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

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.