Types of Ovarian Tumors: Sex Cord-Stromal Tumors & Granulosa-Theca Tumor

by Carlo Raj, MD

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    00:02 Our next topic here is sex cord-stromal tumor.

    00:04 Obviously, a percentage of ovarian tumors are dropping, so therefore I’m going to be much more specific as to what you need to know for these specific tumors.

    00:12 Let’s take a look.

    00:14 Overall frequency, take a look at a measly 5 to 10%, the proportion of malignant ovarian tumors overall only 2 to 3%.

    00:21 The age group will be all over the place and the types include fibroma, granulosa and Sertoli.

    00:27 Let me stop here and make sure that you understand the significance of some of these histologic cells.

    00:34 Fibroma.

    00:35 Okay, we’ll talk about that.

    00:37 Granulosa theca, this is a female. Ovary, follicle.

    00:41 Tell me about the histologic appearance in a normal follicle.

    00:44 Inner granulosa, outer theca.

    00:46 So far, so good.

    00:47 You focus upon the granulosa.

    00:50 Then we have the next type.

    00:51 "Dr. Raj, are you sure that’s not a typo?" I’m positive. It’s not a typo.

    00:56 This is a Sertoli–Leydig cell tumor.

    00:59 "I know for certain in physiology, Dr. Raj, that Leydig cells are found in a male and LH works upon it.

    01:05 And then in a male, it produces testosterone." Absolutely.

    01:09 So what business does this have doing in an ovary? It’s a cancer.

    01:14 Okay? It can do whatever it wants.

    01:16 It can turn into whatever it wants.

    01:19 Your focus is going to be on Leydig of an ovarian tumor.

    01:23 She – genotype XX.

    01:28 She is going to be producing excess testosterone.

    01:33 What do you think is going to happen to her? Masculinization.

    01:39 Let’s see the opposite.

    01:41 If you have a testicular tumor, a male, XY, in which a testicular tumor is a granulosa type.

    01:50 A male should not have normal granulosa cells.

    01:54 We have outer Leydig, inner Sertoli.

    01:57 Right? Our blood test's barrier.

    01:59 But if it’s a granulosa cell tumor in a male, then what is he going to – How is he going to present? That granulosa is going to produce a lot more estrogen.

    02:10 Correct? This estrogen in male, what is going to happen to him? How is he going to present? Feminization.

    02:18 Use your normal anatomy and physiology so that you can truly understand our pathologies.

    02:24 I’ve done this, too, numerous times, yet here’s another example.

    02:29 Granulosa theca cell tumor.

    02:31 Now it becomes easy.

    02:34 So make sure you have granulosa and theca cell.

    02:36 This is tumor though.

    02:37 So therefore this is going to be rather chaotic.

    02:40 It may produce large amounts of estrogen, but we already predicted that.

    02:43 The granulosa cell, responsible for producing your estrogen.

    02:46 Now stop here.

    02:48 What’s my topic and who’s my gender? My topic is ovarian tumor.

    02:51 My gender is female.

    02:53 She is genotypically XX.

    02:56 So she’s already feminized.

    02:57 So what then happens to her or in terms of how is she presenting that makes her more feminine? Well, it’s not so much that.

    03:05 She's -- She’s experiencing precocious puberty.

    03:08 Early, early puberty.

    03:10 So precocious sexual development.

    03:12 Look for breast being developed maybe much earlier, 12 or 13 years of age.

    03:17 Her clitoris is well-developed, so on and so forth.

    03:21 Endometrial hyperplasia and carcinoma post menopausal, that’s dangerous.

    03:25 Isn’t it? Why? I asked you earlier for endometrial hyperplasia and carcinoma, to group them together and the risk factors will be the same.

    03:36 The major risk factor? Good.

    03:38 Estrogen.

    03:40 That’s what you’re producing too much of in this tumor.

    03:44 Potentially malignant especially granulosa type, that’s the one you to pay attention to.

    03:48 And here, we have an interesting, interesting histologic feature.

    03:53 The small follicle, granulosa theca cell tumor.

    03:56 It’s a small follicle with eosinophilic material.

    04:01 That’s what you’d expect to find upon your histologic examination.

    04:05 You will refer to this as being your Call-Exner body.

    04:08 Call-Exner body.

    04:09 At least know the description.

    04:12 Eosinophilic material within your small follicle.

    04:15 You do not find cyst per se, huh? So whenever we talk about follicles that have fluid in them, cyst.

    04:23 Then you go back to surface-derived.

    04:25 With surface derived, you have serous, mucinous and so on and so forth.

    04:29 Here, we have our Sertoli-Leydig cell tumor.

    04:32 Once again, quickly tell me the gender.

    04:36 Female.

    04:38 Genotypically XX.

    04:40 She’s producing a male-like cell known as a Sertoli cell.

    04:46 Responsible for producing androgen.

    04:48 Hence, andro -, androblastoma.

    04:53 Commonly produces masculinization of your female.

    04:55 Blocks normal sexual development in children, and virilization in women.

    04:59 What does that mean to you? It means because of this androgen, she has -- They will describe this being ambiguous genitalia.

    05:07 Look at the clitoris, it looks like a penis.

    05:09 Virilization.

    05:10 That’s your most important.

    05:12 Leydig.

    05:13 Exhibit tubules composed of Sertoli cells or Leydig cells interspersed with stroma.

    05:18 If you take a look at the histologic picture, it looks like seminiferous tubules.

    05:25 Our topic, Sertoli-Leydig cell tumor of the ovary.

    About the Lecture

    The lecture Types of Ovarian Tumors: Sex Cord-Stromal Tumors & Granulosa-Theca Tumor by Carlo Raj, MD is from the course Ovarian Diseases.

    Included Quiz Questions

    1. Postmenopausal women are not affected.
    2. All ages are affected.
    3. Some tend to cause precocious puberty in prepubertal children.
    4. They represent 3–5% of malignant ovarian tumors.
    5. They represent 5–10% of all ovarian tumors.
    1. Granulosa-theca cell tumor
    2. Sertoli-Leydig cell tumor
    3. Endodermal sinus tumor
    4. Choriocarcinoma
    5. Androblastoma
    1. Small follicles with eosinophilic material
    2. Glomeruli-like structure of blood vessels
    3. Well-differentiated tubules interspersed with stroma
    4. Neoplastic syncytiotrophoblasts
    5. Calcium deposits
    1. The tendency to cause precocious puberty
    2. A pattern of leading to virilization in older women
    3. Characteristic yellow appearance on gross examination
    4. Well-differentiated tubules on histology
    5. Elevated serum androgen level

    Author of lecture Types of Ovarian Tumors: Sex Cord-Stromal Tumors & Granulosa-Theca Tumor

     Carlo Raj, MD

    Carlo Raj, MD

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