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. Granulosa-theca cell tumor
    2. Sertoli-Leydig cell tumor
    3. Endodermal sinus tumor
    4. Ovarian choriocarcinoma
    5. Ovarian stromal fibroma
    1. Sertoli-Leydig cell tumor
    2. Granulosa-theca cell tumor
    3. Endodermal sinus tumor
    4. Ovarian choriocarcinoma
    5. Ovarian stromal fibroma
    1. All ages are affected
    2. Girls under age 5 years
    3. Prepubescent girls
    4. Women of childbearing age
    5. Postmenopausal women

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

     Carlo Raj, MD

    Carlo Raj, MD

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