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A description is briefly given of a patient whose pregnancy was complicated by an ovarian thecoma which ruptured spontaneously.Eleven previously reported instances of the combination of thecoma and pregnancy are summarized.Although the present case appears to be the first in which the mother has survived rupture of the tumour, in view of the result to the child this can hardly be claimed as a triumph of obstetrics.
Two cases of coexisting mature teratoma and thecoma are reported. In Case 1, a 36-year-old woman presented with severe genital bleeding and an ovarian tumor, 12 x 9 cm in size, was found. In Case 2, a 48-year-old postmenopausal woman presented with severe lower abdominal pain and an ovarian tumor, 15 x 11 cm in size, was detected. Macroscopically, the resected tumors of both cases showed a unilocular cystic tumor adjacent to a solid tumor. Microscopically, the cystic tumors were composed of cutaneous tissues and the solid tumors consisted of spindle cells with lipid-rich cytoplasm, arranged in interlacing bundles. The cystic tumor and the solid tumor were completely separate and no transitional features were recognized histologically.
Hyperandrogenic states in women are often accompanied by disruption of gonadotropin secretion. However, the role of androgens per se in the pathogenesis of this abnormality is poorly understood. We report a woman with a virilizing ovarian tumor in whom the effects of continuous androgen secretion on the hypothalamic-pituitary axis were investigated in detail. A 29-yr-old woman with previously normal reproductive function, including prior fertility, was evaluated for amenorrhea and hirsutism. She had elevated peripheral serum levels of testosterone (T; 337-500 ng/dl) and androstenedione (A; 258-353 ng/dl). Her serum LH level was above the normal follicular phase range and was hyperresponsive to LHRH, whereas the FSH level was below normal early follicular phase levels and increased minimally in response to LHRH. A luteinized thecoma of the left ovary, shown by catherization of the ovarian venous blood to be secreting both T and A, was removed. Postoperatively, serum T and A levels returned to normal, and the patient had a normal ovulatory menstrual cycle in the 30 days after the operation, documented by daily determinations of plasma estradiol, progesterone, and gonadotropin levels. A repeat LHRH test in the follicular phase of the second postoperative menstrual cycle was completely normal. This case indicates that the characteristic abnormalities of gonadotropin secretion observed in hyperandrogenic states such as polycystic ovarian disease can result from chronic androgen secretion by an ovarian tumor and that normal folliculogenesis and gonadotropin secretion can be promptly restored by the elimination of the androgen excess.
A very rare extraovarian hormone-producing thecoma, originated from the broad ligament, is described. Its preoperative diagnostic difficulty, clinical significance, differential diagnosis and histogenesis are discussed.
A case of ovarian thecoma with endometrial adenocarcinoma is reported with reference to histopathological, pathogenetic and prognostic problems. Endometrial neoplasias complicating gynecogenic ovarian tumours are commonly well differentiated and non-metastasizing. The importance of follow-up, also with regard to the breasts, is underlined for an overall assessment of the hyperestrogenic effects induced by the ovarian tumour.
A retrospective study of 51 thecomas and granulosa-theca cell tumors of the ovary seen at Confederate Memorial Medical Center in Shreveport, Louisiana, is presented. Endometrial tissue was available for study in 38 of the 51 patients. The relation of these tumors to endometrial morphology suggests an excessive estrogenic stimulation in most cases. The microscopic pattern and degree of pleomorphism was of no value in predicting which tumors would behave in a malignant fashion. The incidence of endometrial malignancy associated with these tumors was only 7.8%, which was less than was anticipated. The addition of irradiation and/or chemotherapy is, in our opinion, difficult to evaluate since many of the women with these tumors die of unrelated causes before a recurrence is evident.
We describe a patient with breast cancer metastatic to ovarian thecoma. This finding, to the best of our knowledge, has yet to be reported in literature regardless of the fact that there are many gynecological neoplastic associations. Our hypothesis is that this unusual finding is not accidental, but rather benign lesions may be natural resting sites for metastatic disease. An autopsy series is required to elucidate this incidence.
A case of Thecoma-fibroma secreting oestrogen to cause insulin intolerance in a post-menopausal woman is presented. Blood levels of sugar became normal 24 hours after removal of the tumor. The possible mechanism is presented.
Clement and colleagues recently described a group of six patients who had spindle cell proliferations of the ovary resembling luteinized thecomas. A fatal case of extensive sclerosing peritonitis associated with an identical ovarian proliferation is reported. In addition, several other cases in the literature that almost certainly represent the same disease entity have been identified. To our knowledge, this report increases the number of cases to 13. The extensive peritoneal disease along with the high mitotic activity of the ovarian tumor resulted in the diagnosis of peritoneal dissemination of an ovarian cancer in some cases, including the one currently described. Awareness of this newly described condition, which may be more common than previously thought, may help prevent further misdiagnosis.
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