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Moro F, Giudice MT, Bolomini G, Moruzzi MC, Mascilini F, Quagliozzi L, Ciccarone F, Scambia G, Fagotti A, Valentin L, Testa AC. Imaging in gynecological disease (27): clinical and ultrasound characteristics of recurrent ovarian stromal cell tumors. Ultrasound Obstet Gynecol 2024; 63:399-407. [PMID: 37774092 DOI: 10.1002/uog.27504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/18/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound characteristics of recurrent granulosa cell and Sertoli-Leydig cell tumors. METHODS This was a retrospective observational study performed at Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico, IRCCS, Rome (Gemelli center), Italy. Patients with a histological diagnosis of recurrent granulosa cell tumor or Sertoli-Leydig cell tumor were identified from the database of the Department of Gynecological Oncology. Those who had undergone a preoperative ultrasound examination at the Gemelli center between 2012 and 2020 were included, and the data retrieved from the original ultrasound reports. In all of these reports, the recurrent tumors were described using International Ovarian Tumor Analysis (IOTA) terminology. If a patient had more than one episode of relapse, information from all episodes was collected. If there was more than one recurrent tumor at the same ultrasound examination, all tumors were included. One expert sonographer also reviewed all available ultrasound images to identify typical ultrasound patterns using pattern recognition. RESULTS We identified 30 patients with a histological diagnosis of recurrent granulosa cell tumor (25 patients, 55 tumors) or Sertoli-Leydig cell tumor (five patients, seven tumors). All 30 had undergone at least one preoperative ultrasound examination at the Gemelli center and were included. These women had a total of 66 episodes of relapse, of which a preoperative ultrasound examination had been performed at the Gemelli center in 34, revealing 62 recurrent lesions: one in 22/34 (64.7%) episodes of relapse, two in 4/34 (11.8%) episodes and three or more in 8/34 (23.5%) episodes. Most recurrent granulosa cell tumors (38/55, 69.1%) and recurrent Sertoli-Leydig tumors (6/7, 85.7%) were classified as solid or multilocular-solid tumors, while 8/55 (14.5%) recurrent granulosa cell tumors and 1/7 (14.3%) recurrent Sertoli-Leydig cell tumors were unilocular cysts and 9/55 (16.4%) recurrent granulosa cell tumors were multilocular cysts. The nine unilocular cysts had contents that were anechoic (n = 2) or had low-level echogenicity (n = 7), had either smooth (n = 4) or irregular (n = 5) internal cyst walls, and ranged in largest diameter from 8 to 38 mm, with three being < 20 mm and five being 20-30 mm. On retrospective review of the images, two typical ultrasound patterns were described: small solid tumor measuring < 2 cm (15/62, 24.2%) and tumor with vascularized echogenic ground-glass-like content (12/62, 19.4%). CONCLUSIONS Some granulosa cell and Sertoli-Leydig cell recurrences manifest one of two typical ultrasound patterns, while some appear as unilocular cysts. These are usually classified as benign, but in patients being followed up for a granulosa cell tumor or Sertoli-Leydig cell tumor, a unilocular cyst should be considered suspicious of recurrence. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - M T Giudice
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - G Bolomini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - M C Moruzzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - F Mascilini
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - L Quagliozzi
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - F Ciccarone
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - G Scambia
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Fagotti
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - L Valentin
- Skåne University Hospital Malmö, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità Pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
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Hu X, Li W, Li X, Li D, Cai J, Wang P. 18F-FDG PET/CT features of Meigs syndrome induced by ovarian sex cord stromal tumors: a retrospective clinical study. Sci Rep 2024; 14:347. [PMID: 38172241 PMCID: PMC10764332 DOI: 10.1038/s41598-024-51186-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 01/01/2024] [Indexed: 01/05/2024] Open
Abstract
The objective of this study was retrospectively to analyze the clinical characteristics and 18F-FDG PET/CT findings in Meigs syndrome (MS) patients. A total of 21 patients with MS induced by ovarian stromal tumors and 69 patients with pseudo-MS caused by ovarian cancer (OC-PMS) were subjected to evaluation using 18F-FDG PET/CT. Visual and semi-quantitative methods were employed to analyze the PET/CT findings. Visual analysis included recording whether the density of the primary tumor was uniform, whether there were cystic changes and calcifications, and the location of serous fluid accumulation. Semi-quantitative analysis involved the measurement of the tumor size, SUVmax, and SUVmean. No significant difference was observed in the size and density of primary tumors between the MS group and the OC-PMS group. However, the SUVmax and SUVmean of tumors in the MS group were found to be significantly lower than those in the OC-PMS group. The amount of serous cavity effusion caused by ovarian sex cord stromal tumors was found to be unrelated to the size of the tumor, SUVmax, and SUVmean but was positively correlated with the level of Ca125. MS patients have both benign ovarian tumors and ascites and/or pleural effusion, which may be accompanied by elevated Ca125 levels. This should be considered as one of the differential diagnoses for ovarian cancer. Understanding the PET/CT features of MS can facilitate the attainment of an accurate diagnosis before surgery.
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Affiliation(s)
- Xianwen Hu
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Wenxin Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Xiaotian Li
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China
| | - Dandan Li
- Department of Obstetrics, Zunyi Hospital of Traditional Chinese Medicine, Zunyi, 563000, China
| | - Jiong Cai
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China.
| | - Pan Wang
- Department of Nuclear Medicine, Affiliated Hospital of Zunyi Medical University, 149 Dalian Road, Huichuan District, Zunyi, 563000, China.
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Qin DH, Wang BT, Chen ZY. [MRI Findings of the Uterine Tumors Resembling Ovarian Sex Cord Tumors:Report of Two Cases]. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2023; 45:1015-1018. [PMID: 38173116 DOI: 10.3881/j.issn.1000-503x.15467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Uterine tumors resembling ovarian sex cord tumors are rarely reported with limited imaging findings.The current study reported two case of uterine tumors resembling ovarian sex cord tumors and described the detailed MRI findings,which would provide valuable imaging evidence for the diagnosis of such tumors.
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Affiliation(s)
- De-Han Qin
- Department of Radiology,Hainan Hospital of Chinese PLA General Hospital,Sanya,Hainan 572013,China
| | - Bo-Tao Wang
- Department of Radiology,Hainan Hospital of Chinese PLA General Hospital,Sanya,Hainan 572013,China
| | - Zhi-Ye Chen
- Department of Radiology,Hainan Hospital of Chinese PLA General Hospital,Sanya,Hainan 572013,China
- The Second Clinical Medical College,Southern Medical University,Guangzhou 510515,China
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Roxon C, Slack J, Bender S, Burns H, Turner R. Multiple Sex Cord-stromal Tumors in a Standardbred Stallion Testis. J Equine Vet Sci 2023; 123:104246. [PMID: 36775076 DOI: 10.1016/j.jevs.2023.104246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 01/31/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023]
Abstract
A 12-year-old Standardbred stallion presented with a 5-month history of a growing mass in the left testis as well as an overall decrease in left testicular size. Palpation and ultrasonography of the left testis revealed a firm, hypoechoic, clearly delineated soft tissue mass in the craniolateral portion of the testis that measured 2.5 × 2.3 × 1.9 cm. Two smaller, hypoechoic regions also were visible ultrasonographically in the left testis, suggesting the presence of multifocal/multicentric neoplasia. The affected testis was very small (testicular volume of 40.3 cm3). The right testis was significantly larger (144.3 cm3), and the parenchyma was ultrasonographically normal. Due to the concern that these findings could indicate the presence of a more aggressive tumor type, unilateral orchiectomy was performed. Multiple soft tissue masses were identified grossly, and histopathologic evaluation identified the larger mass as a Sertoli cell tumor and the two smaller masses as mixed sex cord-stromal tumors with Sertoli cell and Leydig cell differentiation. To our knowledge, this the first report of concurrent Sertoli cell and mixed sex cord-stromal tumors in a single descended equine testis.
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Affiliation(s)
- Caroline Roxon
- Department of Clinical Studies (Roxon, Slack, Turner) and Department of Pathobiology (Bender) - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - JoAnn Slack
- Department of Clinical Studies (Roxon, Slack, Turner) and Department of Pathobiology (Bender) - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - Susan Bender
- Department of Clinical Studies (Roxon, Slack, Turner) and Department of Pathobiology (Bender) - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA
| | - Herb Burns
- Pine Bush Equine Services and Veterinary Hospital, Pine Bush, NY
| | - Regina Turner
- Department of Clinical Studies (Roxon, Slack, Turner) and Department of Pathobiology (Bender) - New Bolton Center, University of Pennsylvania School of Veterinary Medicine, Kennett Square, PA.
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Chen Y, Zhou P, Chen J. Fibrothecoma of broad ligament with minor sex cord elements: Case report and brief literature review. Medicine (Baltimore) 2023; 102:e33127. [PMID: 36862914 PMCID: PMC9981358 DOI: 10.1097/md.0000000000033127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
RATIONALE Sex cord-stromal tumors are always found in ovary, but the occurrence of this kind of tumor at extraovarian locations is extremely rare. Up to now, the case concerning fibrothecoma of broad ligament with minor sex cord elements has not been reported, and it is extremely challenging to diagnose before surgery. In this case report, we summarized pathogenesis, clinical features, laboratory finding, imaging studies, pathology, and therapeutic schedule of this tumor, with the aim of raising awareness and attention to this type of disease. PATIENT CONCERNS A 45-year-old Chinese woman was referred to our department with intermittent lower abdominal pain for about 6 years. On examination, both ultrasonography and computed tomography revealed she had a right adnexal mass. DIAGNOSIS Based on the results of histology and immunohistochemistry, the final diagnosis was confirmed as fibrothecoma of broad ligament with minor sex cord elements. INTERVENTIONS This patient underwent laparoscopic unilateral salpingo-oophorectomy with excision of the neoplasm. OUTCOMES Eleven days post-treatment, the patient complained that the symptoms of abdominal pain was disappeared. There is no evidence of disease recurrence 5 years after laparoscopic surgery according to the consequences of radiologic examination. CONCLUSION The natural history of this kind of tumor is uncertain. Although main treatment of this neoplasm might be surgical resection and good prognosis can be achieved, we believe that long-time follow-up is extremely important in all patients diagnosed as fibrothecoma of broad ligament with minor sex cord. Laparoscopic unilateral salpingo-oophorectomy with excision of the tumor should be recommended to these patients.
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Affiliation(s)
- Yanjun Chen
- Department of Reproductive Medicine, Longgang District Central Hospital of Shenzhen, Guangzhou University of Chinese Medicine, Shenzhen, P.R. China
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, P.R. China
| | - Peng Zhou
- Department of Pathology, The Second Xiangya Hospital of Central South University, Changsha, P.R. China
| | - Jianlin Chen
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital of Central South University, Changsha, P.R. China
- *Correspondence: Jianlin Chen, Department of Obstetrics and Gynecology, Second Xiangya Hospital, Central South University, No.139 Renmin Road, Changsha, Hunan 410011, China (e-mail: )
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D'Abbronzo G, Ronchi A, Belfiore MP, Mantia EL, Feroce F, Pignata S, Perdonà S, Franco R. Myoid gonadal stromal tumor, a case report with review of the literature. INDIAN J PATHOL MICR 2022; 65:444-447. [PMID: 35435391 DOI: 10.4103/0377-4929.343206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
The diagnosis of myoid gonadal stromal tumor (MSGT) can represent a difficult challenge, both for the extreme rarity of this neoplasm and for the clinical-radiological characteristics similar to other neoplasms of the testicle. The case management we present suggests how a complete differential diagnosis can be obtained by integrating ultrasonographic and pathological data.
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Affiliation(s)
- Giuseppe D'Abbronzo
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Andrea Ronchi
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maria Paola Belfiore
- Radiology Unit, Department of Clinical and Experimental Medicine, "F. Magrassi-A. Lanzara", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Elvira La Mantia
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Florinda Feroce
- Pathology Unit, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Sandro Pignata
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Sisto Perdonà
- Department of Urogynecology, National Cancer Institute, Pascale Foundation (Scientific Institute for Research and Healthcare), Naples, Italy
| | - Renato Franco
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania "Luigi Vanvitelli", Naples, Italy
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Pang L, Dai Y, Ren F, Peng X, Guo Z. Uterine Tumor Resembling Ovarian Sex Cord Tumors (UTROSCT): Two Case Reports of the Rare Uterine Neoplasm with Literature Review. Curr Med Imaging 2022; 18:1125-1131. [PMID: 35339187 DOI: 10.2174/1573405618666220325095615] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 12/04/2021] [Accepted: 12/22/2021] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Uterine tumors resembling ovarian sex cord tumors (UTROSCTs) are rare neoplasms with unknown etiology. This type of tumor has low malignant potential and mostly manifests as a benign clinical course. MATERIALS AND METHODS This article analyzes the case data, clinical manifestations, and histopathological characteristics of two cases of UTROSCT, and reviews the relevant literature. The diagnosis of UTROSCT is mainly based on histopathological examination. The histological characteristics of granulosa and Sertoli cell tumours are similar to the ovary under the microscope. These cases' clinical and radiological (MRI) findings have also been discussed. RESULTS The sex cord components are mixed in different proportions. The immunohistochemistry is diverse and can express sex cord markers together with both epithelial and smooth muscle markers. Both two cases revealed the signs of intratumoral cystic degeneration, intratumoral hemorrhage, and necrosis under MRI. These MRI features were helpful to prompt UTROSCT, which is histologically similar to granular cell tumors and is conducive to the differential diagnosis. CONCLUSION The current recommended treatment is total hysterectomy, but its biological behavior is not yet clear, and long-term follow-up is needed.
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Affiliation(s)
- Li Pang
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Yawen Dai
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Fang Ren
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Xu Peng
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
| | - Zhiqiang Guo
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shen Yang, China
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Ambrosio M, Testa AC, Moro F, Franchi D, Scifo MC, Rams N, Epstein E, Alcazar JL, Hidalgo JJ, Van Holsbeke C, Burgetova A, Dundr P, Cibula D, Fischerova D. Imaging in gynecological disease (19): clinical and ultrasound features of extragastrointestinal stromal tumors (eGIST). Ultrasound Obstet Gynecol 2020; 56:749-758. [PMID: 31909545 DOI: 10.1002/uog.21968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/18/2019] [Accepted: 12/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To describe the clinical and sonographic characteristics of extragastrointestinal stromal tumors (eGISTs). METHODS This was a retrospective multicenter study. The data of patients with a histological diagnosis of eGIST who had undergone preoperative ultrasound examination were retrieved from the databases of nine large European gynecologic oncology centers. One investigator from each center reviewed stored images and ultrasound reports, and described the lesions using the terminology of the International Ovarian Tumor Analysis and Morphological Uterus Sonographic Assessment groups, following a predefined ultrasound evaluation form. Clinical, surgical and pathological information was also recorded. RESULTS Thirty-five women with an eGIST were identified; in 17 cases, the findings were incidental, and 18 cases were symptomatic. Median age was 57 years (range, 21-85 years). Tumor marker CA 125 was available in 23 (65.7%) patients, with a median level of 23 U/mL (range, 7-403 U/mL). The vast majority of eGISTs were intraperitoneal lesions (n = 32 (91.4%)); the remaining lesions were retroperitoneal (n = 2 (5.7%)) or preperitoneal (n = 1 (2.9%)). The most common site of the tumor was the abdomen (n = 23 (65.7%)), and less frequently the pelvis (n = 12 (34.3%)). eGISTs were typically large (median largest diameter, 79 mm) solid (n = 31 (88.6%)) tumors, and were less frequently multilocular-solid tumors (n = 4 (11.4%)). The echogenicity of solid tumors was uniform in 8/31 (25.8%) cases, which were all hypoechogenic. Twenty-three solid eGISTs were non-uniform, either with mixed echogenicity (9/23 (39.1%)) or with cystic areas (14/23 (60.9%)). The tumor shape was mainly lobular (n = 19 (54.3%)) or irregular (n = 10 (28.6%)). Tumors were typically richly vascularized (color score of 3 or 4, n = 31 (88.6%)) with no shadowing (n = 31 (88.6%)). Based on pattern recognition, eGISTs were usually correctly classified as a malignant lesion in the ultrasound reports (n = 32 (91.4%)), and the specific diagnosis of eGIST was the most frequent differential diagnosis (n = 16 (45.7%)), followed by primary ovarian cancer (n = 5 (14.3%)), lymphoma (n = 2 (5.7%)) and pedunculated uterine fibroid (n = 2 (5.7%)). CONCLUSIONS On ultrasound, eGISTs were usually solid, non-uniform pelvic or abdominal lobular tumors of mixed echogenicity, with or without cystic areas, with rich vascularization and no shadowing. The presence of a tumor with these features, without connection to the bowel wall, and not originating from the uterus or adnexa, is highly suspicious for eGIST. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M Ambrosio
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A C Testa
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
- Dipartimento Scienze della Vita e Sanità pubblica, Università Cattolica del Sacro Cuore, Rome, Italy
| | - F Moro
- Dipartimento Scienze della Salute della Donna e del Bambino, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - D Franchi
- Division of Gynecology, European Institute of Oncology, Milan, Italy
| | - M C Scifo
- Department of Obstetrics and Gynecology, S. Orsola Malpighi Hospital, University of Bologna, Bologna, Italy
| | - N Rams
- Hospital Santa Cruz y San Pablo, Barcelona, Spain
| | - E Epstein
- Department of Clinical Science and Education, Karolinska Institutet & Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
| | - J L Alcazar
- Department of Obstetrics and Gynecology, Clinica Universidad de Navarra, University of Navarra, Pamplona, Spain
| | - J J Hidalgo
- Department of Obstetrics and Gynecology, Clinic Hospital Valencia, Valencia, Spain
| | | | - A Burgetova
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - P Dundr
- Department of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Cibula
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - D Fischerova
- Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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Sato M, Yano M, Sato S, Aoyagi Y, Aso S, Matsumoto H, Yamamoto I, Nasu K. Uterine tumor resembling ovarian sex-cord tumor (UTROSCT) with sarcomatous features without recurrence after extended radical surgery: A case report. Medicine (Baltimore) 2020; 99:e19166. [PMID: 32176042 PMCID: PMC7220453 DOI: 10.1097/md.0000000000019166] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE The malignant potential and the appropriate treatment of uterine tumor resembling ovarian sex-cord tumor (UTROSCT) is controversial. Although these tumors generally have benign outcomes, several reports have described recurrences, metastases, and deaths associated with this disease. PATIENT CONCERNS A 57-year-old Japanese woman (gravida 2, para 2) was referred to our hospital for the evaluation and treatment of uterine fibroids. Magnetic resonance imaging revealed a right ovarian mass and multiple fibroids in the uterine myometrium. DIAGNOSES The patient was diagnosed with UTROSCT with sarcomatous features. INTERVENTIONS She initially underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy, followed by second-stage surgery comprising pelvic and para-aortic lymphadenectomy and subtotal omentectomy. OUTCOMES No postoperative recurrence was observed in the patient in 36 months. LESSONS In this case, extended radical surgery prevented the development of recurrent disease in a patient with UTROSCT with sarcomatous features. These clinicopathological findings suggest that UTROSCT is associated with several risk factors, including older age, presence of necrosis, lymphovascular invasion, significant nuclear atypia, and significant mitotic activity. This lesion type should be considered malignant and treated with curative intent.
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Affiliation(s)
- Miho Sato
- Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
| | - Mitsutake Yano
- Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
- Department of Pathology, Saitama Medical University International Medical Center, Saitama
| | - Shimpei Sato
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
| | - Yoko Aoyagi
- Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
| | - Saki Aso
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
| | - Harunobu Matsumoto
- Department of Obstetrics and Gynecology, Nakatsu Municipal Hospital
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
| | | | - Kaei Nasu
- Department of Obstetrics and Gynecology, Oita University Faculty of Medicine, Oita
- Division of Obstetrics and Gynecology, Support System for Community Medicine, Oita University Faculty of Medicine, Oita, Japan
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Sharma R, Goel RK, Rana A, Sachdev R. Ovarian steroid cell tumor, not otherwise specified. Pathologica 2018; 110:121-122. [PMID: 30546150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023] Open
Abstract
Ovarian steroid cell tumours are rare virilizing tumours. They are three types of tumours of ovary which are characterized by steroid cell proliferation : Leydig cell tumour, steroid cell tumour, Not Otherwise Specified (NOS) and stromal luteoma. Here we present a case of 36 year old female, who presented with history of weight loss since last two and half months. There is history of amenorrhoea and hirsuitism. Her CA was 125: 11.4 IU/ml (0-35 U/mL). Blood Testosterone levels was elevated with value of 150 ng/ml (5.71-77 ng/ml). Serum Inhibin A, Inhibin B, FSH, LH and prolactin were within normal limits. The steroid cell tumour, NOS are mostly benign but few of them behave in malignant fashion. Hayes and Scully gave few histopathological features which favour malignant behavior. These tumours should be differentiated from leydig cell tumour by lack of cytoplasmic Reinkes' crystals as well as from other neoplasms like primary clear cell carcinoma, metastatic clear cell renal cell carcinoma and adrenocortical tumour.
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Affiliation(s)
- R Sharma
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, Haryana 122 001, India
| | - R K Goel
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, Haryana 122 001, India
| | - A Rana
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, Haryana 122 001, India
| | - R Sachdev
- Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Sector-38, Gurgaon, Haryana 122 001, India
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Peng Y, Lin J, Guan J, Chen L, Zhang X, Li S, Wang H, Liu M, Guo Y. Ovarian collision tumors: imaging findings, pathological characteristics, diagnosis, and differential diagnosis. Abdom Radiol (NY) 2018; 43:2156-2168. [PMID: 29198011 DOI: 10.1007/s00261-017-1419-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Collision tumors are uncommon neoplasms in which elements of differing histologic origins coexist in a single mass. Ovarian collision tumors are a rare subtype of such lesions. The identification of collision tumors by radiologic examinations is essential to ensure that comprehensive biopsies are performed to guide appropriate treatments. According to the clinical and imaging findings of 12 patients and reviews of previous studies, ovarian collision tumors are mixtures of different combinations of epithelial tumors, germ cell tumors, and sex-cord-stromal tumors. The smaller tumors are usually located inside ("nested tumor") or on the wall ("back to back") of the larger tumors. Each type of ovarian collision tumors presents specific CT/MRI features in accordance with their histologic origins and collision patterns. Knowledge of the imaging features of ovarian collision tumors is crucial to aid preoperative diagnostic accuracy.
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Affiliation(s)
- Yang Peng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Jinhua Lin
- Department of Medical Ultrasound, Institute of Diagnostic and Interventional Ultrasound, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Jian Guan
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China.
| | - Lili Chen
- Department of Pathology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Xiaoling Zhang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Shurong Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Huanjun Wang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Mingjuan Liu
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
| | - Yan Guo
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, 58 Zhongshan Road 2, Guangzhou, Guangdong, People's Republic of China
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12
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Zhang H, Zhang H, Gu S, Zhang Y, Liu X, Zhang G. MR findings of primary ovarian granulosa cell tumor with focus on the differentiation with other ovarian sex cord-stromal tumors. J Ovarian Res 2018; 11:46. [PMID: 29871662 PMCID: PMC5989475 DOI: 10.1186/s13048-018-0416-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 05/20/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To describe magnetic resonance imaging (MRI) features of ovarian granulosa cell tumors (OGCTs) and compare with other sex cord-stromal tumors (OSCs) in ovary. METHODS MR findings of 18 patients with surgically confirmed ovarian granulosa cell tumor were retrospectively reviewed by two radiologists with consensus reading. All MR examinations were prospectively performed within one month. Clinical and imaging characteristics of OGCTs were evaluated and compared with OSCs (control group). RESULTS In 18 patients, 20 ovarian granulosa cell tumors were detected on MRI. Sixteen tumors appeared as solid or mostly solid mass (16/20), while 4 tumors as cystic mass. Pathological pelvic fluid was detected in 1 OGCT (1/18) and 11 OSCs (11/34) (p = 0.031).On T2 weighted imaging (T2WI), most of OGCTs displayed hyperintense signal and mixed signal (19/20); on T1 weighted imaging (T1WI), 11 OGCTs (11/20) displayed similar signal as on T2WI imaging. The lesion signal between OGCT and OSC differed significantly on both T1WI (p = 0.017) and T2WI (p = 0.002). Tumoral bleeding was detected in 6 OGCTs on MRI. On diffusion weighted imaging (DWI) images, OGCTs mostly appeared as high signal (16/20). Average apparent diffusion coefficient (ADC) value derived from DWI images in the OGCT group (0.84 ± 0.26× 10- 3 mm2/s was less than the control group (1.22 ± 0.47 × 10- 3 mm2/s) with statistical difference (p = 0.002). CONCLUSIONS MRI could provide important information in OGCT diagnosis. ADC value might be useful in differentiating OGCT from OSC.
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Affiliation(s)
- He Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Hongyu Zhang
- 0000 0004 1757 9055grid.452354.1Department of Ultrasound, Daqing Oilfield General Hospital, Daqing, Heilongjiang Province 163001 People’s Republic of China
| | - Shouxin Gu
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Yanyu Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Xuefen Liu
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
| | - Guofu Zhang
- 0000 0001 0125 2443grid.8547.eDepartment of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011 People’s Republic of China
- 0000 0001 0125 2443grid.8547.eInstitute of functional and molecular medical imaging, Fudan University, Shanghai, 200040 People’s Republic of China
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Tomimatsu T, Fukuda Y, Mimura K, Yoshino K, Kato H, Tsuboyama T, Hori Y, Kimura T. Intense fluorodeoxyglucose uptake by a benign sclerosing stromal tumor of the ovary. Taiwan J Obstet Gynecol 2017; 55:893-894. [PMID: 28040143 DOI: 10.1016/j.tjog.2016.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2016] [Indexed: 11/18/2022] Open
Affiliation(s)
- Takuji Tomimatsu
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
| | - Yayoi Fukuda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Hiroki Kato
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takahiro Tsuboyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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14
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Limaiem F, Boudabous E, Ben Slama S, Chelly B, Lahmar A, Bouraoui S, Gara F, Mzabi S. Sclerosing stromal tumour of the ovary: two case reports. Pathologica 2013; 105:62-65. [PMID: 23951586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
Sclerosing stromal tumours are rare benign ovarian neoplasms of the sex cord stromal that occur predominantly in the second and third decades of life. Herein, we report two cases of sclerosing stromal tumour of the ovary. The two patients were 16 and 45 years old and both presented with pelvic pain. Ultrasonography demonstrated a heterogeneous solid mass of the left and right ovary, respectively, with some cystic foci in the second tumour. Laboratory tests including tumour markers and serum hormonal assays were normal in both cases. The two patients underwent left and right salpingo-oophrectomy, respectively. Microscopically, the tumours showed a pseudolobular pattern with cellular areas separated by oedematous and collagenous areas. The cellular areas were richly vascularized, with a hemangiopericytic pattern, and were composed of an admixture of theca-like and spindle-shaped cells. Immunohistochemical studies showed that the tumour cells were positive for smooth muscle actin, inhibin and vimentin, but negative for cytokeratin. The final pathological diagnosis was sclerosing stromal tumour. Postoperative course was uneventful for both patients.
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Affiliation(s)
- F Limaiem
- Departments of Pathology, Mongi Slim Hospital, La Marsa, Tunisia.
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15
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Dar UK, Khan I, Javed M, Ali M, Hyder SW, Murad S, Anwar J. Development of 99mTc-5-fluorouracil as a potential tumor diagnostic agent. Pak J Pharm Sci 2013; 26:333-337. [PMID: 23455204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
5-Fluorouracil is a well know drug for chemotherapy of various types of cancer. In the present study, we radiolabeled 5-fluorouracil with (99m)Tc for a diagnostic study of cancer. After successful labeling of the drug we performed an animal study to evaluate the potential of this radiopharmaceutical as a tumor diagnostic agent. The results showed 98.1 ± 1.2% labeling efficacy of 5-fluorouracil with (99m)Tc. The in vitro stability of the radiolabeled drug at room temperature at 4 hr of post-labeling was >96.5 ± 0.4%. The binding of the radiolabeled drug with plasma proteins was 66.6 ± 3%. Partition coefficient results showed that this drug is hydrophilic in nature. Biodistribution study in rabbit models displayed faint uptake in liver. Both kidney and bladder were prominent as excretory route of the labeled drug. Bioevaluation was performed in Swiss Webster mice having naturally developed tumor. Mice were dissected, uptake of drug in various organs was studied and results showed prominent uptake in liver and tumor. Tumor was further investigated by histopathological study.
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16
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Varras M, Vasilakaki T, Skafida E, Akrivis C. Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumour, not otherwise specified: our experience of a rare case with female virilisation and review of the literature. Gynecol Endocrinol 2011; 27:412-8. [PMID: 20586551 DOI: 10.3109/09513590.2010.495432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Ovarian steroid cell tumours, not otherwise specified (NOS) are rare sex cord-stromal tumours of the ovary. These tumours should be considered a cause of isosexual precocious puberty in children and virilisation in adults. CASE We report a case of 40-year-old woman with mental handicap who presented with 3 years of amenorrhea and progressive virilisation. Pelvic ultrasonography identified a 6.19 × 6.15 cm well-defined echogenic-multilobular mass arising from the left ovary. Fluid in the cul-de-sac was noted. Colour Doppler examination with endovaginal ultrasonography showed high vascularity of the tumour with low resistance to flow. A computed tomography (CT) scan of the upper and lower abdomen showed a lobular mass with diaphragms in the left adnexal structure and fluid in the cul-de-sac; no adrenal gland enlargement or additional tumour was detected. Laboratory analysis revealed increased levels of serum total testosterone. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histological examination showed a benign steroid cell tumour, NOS without evidence of necrosis, haemorrhage or invasion. The immunohistochemical study showed that the tumour cells were positive for inhibin, CD 99, Melan A and vimentin and negative to CK AE1, CK AE3, progesterone and estrogen receptors. CONCLUSION Careful medical history, physical examination, laboratory serum values and imaging studies are helpful in making the pre-operative diagnosis. Steroid cell tumours, NOS are usually benign, unilateral and characterised by the composition of two similar-appearing polygonal cell types. They differ from Leydig cell tumours in the lack of crystals of Reinke in their cytoplasm.
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Affiliation(s)
- Michail Varras
- Department of Obstetrics and Gynecology, Tzaneio General State Hospital, Piraeus, Greece.
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17
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AbdullGaffar B. Cytokeratin expressing epithelioid cells in ovarian sclerosing stromal tumor: A potential diagnostic pitfall that may be mistaken for metastatic carcinoma. Hematol Oncol Stem Cell Ther 2010; 3:207-8. [PMID: 21150244 DOI: 10.5144/1658-3876.2010.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Abstract
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.
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Affiliation(s)
- Ronald S Swanger
- Department of Radiology, New York Medical College, Valhalla, NY, USA.
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19
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Ding DC, Hsu S. Lipid cell tumor in an adolescent girl: a case report. J Reprod Med 2007; 52:956-958. [PMID: 17977174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND Lipid cell tumors of the ovary are rare sex cord neoplasms and account for < 0.1% of ovarian tumors. CASE A 16-year-old girl sought medical advice because of amenorrhea and virilization, manifested as facial hirsutism and temporal balding. Her total testosterone level was increased in comparison with normal values. Ultrasonography revealed an echogenic left adnexal tumor about 5.7 x 6.3 x 5.5 cm. The patient underwent laparoscopic ovarian cystectomy, and pathology showed a lipid cell tumor. Postoperatively, the serum testosterone level returned to normal. CONCLUSION The tumor appeared to be the source of hyperandrogenism in this woman.
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Affiliation(s)
- Dah-Ching Ding
- Graduate Institute of Medical Science, School of Medicine, Tzu Chi University, Taiwan, ROC.
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20
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Chen CY, Wu YC, Yen MS, Hung JH, Yuan CC, Chao KC. The power Doppler velocity index, pulsatility index, and resistive index can assist in making a differential diagnosis of primary ovarian carcinoma and Krukenberg tumors: a preliminary study. J Ultrasound Med 2007; 26:921-6; quiz 927-9. [PMID: 17592055 DOI: 10.7863/jum.2007.26.7.921] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE The aim of this study was to compare the effectiveness of transvaginal power Doppler sonography with spectral Doppler analysis as an aid in preoperatively distinguishing primary ovarian carcinoma and metastatic carcinoma to the ovary (Krukenberg tumors). METHODS Fifty women with ovarian disease were preoperatively examined with transvaginal power Doppler sonography. Six basic parameters were measured, including intratumoral peak systolic velocity, end-diastolic velocity, time-averaged maximum velocity, pulsatility index (PI), resistive index (RI), and velocity index (VeI). Blood flow analyses were detectable in all patients. Twelve patients with metastatic carcinoma to the ovary were classified as group 1; 38 patients with primary ovarian carcinoma were classified as group 2. Comparison of intratumoral blood flow analyses between the two groups was performed. RESULTS The PI, RI, and VeI were significantly lower in patients with metastatic carcinoma to the ovary than those with primary ovarian carcinoma (P < .05). There were no significant differences in the peak systolic velocity (P = .871), end-diastolic velocity (P = .508), and time-averaged maximum velocity (P = .850) between the two groups. CONCLUSIONS Transvaginal power Doppler sonography with spectral Doppler analysis is an effective method in evaluating intratumoral blood flow of Krukenberg tumors. Low impedance (PI, RI, and VeI) might assist us in making differential diagnoses between primary ovarian carcinoma and Krukenberg tumors according to our preliminary results.
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MESH Headings
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/physiopathology
- Adult
- Aged
- Blood Flow Velocity/physiology
- Carcinoma/diagnostic imaging
- Carcinoma/physiopathology
- Carcinoma/secondary
- Carcinoma, Endometrioid/diagnostic imaging
- Carcinoma, Endometrioid/physiopathology
- Cystadenocarcinoma, Papillary/diagnostic imaging
- Cystadenocarcinoma, Papillary/physiopathology
- Cystadenocarcinoma, Serous/diagnostic imaging
- Cystadenocarcinoma, Serous/physiopathology
- Diagnosis, Differential
- Female
- Humans
- Krukenberg Tumor/diagnostic imaging
- Krukenberg Tumor/physiopathology
- Middle Aged
- Neoplasms, Germ Cell and Embryonal/diagnostic imaging
- Neoplasms, Germ Cell and Embryonal/physiopathology
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/physiopathology
- Prospective Studies
- Pulsatile Flow/physiology
- Regional Blood Flow/physiology
- Sex Cord-Gonadal Stromal Tumors/diagnostic imaging
- Sex Cord-Gonadal Stromal Tumors/physiopathology
- Ultrasonography, Doppler
- Ultrasonography, Doppler, Color
- Ultrasonography, Doppler, Pulsed
- Vascular Resistance/physiology
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Affiliation(s)
- Chih-Yao Chen
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, Republic of China
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21
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Abstract
OBJECTIVE Burkitt's lymphoma (BL) occurs mostly in children; bilateral ovarian involvement mimicking a gynecologic malignancy in adults is extremely rare. Here, we report a patient with BL mimicking a gynecologic tumor. CASE REPORT A 50-year-old Taiwanese woman presented with the complaint of persistent lower abdominal distension with dull pain, easy satiety, and progressively increasing abdominal girth for 2 weeks. Amenorrhea was also noted for about 2 months, and her review of systems was negative for the common "B" symptoms associated with lymphoma. At our hospital, imaging studies revealed a huge pelvic mass (10.8 x 8.7 cm), suggesting a large subserous myoma or an ovarian tumor. Under the impression of pelvic mass, she underwent exploratory laparotomy. Primary ovarian sex-cord malignancy with cecum involvement was impressed by the primitive intraoperative frozen section report. Subsequently, an optimal cytoreductive operation with right hemicolectomy was performed. However, final histopathologic report was an extranodal multifocal BL. CONCLUSION Although extranodal BL in ovaries is a rare condition, it should be noted in the differential diagnosis of pelvic gynecologic malignancies.
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Affiliation(s)
- Szu-Ching Lu
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical Center, Tainan, Taiwan
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22
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Abstract
Meigs' syndrome caused by sclerosing stromal tumor is extremely rare and only two cases have been reported to date. An elevated serum level of CA-125 is also unusual and it has been thought that it is the consequence of physical irritation and inflammation. In this report, we present the case of a 50-year-old postmenopausal woman with a sclerosing stromal tumor presenting with Meigs' syndrome and an elevated CA-125 level (1476.8 IU/mL). This case highlights the difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy and it should be considered in the differential diagnosis in postmenopausal patients with pelvic mass, ascites, pleural effusions and elevated serum CA-125.
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Affiliation(s)
- Nan Hee Jung
- Department of Obstetrics and Gynecology, College of Medicine, Korea University, Kyounggi-do, Korea
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23
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Korczyiński J, Gottwald L, Pasz-Walczak G, Kubiak R, Bieńkiewicz A. [Sclerosing stromal tumor of the ovary in a 30-year-old woman. A case report and review of the literature]. Ginekol Pol 2005; 76:471-5. [PMID: 16149265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Sclerosing stromal tumor of the ovary (SST) is an extremely rare neoplasm occurring predominantly in the second and third decades of life. It is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and lipoid cell tumors. It presents most often with non-specific symptoms. We describe the case of a 30-year-old woman who developed menstrual irregularities and pelvic pain. She was diagnosed and treated operatively at our Department. During surgery, a benign tumor was found in the right ovary. Light microscopic and ultrastructural study confirmed the diagnosis of sclerosing stromal tumor of the ovary.
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Affiliation(s)
- Jerzy Korczyiński
- Klinika Ginekologii Onkologicznej, Katedry Onkologii Uniwersytetu Medycznego w Lodzi
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24
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Popovska S, Popovski K, Gorchev G, Marinov E. [Sclerosing stromal ovarial tumor--a case report and review]. Akush Ginekol (Sofiia) 2005; 44:42-5. [PMID: 16028379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sclerosing stromal tumor (SST) is a rare benign ovarian neoplasm of stromal origin with less than 100 cases reported in the literature. Unlike the other stromal tumors, the comas and fibromas, which tend to occur in the fifth and sixth decades, sclerosing stromal tumors predominantly affect females in the second and third decades. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity of the tumor are clearly reflected at ultrasonography. We present a case of SST of the ovary in a 26-year-old female, and describe the ultrasound findings with pathologic correlation.
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25
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Bouraoui S, Ben Fadhl C, Bellil K, Guettiti-Tounsi H, Mekni A, Kchir N, Zouari F, Zitouna M, Haouet S. [Sclerosing stromal tumor of the ovary. Report of 3 cases]. Tunis Med 2004; 82:1111-5. [PMID: 15822514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Sclerosing Stromal Tumor (SST) is an uncommon benign tumor of the ovary, distinct from thecoma and fibroma because of predominant occurrence below 30 years of age, lack of hormonal manifestations and histologic heterogenity. Three cases of SST occuring in a 15, 26 and 56-year-old females are reported. Review of the literature and clinicopathological features are described in the present article. Histogenesis and differential diagnosis are also discussed.
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Affiliation(s)
- Sâadia Bouraoui
- Service d'Anatomie et de Cytologie Pathologiques, Hôpital la Rabta
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26
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Calabrese M, Zandrino F, Giasotto V, Rissone R, Fulcheri E. Sclerosing stromal tumor of the ovary in pregnancy: clinical, ultrasonography, and magnetic resonance imaging findings. Acta Radiol 2004; 45:189-92. [PMID: 15191104 DOI: 10.1080/02841850410004148] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We report a case of sclerosing stromal tumor of the ovary in a 30-year-old pregnant patient presenting with pelvic pain, dysuria, and metrorrhagia. Very few reports of sclerosing stromal tumor of the ovary during pregnancy have been presented. The purpose of our work is to present the findings at physical examination, ultrasonography, magnetic resonance imaging, and histopathology, to review the literature regarding this uncommon neoplasm, and to show the usefulness of magnetic resonance imaging in the assessment of pelvic masses during pregnancy.
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Affiliation(s)
- M Calabrese
- Department of Experimental Medicine, Section of Diagnostic Imaging and Radiotherapy, University of Genoa, Genoa, Italy
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27
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Abstract
Sclerosing stromal tumor (SST) of the ovary is a very rare sex cord stromal tumor occurring in a younger age group than other types of stromal tumors and most commonly accompanied by menstrual irregularity. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity are clearly reflected at ultrasonography and MRI. We report the ultrasonographic and MR features of three cases of histologically confirmed SSTs, and relate them to the pathological findings.
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Affiliation(s)
- Jin Young Kim
- Department of Radiology, School of Medicine, Catholic University of Daegu, Daegu, Korea.
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28
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Abstract
Gonadal stroma tumors account for 8% of pediatric testicular tumors and are therefore exceedingly rare. They generally exhibit a benign behavior. We report two consecutive cases of gonadal stroma tumors in infants. A 5-month-old boy presented with a Sertoli cell tumor and a 2-month-old boy with a juvenile granulosa cell tumor without systemic disease. Both were diagnosed incidentally during routine examinations. Organ-sparing surgery and radical orchiectomy, respectively, was the therapy of choice. Although neonatal testicular tumors are rare, they should be considered in the differential diagnosis of a newborn with a scrotal mass.
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Costero-Barrios CB, López-Briano MDR. [Extraovarian sex cord mesenchymatose tumor]. GAC MED MEX 2003; 139:611-6. [PMID: 14723057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Abstract
A 32-year-old female presented with a large tumoral mass in the left upper quadrant (ULQ) of the abdomen with abdominal and retroperitoneal components, infiltrating the spleen and adhered to pancreatic tail, colon, left kidney, and stomach that could be completely resected along with the spleen. Histopathologic study including immunohistochemical profile was coincident with results obtained at Barnes-Jewish Hospital of Washington University Medical Center, USA. This study showed areas of granulosa tumor cells as well as thecal features of fusiform cells with eosinophilic cytoplasm and tubular formations corresponding to Sertoli cells. According with embryologic development, the specialized stroma of the genital crest is induced to proliferase after primordial germ cells infiltrate the crest; in this way, tumoral growth can occur at any site along this migration. The predominating localization of this unique ectopic tumor coincides with the descending route of the ovaries or its components. This case, included in unclassified forms of stromal sex cord tumors, is considered a monodermal malignant teratoma. Is was the second tumor of retroperitoneal localization and the eleventh ectopic, according to the world literature reviewed.
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Affiliation(s)
- Cesáreo B Costero-Barrios
- Facultad de Medicina Universidad Autónoma de San Luis Potosí, Servicio de Anatomía Patológica, Centro Médico del Potosí, S.L.P. México.
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Abstract
The sclerosing stromal tumor (SST) of the ovary is a distinct benign neoplasm that differs from fibromas, thecomas, luteinized tumors and lipoid cell tumors. It accounts for 6% of ovarian stromal tumors and tends to occur at an earlier age. On gray-scale ultrasound examination, SSTs of the ovary are solid or cystic and multilocular. We describe here, we believe for the first time, the findings on color Doppler imaging of an SST of the ovary. A 29-year-old woman presented with an organic ovarian mass. She underwent a transvaginal ultrasound examination that revealed an echogenic cyst with acoustic shadowing. Color Doppler demonstrated marked peripheral vascularization. Findings on computed tomography and magnetic resonance imaging strongly suggested the preoperative diagnosis of SST of the ovary, which was confirmed at pathology. Association of an echogenic ovarian mass with acoustic shadowing and a high degree of peripheral vascularization may strongly suggest the diagnosis of SST of the ovary.
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Affiliation(s)
- B Deval
- Department of Gynécologie, Hôpital Beaujon, Assistance Publique-Hopitaux de Paris, Clichy, France.
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Affiliation(s)
- David E Bryan
- Department of Urology, Indiana University School of Medicine and Riley Children's Hospital, Indianapolis, USA
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Abstract
Over 90 cases of sclerosing stromal tumor of the ovary (SST) have been reported in the English-language literature, but these authors did not mention the cytologic examination of SST. In 2 patients with SST, we were able to collect specimens for tumor imprint cytology. The number of cells in the specimens was extremely small. Two types of benign cells were observed against a clean background, comprising cells with round nuclei surrounded by abundant cytoplasm and cells with spindle-shaped or oval nuclei that had scanty cytoplasm. Our present findings suggest that intraoperative imprint cytology was able to rule out cancer. Considering that SST most commonly occurs in young women requiring conservative treatment, imprint cytology seems to have a potential diagnostic significance.
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Affiliation(s)
- Mikio Mikami
- Department of Obstetrics and Gynecology, National Saitama Hospital, Wako, Saitama, Japan.
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Abstract
We present the sonographic, computed tomographic, and magnetic resonance imaging findings in a case of a sclerosing stromal tumor of the ovary with pathologic correlations.
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Affiliation(s)
- P Torricelli
- Department of Radiology, University of Modena and Reggio Emilia, Policlinico di Modena, Via del Pozzo 71, 41100 Modena, Italy
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Karabulut N, Karabulut A, Pakdemirli E, Sabir N, Soysal SK, Soysal ME. Stromal tumor of the sex cord in a woman with testicular feminization syndrome: imaging features. AJR Am J Roentgenol 2002; 178:1496-8. [PMID: 12034627 DOI: 10.2214/ajr.178.6.1781496] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Nevzat Karabulut
- Department of Radiology, Pamukkale University Hospital, 20010 Denizli, Turkey
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Abstract
Sclerosing stromal tumors are rare benign ovarian stromal tumors, which have distinctive clinical and pathologic features. The tumors occur predominantly in the second and third decades and are histologically characterized by the pseudolobular pattern of the cellular and hypocellular areas, marked vascularity, and heterogeneity of the cellular area. We analyzed 7 cases of sclerosing stromal tumors, which showed a typical sonographic appearance. On sonograms, sclerosing stromal tumors were solid and cystic and contained multiple round or cleftlike cysts. Ascites was rare. On transvaginal color Doppler sonograms, sclerosing stromal tumors were very hypervascular in the peripheral solid area and internal intercystic space and showed low-impedance flow. We conclude that sclerosing stromal tumors should be considered in young women with menstrual irregularity who have hypervascular solid and cystic adnexal masses.
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Affiliation(s)
- M S Lee
- Department of Radiology, Samsung Cheil Hospital, Sungkyunkwan, University School of Medicine, Seoul, Korea
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Joja I, Okuno K, Tsunoda M, Takeda Y, Sugita K, Mizutani Y, Miyagi Y, Kudo T, Notohara K, Hiraki Y. Sclerosing stromal tumor of the ovary: US, MR, and dynamic MR findings. J Comput Assist Tomogr 2001; 25:201-6. [PMID: 11242213 DOI: 10.1097/00004728-200103000-00007] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The US, MR, and dynamic MR findings in four patients with sclerosing stromal tumor of the ovary are reported. US showed a tumor with multilocular cystic components and irregularly thickened septa and tumor walls or a solid tumor including several small cystic components. On T2-weighted MR images, signal intensities of the cystic components were high and those of the solid components were inhomogeneous, ranging from intermediate-high to high. Dynamic MRI demonstrated marked early enhancement of the solid components.
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Affiliation(s)
- I Joja
- Department of Medical Radiotechnology, Faculty of Health Sciences, Okayama University Medical School, Okayama, Japan.
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Abstract
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.
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Affiliation(s)
- E K Outwater
- Department of Radiology, University of Arizona, Tucson, USA
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Abstract
A 24-year-old woman presented with continuous vaginal bleeding and anemia. Pelvic sonography demonstrated an enlarged uterus measuring 8.9 x 4.9 x 4.7 cm and a mass within the endometrial cavity measuring 3.0 x 1.8 cm. The mass appeared to be polypoid and echogenic, contained a small cyst, and was suggestive of a polyp. The patient underwent total vaginal hysterectomy. Pathologic examination revealed a uterine sex cord-stromal tumor. To our knowledge, the sonographic features of uterine sex cord-stromal tumor have not been previously reported. The sonographic appearance mimicked that of a polyp.
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Affiliation(s)
- A Franco
- Department of Radiology, Columbia University College of Physicians and Surgeons, Harlem Hospital Center, New York, New York 10037, USA
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Ruibal Francisco JL, Palomino Bueno MC, Rivilla Parra F, Ortega Medina L, Bueno Lozano G, Casado de Frías E. [Sexual precocity in a 7-year old girl, due to a tumor of the ovarian sex cord with annular tubules (SCTAT of Scully)]. An Esp Pediatr 1998; 48:409-11. [PMID: 9629801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Uygur MC, Gür E, Altug U, Ustün H, Emir L, Erol D. Malignant gonadal stromal tumor with bulky metastasis at diagnosis. Urol Int 1998; 59:191-3. [PMID: 9428440 DOI: 10.1159/000283061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A 63-year-old man underwent inguinal orchiectomy for painless enlargement of the left testis. The diagnosis of malignant gonadal stromal tumor was made on the basis of morphology and immunohistochemical studies. At computed tomography there was bulky retroperitoneal metastasis. The patient then underwent retroperitoneal lymphadenectomy and received 6 courses of platinum-based chemotherapy at the end of which complete response was documented. However, at 18 months' follow-up, computed tomography revealed recurrent retroperitoneal metastasis. The patient was put on chemotherapy regimen again. But he developed pulmonary metastasis and died 28 months after the initial diagnosis. The clinical course of this patient suggests that malignant gonadal stromal tumor, if metastatic at diagnosis, may have a poor prognosis against most aggressive treatment approaches.
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Affiliation(s)
- M C Uygur
- Urology Clinic of the Ministry of Health, Ankara Hospital, Turkey
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41
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Affiliation(s)
- J Hamlin
- Department of Radiological Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73190, USA
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42
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Affiliation(s)
- W K Moon
- Department of Radiology, College of Medicine, Seoul National University, Republic of Korea
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43
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Dempsey TJ, Brooks JP. Malignant gonadal stromal tumor: sonographic findings with pathologic correlation. J Clin Ultrasound 1994; 22:408-411. [PMID: 8071461 DOI: 10.1002/jcu.1870220610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Affiliation(s)
- T J Dempsey
- Department of Radiology, Veteran's Administration Medical Center, Memphis, Tennessee 38104
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