Recent Advances in the Pathology and Classification of Ovarian Sex Cord-Stromal Tumors

Non-Peutz-Jeghers syndrome associated ovarian sex cord tumor with annular tubules: a case report

OBJECTIVE

Sex cord tumors with annular tubules (SCTAT) are a rare subtype of sex cord stromal tumor of the ovary. An evidence-based management plan with follow-up evaluations is difficult to outline because of the rarity of these tumors. We describe the case of a premenarcheal patient with a SCTAT.

DESIGN

Case report.

SETTING

The patient was encountered during routine patient care process.

PATIENT(S)

The patient presented with a pelvic mass and precocious puberty. Her condition was diagnosed as SCTAT. Her clinical presentation was consistent with an estrogen-secreting tumor, resulting in early menarche and premature breast development. Inhibin and estradiol levels were markedly elevated preoperatively and normalized 5 weeks after surgical removal of the tumor. The preoperative computed tomography scan demonstrated a 12-cm abdominopelvic mass, which appeared to be mostly cystic.

INTERVENTION(S)

The patient was treated surgically. She underwent laparotomy, right salpingo-oophorectomy, ipsilateral pelvic and paraaortic lymph node sampling, and partial omentectomy. Peritoneal biopsy samples were obtained from the abdomen and pelvis.

MAIN OUTCOME MEASURE(S)

The patient did well postoperatively. She is being observed with serial examinations and serum inhibin measurements.

RESULT(S)

Normalization of serum estradiol and inhibin along with cessation of menstruation were seen 5 weeks postoperatively, with persistence of morphologic signs of precocious puberty and advanced bone age at 11 months after the diagnosis.

CONCLUSION(S)

The diagnosis of SCTAT was established on final pathology examination based on morphologic features of the tumor microscopically and the marker expression profile on immunohistochemistry. Primary management was surgical.

Wnt signaling in ovarian tumorigenesis

Data are emerging implicating Wnt signaling in ovarian tumorigenesis. We sought to review the current literature on the subject and discuss the pathway's potential role as a prognostic marker and therapeutic target. We conducted a systematic literature review of studies investigating the association between Wnt signaling and ovarian cancer. Search strategies included online searching of the MEDLINE database and hand searching of relevant publications and reviews. Additional reports were collected by systematically reviewing all references from retrieved papers. Twenty-nine papers were identified that directly investigate Wnt signaling and ovarian cancer. Mutations in the CTNNB1 gene that codes for beta-catenin, the key effector in the pathway, are directly linked to carcinogenic transformation but are mostly found in ovarian endometrioid adenocarcinomas, a histologic subtype of epithelial ovarian cancer. These mutations, along with others, lead to deregulation of the pathway and transcription of target genes. Differences in various intra- and extracellular components of the Wnt pathway have been demonstrated between normal ovarian and cancer cell lines and between benign tissue and ovarian cancer. These differences implicate Wnt signaling in the molecular events that lead to ovarian cancer development despite the fact that gene mutations are uncommon. The data suggest that Wnt signaling plays a role in ovarian tumorigenesis. The exact mechanisms by which this occurs need to be further elucidated. Wnt signaling is probably involved via multiple, diverse mechanisms. Further research in this area is warranted.

A very rare cause of virilization in childhood: ovarian Leydig cell tumor

Virilization in childhood results from an adrenal and/or ovarian disorder. These children usually present with hyperandrogenism: acne, deepening voice, abnormal hair growth, cliteromegaly. Ovarian Leydig cell tumor is a very rare cause of hyperandrogenism in childhood. They are usually benign and surgical treatment is usually curative if the tumor is limited to the ovaries. We present the youngest case of ovarian Leydig cell tumor reported in the literature who presented with hyperandrogenism that was satisfactorily resolved after resective surgery. Rare causes of virilization should be investigated with special attention paid to tumoral disease in the differential diagnosis.

Ultrasound of ovarian sex-cord tumor with annular tubules

Sex-cord tumors with annular tubules (SCTAT) have been extensively reported in the literature with great emphasis on the cytologic and histologic appearance. The association of Peutz-Jeghers syndrome (PJS) with bilateral benign, typically multifocal, small, and sometimes calcified SCTAT has also been reported. We present and describe the sonographic findings of bilateral SCTAT in a patient with PJS.