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ovarian thecoma

Wednesday 14 July 2004

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

Thecoma has lipid vacuolated spindle cells with hyaline plaques. They can produce estrogens and androgens. They are most common in older women. The estrogen exposure can lead to endometrial hyperplasia and dysfunctional uterine bleeding, as well as endometrioid adenocarcinoma and other endometrial carcinomas.

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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