MEDizzy - A 39-year-old woman presents with increasing abdominal

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Reproductive Systems and Skin

A 39-year-old woman presents with increasing abdominal distention and pelvic pain. A CT scan finds a slight amount of fluid in the pleural cavity and also a 3.5-cm tumor of the right ovary. The tumor is resected and histologic sections reveal the tumor to be composed of spindle-shaped cells. These cells did not stain with an oil red O special stain. Which of the following types of ovarian tumor is most likely to produce this constellation of findings?

ExplanationOvarian neoplasms are divided into four main categories: epithelial tumors, sex cord-stromal tumors, germ cell tumors, and metastases. Examples of ovarian stromal tumors include thecomas, fibromas, granulosa cell tumors, and Sertoli-Leydig cell tumors. Histologically, thecomas are composed of spindle-shaped cells with vacuolated cytoplasm. They are vacuolate because of steroid hormone (estrogen) production, which can be stained with an oil red O stain. Fibromas are also composed of spindle-shaped cells, but they do not produce steroid hormones and are oil red O–negative. Fibromas are associated with Meigs syndrome, which consists of an ovarian fibroma, ascites, and hydrothorax. The stromal cells of the ovary are the precursors of endocrine-active cells, so it is easy to understand that neoplasms derived from these stromal cells are often associated with hormone production. For example, granulosa cells normally secrete estrogens, thecal cells normally secrete androgens, and hilar cells (Leydig cells) may secrete androgens. Excess androgen production in females may lead to masculinization and produce symptoms such as amenorrhea, loss of secondary female sex characteristics, and the development of secondary male characteristics, such as hirsutism, temporal balding, and deepening of the voice. Ovarian tumors associated with excess androgen production include androblastomas (Sertoli-Leydig cell tumors). Other ovarian diseases associated with excess androgen production include polycystic ovarian disease and hyperthecosis. Excess estrogen production is associated with precocious puberty in the young and with endometrial hyperplasia and cancer in older women. Ovarian tumors that may secrete estrogens include granulosa cell tumors and thecomas.