中华放射学杂志

Objective To analyze and compare the MRI appearances of ovarian thecoma with pathologic findings in order to improve the knowledge of the disease.Methods Nineteen cases of ovarian thecoma confirmed by histopathology were analyzed.MRI morphological characteristics and signal intensity of the lesions were observed and compared with findings of pathomorphology.Correlation analysis between tumor size and amount of ascites was made.Results Ovarian thecoma displayed iso-or hypointense signal on T_1WI and significant hypointensity in the focal lesion on T_2WI.Hyperintensity occurred when cystic degeneration of the lesions existed.Fibrous septation was detected in some lesions.After enhancement,most lesions showed mild early enhancement with slight increase on the delayed phase.Pathological necrosis and cystic degeneration were seen in 9 cases which corresponded to the number and shape of the cystic lesions on MRI.A large amount of collagen hyperplastic was found between the oncocytes microscopically in 15 cases, which displayed significant hypointensity in the focal lesion on T_2WI;another 4 cases showed relatively less amounts of collagen hyperplastic and more oncocytes,which appeared moderate intensity in the focal leisom on T_2WI.The amount of ascites was not significantly correlated with the lesion size(r=0.43,P=0.10). Conclusions Hypointensity on T_2WI and mild enhancement pattern due to poor blood supply are the characteristics of ovarian thecoma.The MR findings can reflect the pathologic features of the tumor,which is helpful in the diagnosis and differential diagnosis.

A Case of Ovarian Low-Grade Stromal Sarcoma with Thecomatous Features: So-Called "Malignant Thecoma" / 대한산부인과학회잡지

Theca cell tumors of the ovary have been generally regarded as almost invariably benign neoplasms. Even though several case reports of the malignant variant of this tumor have appeared in the world literature, but the term "malignant thecoma" is controversial and doubtful. If a thecoma ever becomes malignant, the tumor cells dedifferentiate so that they can not be recognized any longer as theca cells: instead, they proliferate as a stromal sarcoma or fibrosarcoma. We have experienced a rare case of ovarian low-grade stromal sarcoma with thecomat ous features in a 66-year-old postmenopausal woman. The clinicopathologic finding and a review of literature on ovarian stromal sarcoma and malignant thecoma were described brie fly.