[Hormonally-active ovarian tumors in 30 years of data (1965-1994)].
INTRODUCTION: Authors have investigated the incidence and distribution of hormonally active ovarian tumors in a 30-year surgical material. Out of 552 ovarian tumors, there were 28 hormonally active tumors (5.07%): 18 granulosa cell tumors, 4 thecomas, 2 arrhenoblastomas, 2 malignant v. Kalden folliculomas. There were laso 2 benign tumors: ectopic adrenal ovarian tumor, and ovarian tube hydatidiform mole. They secrete estrogen and testosterone and their effects are evident: prior to puberty (Praecox pubertas), during the reproductive period, but most often in menopause. In order to make the diagnosis, when uterine hemorrhage occurs, it is necessary to perform explorative curettage, but the tumors must be surgically removed. It is necessary to perform that kind of surgery, which corresponds to the age of the woman. Recurrences may appear even 35 years later. MATERIAL AND METHODS: Hysterectomy with bilateral adnexectomy was performed in 18 (64.28%) postmenopausal women. In 4 (14.29%) women of reproductive age unilateral adnexectomy was performed, while explorative laparotomy was performed also in 4 (14.29%) women. 5-year survival in the first stage of the disease was 75% (20 women). During the first three years 5 (17.86%) women decreased in the IV stage of the disease, as well as one woman (3.57%) in the II b stage, which makes a total of 6 women (21.43%) with fatal outcome. Ovarian tumors also include hormonally active tumors which secrete female and male sex hormones, and whose effects are evident on hormonal receptors. They are divided into benign or malignant, whereas they are all potentially malignant. We differentiate two groups: 1. Feminizing mesenchymomas, which secrete female sex hormones and 2. Virilizing tumors, which secrete male sex hormones. These tumors may occur prior puberty, during the reproductive period and in the postmenopausal period--senium. They can cause minor, long-term or hemorrhages similar to menstruation, as well as hypertrophy of the myometrium. Glandular cystic hyperplasia occurs often, whereas proliferation is rare. Histopathological findings after surgery (for example of myoma) are often surprising, because they reveal hormonally active undetected ovarian tumors or glandular cystic endometrial hyperplasia. All hormonally active tumors are potentially malignant. The aim of this retrospective study was to compare our prior attitudes and interventions with newer attitudes and to make changes on behalf of our patients. RESULTS: Our investigation included 552 adnexal tumors in a 30-year material. Each woman with uterine hemorrhage had undergone explorative curettage and the material was sent for histopathological analysis. During the investigated period 28 hormonally active tumors were found: 2 benign and 26 malignant or potentially malignant tumors (Table 2). There were 18 cases (40.91%) with granulosa cell tumors, 6 cases (13.64%) with cystadenocarcinoma ovarii serosum; 3 cases (6.82%) with borderline tumors; 4 cases (9.09%) with thecoma of the ovarii. Pseudomucious adenocarcinoma was found in 2 cases (4.55%) as well as endometrial adenocarcinoma, malignant mesenchymoma, arrhenoblastoma, malignant folliculoma v. Kalden; whereas malignant teratoma was established in 1 case (2.27%), as well as anaplastic carcinoma, metastatic carcinoma--Krunberg. It is obvious that hormonally active tumors make almost half of the cases (46.43%) and occur mostly at the age of 50-59 years of age (3.4%). Out of 28 patients, 18 underwent hysterectomy and bilateral adnexectomy (64.28%); 4 (14.29%) underwent unilateral adnexectomy that is explorative laparotomy for taking bioptic samples for histological examination (14.29%). Out of 28 patients, 4 were women of reproductive age. All of them underwent adnexectomy and are alive. Hemorrhages usually occur a few years after menopausal period. In one case it occurred 35 years after menopause (arrhenoblastoma), in another 25 years after menopause due to endometrial carcinoma asso