Pelvic effusion in patients with ovarian thecoma-fibroma associated with the tumor size and plaste CA-125 level: A retrospective magnetic resonance imaging study.

PURPOSE: To survey the occurrence rate of ascites in patients with thecoma-fibroma and its potential correlation with tumor MR imaging characteristics. METHODS: A total of 40 patients with surgically proven thecoma-fibroma were enrolled in this retrospective study. We determined the tumor size, the components (solid or cystic) and their signal intensity features. Second, we identified ascites according to the fat-suppressed sagittal T2-weighted imaging sequence and divided all cases into two groups (with or without ascites). Furthermore, we explored the correlations of ascites with tumor size, tumor solidity, pathological types, patient's postmenopausal status and serum CA-125 levels by using the χ2 test. RESULTS: (1) Among the 40 cases, 15 tumors were fibromas, 15 thecomas, and 10 fibrothecomas. Nine patients (26.47%) had elevated CA-125 levels (>35.0 U/ml). (2) Thirty-one patients had ascites (77.50%), 29 of which had a small amount of ascites. Nine cases had no ascites (22.50%). (3) MRI showed a solid mass in 22 cases (55.0%), cystic mass in five cases (12.5%) and mixed solid-cystic mass in 13 cases (32.5%). The χ2 test revealed that the incidence of ascites was significantly correlated with tumor size, tumor solidity and serum CA-125 levels (P < 0.05), but not with menopause and pathological type (P > 0.05). CONCLUSION: Our data revealed that the incidence of ascites was 77.50% and was mainly correlated with tumor size and elevated CA-125 levels. These findings have potential value for improving the diagnosis and differential diagnosis of thecoma-fibroma.

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)

Sex cord stromal tumours of the ovary, experience at Shifa International Hospital Islamabad.

This descriptive study was carried out at Pathology Department, Shifa International Hospital from 2007 to 2016; all sex cord stromal tumours diagnosed during this time period were included. Epithelial, germ cell and metastatic tumours were excluded from the study. A total of 1254 Ovarian tumours were brought to Shifa of which47 (4%) were labeled as sex cord stromal tumours. Of these 36( 76 %)were granulosa cell tumour (adult33, juvenile3), 7 were labeled as sertoli leydig cell tumours (15%), 3 as thecoma/ fibroma group (7%)and only one case was labeled as microcystic stromal tumour of the ovary (2%). Overall age range for sex cord stromal tumours was 42 (12-71). Immunohistochemistry was done in 41 out of 47 cases. Sex cord stromal tumours of the ovary are rare tumours comprising 4% of the total. Adult Granulosa cell tumour is the commonest tumour seen in our study.

Contribution of ultrasound in the study of ovarian fibrothecomas: a series of 47 cases.

INTRODUCTION: Ovarian fibro-thecoma are rare presenting 1 to 4, 7%of ovarian organictumors. These tumors are of stromal origin and contain varied proportion of fusiform connective tissue cells and theca cells. They mainly affect menopausal or perimenopausal women. This tumor is benign in most cases and may be responsible for hormone secretion. OBJECTIVES: Study the epidemiological and clinical data of patients with ovarian fibro-thecoma, analyze ultrasonographic characteristics of these tumors,and evaluate the sensitivity and specificity of pelvic ultrasound in ovarian fibro-thecoma approach. METHODS: A retrospective study of 47 patients who underwent surgical treatment for ovarian fibro-thecoma was performed. Data were collected in our department of gynecologyand obstetrics A within Charles Nicole hospital in Tunis, over a period of 18 years between January 1994 and December 2012. For each of our observations, we analyzed the clinical and para-clinical data, including U.S. characteristics and available MRI data with confrontation to the final histological results. RESULTS: The average age of patients was 45.2 years. The average gravidity was 4 and the mean parity was 3. . Thirty-eight of our patients were postmenopausal (80.85%). Ovarian tumor was discovered incidentally in 11 cases and on the occasion of functional symptoms in 36 cases including pelvic pain in 18 cases. Physical examination revealed a pelvic mass in 17 patients and pelvic-abdominal in 14 patients. All patients underwent a pelvic ultrasound. . Ultrasound identified 49 tumors (2 cases of bilateral tumors). Average size of tumors was 10, 05 cm (4 to 30 cm). ) . Ovarian tumor was echogenic in 9 cases (18.36%), hypoechoic in 14 cases (28.47%), mixed in 14 cases (28.47%) and anechoic in 12 cases (24.49%). The tumor was found to be solid in 27 cases (55.1%); cystic in 8 cases (16.3%) and solido cystic in 14 cases (28.6%).It was compartmentalized in 10 cases. Extra cystic vegetations were found in 2 patients. The tumor was nonvascularized at color Doppler in 47 cases (95.9%) and slightly vascularized in 2 cases (4.1%). Intra peritoneal effusion was objectified in 15 cases. The diagnosis of ovarian fibro-thecoma was raised based on U.S in 25 cases (51.02%) before surgery .MRI was performed in four cases. All patients underwent surgery. We performed laparotomy in 36 cases and laparoscopy in 11 cases. By laparotomy were performed a total hysterectomy with bilateral oophorectomy in most cases (26 patients). By laparoscopy we did lumpectomy in all cases. . The final pathologic examination revealed 19 fibromas, 14cystadénofibromas and 14 fibrothecomas. CONCLUSION: The paraclinical exploration of ovarian fibro-thecoma isbased, as all ovarian tumors, on ultrasound examination. The most typical features are images of solid tumors with regular contours, echogenic or mixed with the presence of streakedshadows.

[Clinical, hormonal and histological features in ovarian stromal hyperthecosis].

The aim of our study was to investigate clinical, hormonal and histological features of ovarian stromal hyperthecosis We have studied 104 patients with a histological diagnosis of ovarian stromal hyperthecosis and hyperplasia. Analyzing the results we can conclude that clinical features of ovarian stromal hyperthecosis and hyperplasia with polycystic ovarian disease and without it were identical and characterised by virilization syndrome, disorders of menstrual cycle and reproductive function; metabolic and vegeto-vascular disorders; breast and endometrial hyperplasias, high blood level of testosterone . The histological study of ovarian stromal hyperthecosis has showed that superficial part of ovarian cortex is hypocellular and fibrotic, contains scattered follicles with few granulosa cells, luteinized internal theca cells, hyperplasia of deep cortex and medulla, corpus luteus is absent.

[Incidence and management of the ovarian fibroma and thecoma. Experience of The First Surgical Clinic Iasi]. / Fibroamele si tecoamele ovariene in experienta Clinicii I Chirurgie Iasi. Incidenta si conduita.

The ovarian fibroma, thecoma and fibro-thecoma are a rare benign tumors growing from the connective tissue of the ovarian cortex. The general surgeon may confront in his practice solid ovarian mass, sometimes in emergency. Between 1995 and 2005, we report thirteen cases of ovarian fibroma (two bilateral) and two ovarian thecoma with mean age 53 years operated in First Surgical Clinic Iasi. Four of them were operated on as emergencies. Clinical ascites are found in three patients with large tumors. The early symptoms were pelvic pain and abnormal uterine bleeding. Patients with large tumors or ascites were admitted with compression symptoms or abdominal distension. Ultrasonography showed a solid uniformly hypo-echogenic mass, with very marked sound attenuation. We performed oophorectomy in six cases (laparoscopic approach in four cases) and salpingo-oophorectomy in nine cases (using laparoscopic stapler in three cases). There were no conversions to laparotomy. In all cases the diagnosis was established by histological examination. Laparoscopic approach is associated with significantly less operative morbidity, less postoperative pain, shorter hospital stays and shorter recovery periods, best cosmetic results.

Synchronous primary neoplasms of the uterine corpus and the ovary: a case report.

OBJECTIVE: To determine the frequency of synchronous primary neoplasia of the ovaries in patients with primary malignant neoplasia of the uterus, and to analyze the clinical and histological characteristics of these cases. MATERIALS AND METHODS: Clinicopathological data from a series of patients treated for primary malignant neoplasia of the uterus between 1985 and November 2003 have been studied retrospectively. RESULTS: Synchronous primary neoplasia of the ovaries was found in 13 out of 173 patients (7.5%) treated for primary malignant neoplasia of the uterus. In four patients (2.3%) the histological findings suggested ovarian metastases from primary endometrial adenocarcinoma. In four other cases (2.3%) there was extension of the primary uterine sarcoma to the ovaries. In the remaining five cases (2.9%) primary endometrial adenocarcinoma coexisted with: a) ovarian cystadenocarcinoma in two cases, b) ovarian fibromathecoma in two cases, and c) ovarian tumor of borderline malignancy in one case. CONCLUSIONS: Coexistence of distinct primary neoplasias in the uterus and ovaries is rare. Diagnosis of two primary malignancies in the uterus and ovaries should be based on histological examination. Treatment should be appropriate for both tumors, taking into consideration that treatment of one tumor will not lead to subtreatment of the other.

[Anatomo-clinical characteristics of ovarian fibrothecal tumors. 19 cases over 12 years: 1981-1992[]. / Caractéristiques anatomo-cliniques des tumeurs fibrothécales de l'ovaire. A propos de dix-neuf cas en douze ans: 1981-1992.

The quasi-constantly benign nature of fibrithecomas of the ovary has been known for many years. However, there have been very few studies of their incidence and clinical characteristics. The aim of this study, based upon 19 cases of fibrothecal tumours of the ovary operated upon at the Rabta maternity unit during a 12 year period, is to give an idea as to epidemiological factors, diagnostic conditions and treatment methods used among the women studied.

[The prognostic factors in patients with malignant granulosa-theca cell tumors of the ovaries]. / Faktory prognoza u bol'nykh so zlokachestvennymi granulezotekakletochnymi opukholiami iaichnikov.

The extent of tumor, as revealed by surgery in 113 primary patients with malignant granulosa-stromal cell tumors of the ovaries (granulosa cell--77, theca cell--17 and mixed theca-granulosa cell tumors--19 patients), was analysed versus duration of disease, laterality of tumor and patient age. Factors which were significantly or as a marked tendency associated with stage III and IV of disease and thus suggested poor prognosis were identified.

Ovarian fibrothecoma: sonographic and histologic findings.

The sonographic and histologic findings observed in 11 cases of ovarian fibrothecoma were compared, and an attempt was made to find a correlation between each histologic type of the tumor (pure thecoma, predominantly fibrous fibrothecoma, mixed fibrothecoma) and its sonographic appearance. The presence of a homogeneous echogenic pattern, with marked posterior acoustic shadowing, in the absence of any calcification, was highly suggestive of a predominantly fibrous ovarian fibrothecoma; the presence of a diffusely hypoechoic ovarian mass, with no posterior echo enhancement, was strikingly correlated with pure thecomas; mixed fibrothecomas were characterized by the presence of an echogenic pattern with no posterior acoustic shadowing. Sonographic findings, even though nonspecific, can provide the clinician with useful information which permits to detect these rare neoplasms preoperatively.

Mouse ovarian tumors--a review including classification and induction of neoplastic lesions and description of several previously unreported types.

The purpose of this study is to review the pertinent literature on the incidence, methods of induction and pathogenesis of ovarian tumors of mice. Strains of mice with a high incidence of spontaneously occurring granulosa cell tumors (gct) and tubular adenomas (ta) are the C3HeB/Fe and C3HeB/De; strain HAN:NMRI developed Sertoli cell tumors and (DBA x Ce)F1 hybrids had a high incidence gct. Ninety-five percent of hybrid (C57BL/6J x C3H/HeJ)F1 WxWv mice which lack germ cells develop complex tubular adenomas. Strain LT, in which a high percentage of ovarian ova develop parthenogenetically, develops has a high incidence of teratomas. The use of hormones, castration and transplantation of the ovaries in a number of inbred strains results in a high incidence of ovarian tumors; in strain Maf/Sp gct and luteomas were induced in 82%. Irradiation with gamma rays produced a similar incidence of ovarian tumors in (C57L x A)F1 hybrids. The chemical inducing the highest incidence (92%) of ovarian tumors of mice is 9,10 Dimethyl 1,2 benzanthracene (DMBA). Recently, 4-Vinylcyclohexene was shown to induce a high incidence of ovarian tumors. A number of rare ovarian tumors were reported. Described are five androblastomas composed of either Leydig or Sertoli cells or a combination of the two cell types and a single undifferentiated androblastoma. Seven teratomas were described, three of which contained large amounts of neural tissue; another was classified as a teratoma with a parieto-visceral yolk-sac carcinoma component.

Granulosa- and theca-cell tumors. Incidence and occurrence of second primary tumors.

An analysis of 936 women with granulosa- and theca-cell tumors reported to the Swedish Cancer Registry between 1958 and 1972 showed crude annual incidence rates for these lesions of 0.72 and 0.74, respectively, pre 100 000 of the female population, unchanged during the period. The age-specific incidence rates, both groups taken together, increased almost linearly from 35 to 69 years. The women displayed an increased risk of developing endometrial carcinoma and malignant lymphoma, possibly also breast, colon and thyroid carcinoma.

Theca-cell tumors. Clinical features and prognosis.

During the period 1923 to 1972, 62 women with theca-cell tumors were treated at Radiumhemmet. The mean age at diagnosis was 59.5 years. Concomitant endometrial carcinoma was found in 13 patients. At 1978, after a mean observation time of 15.5 years, 30 patients were alive. No patient died from thecoma. Malignant disease caused death in 7 women. No difference in survival was found between 20 patients and 40 controls matched by age and place of residence.

Surgical lesions of the ovary in infancy and childhood.

In 27 years, 64 patients were operated upon for ovarian lesions, 43 for tumors, 12 for nonneoplastic cysts and nine for ovarian torsion. Of all the girls in this age group who were operated upon for appendicitis, 2 percent had ovarian lesions. Of the girls referred for isosexual precocity in the last ten years, 4.7 per cent had ovarian lesions. Of the girls in this age group operated upon for malignant abdominal lesions, excluding hepatic, in the last 15 years, 10.8 per cent had ovarian tumors. Of the 11 tumors with endocrine function, four were malignant. This association is statistically significant. There were no operative deaths. There were no postoperative deaths among six patients with Stage I and II lesions. Mortality was confined to the two patients with Stage III and IV lesions. The surgical approach was designed to conserve ovarian tissue, and adjunctive chemotherapy and radiotherapy were infrequently used.

Thecoma in pregnancy.

A description is briefly given of a patient whose pregnancy was complicated by an ovarian thecoma which ruptured spontaneously.Eleven previously reported instances of the combination of thecoma and pregnancy are summarized.Although the present case appears to be the first in which the mother has survived rupture of the tumour, in view of the result to the child this can hardly be claimed as a triumph of obstetrics.