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thecoma

Wednesday 14 July 2004

Definition: Ovarian thecoma is a relatively rare sex cord tumor which occurs before and after menopause.

Links

- Ovary : Thecoma at WebPathology

Clinical synopsis

- Age at diagnosis: Usually > 40 years old (65% post-menopausal)
- +/- hormonally active (estrogenic or androgenic)
- usually benign
- unilateral (in 90% of cases)
- Rare in childhood
- Typically estrogenic manifestations
- Some may be androgenic: particularly those containing steroid cells
- Nearly always benign
- A few malignant examples

Macroscopy

- well defined, firm, solid, covered by intact ovarian serosa;
- usually yellow
- Usually unilateral
- Variable size
- Well-defined capsule
- Firm consistency
- Cut surface:

  • largely or entirely solid
  • may be cysts
    - Yellow color
  • Cut surface of thecoma showing a predominance of yellow areas alternating with whitish foci.

Microscopy

- Fascicles of spindle cells with:

  • centrally placed nuclei
  • moderate amount of pale cytoplasm
  • Bland microscopic appearance of thecoma, with some variability in cellularity.

- Intervening tissue may show:

  • considerable collagen deposition
  • focal hyaline plaque formation

- Degree of cellularity varies considerably
- Some in young women are heavily calcified

- Plump ovoid to spindle cells
- Thecomas are inhibin+
- The tumor cells have abundant pale cytoplasm.
- Hyaline plaques are conspicuous.

- spindle cells

  • moderate pale cytoplasm containing lipid droplets
  • central nuclei

- stroma

  • collagen deposition
  • focal hyaline plaque formation
  • +/- heavily calcified
  • +/- prominent stromal hyperplasia (hyperthecosis)

- fat stains+ (on fresh/frozen tissue)

  • Oil red O+: abundant intracytoplasmic neutral fat
  • Sudan black + (fat stains)

- silver stains

  • reticulin fibers surrounding individual cells
  • usually reticulin fibers surrounding individual cells
  • may be islands devoid of reticulin, especially in areas of luteinization

- Estradiol usually limited to a small number of tumor cell

Variants

- May be prominent stromal hyperplasia, particularly if postmenopausal.

  • transitions may then be seen from focal stromal hyperplasia through diffuse thecomatosis (hyperthecosis) to thecoma, suggesting pathogenetic continuum
  • likely that small tumors designated stromal luteomas4,5 are a manifestation of this spectrum

- Sometimes, ovarian tumors otherwise typical of thecoma contain cells with features of steroid hormone-secreting cells (lutein, Leydig, and adrenal cortical):

  • generally designated luteinized thecoma:
    • some associated with peculiar form of sclerosing peritonitis
  • stromal–Leydig cell tumor or Leydig cell-containing thecoma
    • terms reserved for rare examples with Reinke crystalloids in cytoplasm of these cells
    • tend to occur in younger women
    • may have an androgenic rather than estrogenic effect

- ovarian luteinized thecoma (Luteinized Thecoma of Ovary)

  • thecoma with steroid hormone secreting cells
  • edema
  • focal mitotic activity

- Leydig cell containing thecoma

  • cytoplasmic Reinke crystalloids

- during pregnancy (15327450)

- fibrothecoma

Cytogenetics

- trisomy 12
- tetrasomy 12 (11148462)

Differential diagnosis

- ovarian fibroma

  • Yellow color important feature in differential diagnosis with fibroma.
    - ovarian lipid cell tumor

See also

- ovarian sex cord-stromal tumors
- INHA
- ovarian fibroma

References

- Waxman M, Vuletin JC, Urcuyo R, Belling CG. Ovarian low-grade stromal sarcoma with thecomatous features. A critical reappraisal of the so-called “malignant thecoma.”. Cancer. 1979;44:2206–2217.

- Young RH. Meigs’ syndrome: Dr. Richard Cabot’s hidden first American case. Int J Surg Pathol. 2001;8:165–168.

- Gaffney EF, Majmudar B, Hewan-Lowe K. Ultrastructure and immunohistochemical localization of estradiol of three thecomas. Hum Pathol. 1984;15:153–160.

- Hayes MC, Scully RE. Stromal luteoma of the ovary. A clinicopathological analysis of 25 cases. Int J Gynecol Pathol. 1987;6:313–321.

- Scully RE. Stromal luteoma of the ovary. A distinctive type of lipoid-cell tumor. Cancer. 1964;17:769–778.

- Zhang J, Young RH, Arseneau J, Scully RE. Ovarian stromal tumors containing lutein or Leydig cells (luteinized thecomas and stromal Leydig cell tumors). A clinicopathologic analysis of fifty cases. Int J Gynecol Pathol. 1982;1:270–285.

- Roth LM, Sternberg WH. Partly luteinized theca cell tumor of the ovary. Cancer. 1983;51:1697–1704.

- Clement PB, Young RH, Hanna W, Scully RE. Sclerosing peritonitis associated with luteinized thecomas of the ovary. A clinicopathological analysis of six cases. Am J Surg Pathol. 1994;18:1–13.

- Iwasa Y, Minamiguchi S, Konishi I, Onodera H, Zhou J, Yamabe H. Sclerosing peritonitis associated with luteinized thecoma of the ovary. Pathol Int. 1996;46:510–514.

- Werness BA. Luteinized thecoma with sclerosing peritonitis. Arch Pathol Lab Med. 1996;120:303–306.

- Sternberg WH, Roth LM. Ovarian stromal tumors containing Leydig cells. I. Stromal-Leydig cell tumor and non-neoplastic transformation of ovarian stroma to Leydig cells. Cancer. 1973;32:940–951.

- Takeuchi S, Ishihara N, Ohbyashi C, Itoh H, Maruo T. Stromal Leydig cell tumor of the ovary: case report and literature review. Int J Gynecol Pathol. 1999;18:178–182.

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