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.
Ovary : Thecoma at WebPathology
Age at diagnosis: Usually > 40 years old (65% post-menopausal)
+/- hormonally active (estrogenic or androgenic)
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
well defined, firm, solid, covered by intact ovarian serosa;
- largely or entirely solid
- may be cysts
- Cut surface of thecoma showing a predominance of yellow areas alternating with whitish foci.
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.
- moderate pale cytoplasm containing lipid droplets
- central nuclei
- 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)
- 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
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
- focal mitotic activity
Leydig cell containing thecoma
- cytoplasmic Reinke crystalloids
during pregnancy (15327450)
- Yellow color important feature in differential diagnosis with fibroma.
ovarian lipid cell tumor
ovarian sex cord-stromal tumors
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