Analysis for steroid production of a Sertoli-Leydig cell tumor

Tumor de células de Sertoli-Leydig do ovário - Apresentação de um caso e revisão da literatura

Os autores relatam um caso de tumor de células de Sertoli e Leydig (TCSL), estádio Ia, no ovário direito de uma paciente com 10 anos de idade. O tumor era não funcionante e as manifestações iniciais foram dor e aumento do volume abdominal. Ao exame físico palpava-se uma massa endurecida na região hipogástrica. A criança não apresentava sinais de virilização ou puberdade precoce. O tratamento foi realizado com cirurgia; salpingo-ooforectomia direita e biópsia em cunha do ovário esquerdo. Histologicamente o tumor era bem diferenciado e não apresentava elementos heterólogos. A paciente apresenta há 26 meses sobrevida livre de doença. Acreditamos que este seja o primeiro caso de TCSL de ovário em crianças com idade igual ou inferior a 10 anos, publicado na literatura médica brasileira indexada.

HPLC–RIA analysis of steroid hormone profile in a virilizing stromal tumor of the ovary

The pathological steroid biosynthesis of a virilizing ovarian tumor was examined via high performance liquid chromatography-radioimmunoassay (HPLC-RIA) determination of the intratissular steroid concentrations. Sex cord-stromal tumor of the ovary was obtained surgically from an 18-year-old female patient with extremely high androst-4-ene-3,17-dione (4-en-dione) and testosterone (Test) blood serum levels. The tissue specimen was extracted with ethyl acetate and the extract was then purified on a C18 mini-column with methanol-water eluents. Steroids were isolated by reversed-phase HPLC on a C18 silica gel column with 51%, 55% and 64% v/v methanol-water eluents. Steroids in the collected eluent fractions were detected by the radioactivity of tritiated internal standards and then quantified by specific RIAs. In the tumor specimen, very high 17alpha-hydroxyprogesterone (17-OH-Prog; 6300 fmol/g), dehydro-epiandrosterone (2870 fmol/g), androst-4-ene-3,17-dione (3000 fmol/g), testosterone (5700 fmol/g) concentrations, and less progesterone (PROG; 320 fmol/g) and androst-5-ene-3beta,17beta-diol (5-en-diol; 320 fmol/g), were determined. Tissue levels of 5alpha-dihydrotestosterone (DHT), 5alpha-androstane-3alpha,17beta-diol (3alpha-diol), 5alpha-androstane-3beta,17beta-diol (3beta-diol), and 17beta-estradiol were found to be 71, 20, 28, and 12 fmol/g, respectively. Steroid profile analysis verified a pathological steroid biosynthesis in the ovarian tumor and suggested that the 17alpha-hydroxylase (17alpha-H), 17,20-lyase (17,20-L), and 3beta-hydroxysteroid dehydrogenase/Delta5-4-isomerase (Delta5-3beta-HSD) activities were particularly elevated in this tumorous tissue. Present data demonstrate that the analysis of intratissular steroid profile by a HPLC-RIA method may valuably contribute to the steroidal pathophysiology of endocrine tumors.

Virilizing tumors of the ovary: imaging features

AIM

Virilizing tumors of the ovary are an uncommon cause of a common clinical problem. The reported imaging features of these tumors are based on case reports. The purpose of this study was to determine the spectrum of imaging characteristics of these tumors based on a larger referral population.

PATIENTS AND METHODS

Case records from the Armed Forces Institute of Pathology were searched for clinical evidence of virilization as a presentation of an excised sex cord-stromal and steroid cell ovarian tumor. Records and imaging studies on 14 patients with virilizing tumors were found. All available imaging studies (ultrasound studies of the pelvis (11 patients), CT scans of the pelvis (five patients), MRI examinations of the pelvis (two patients), and plain films of the pelvis (four patients) were reviewed by three radiologists independently for ascites, calcification, percent solid portion, echogenicity and attenuation.

RESULTS

On CT and/or ultrasound most (69%) of the tumors appeared to be solid or mostly solid. The amount of solid tissue varied with the tumor type, granulosa cell tumors were predominantly cystic. The masses were isoechoic (82%) or hypoechoic (18%). Ascites was an infrequent (23%) finding. Only a minority of these tumors (14%) were calcified on imaging studies. Six tumors were 5.0 cm or less in mean size, and two less than 3.0 cm in size. All cases were stage I tumors at presentation.

CONCLUSION

The majority of virilizing tumors of the ovary are typically solid, noncalcified, confined to the ovary at presentation, and not associated with ascites. Variability in appearance depends in part on tumor type. Many are small and may be difficult to recognize as a mass morphologically.

Ovarian tumors with functioning manifestations

Various categories of ovarian tumors, particularly those of gonadal stromal origin, are capable of producing a variety of hormones that occasionally induce interesting clinical manifestations. The endocrine manifestations associated with gonadal stromal tumors are often due to hormone production by the tumor cells. Sometimes the tumor cells produce only one hormone, while more frequently the hormonal manifestations result from a summation of various hormones including transformation of a variety of prehormones produced by different components of the tumor including its supportive or reactive stroma. The mechanisms involved in the production and transformation of various hormones and prehormones are complex and not thoroughly established at this time. This review will focus on gonadal stromal tumors and discuss evidence available for linkage of the clinical manifestations to hormones produced by the various neoplasms.