Arrhenoblastoma
Arrhenoblastoma is a tumor emanating from the male elements of the female gonad. It is the most common virilizing ovarian tumor. Arrhenoblastoma develops at any age, often in childbearing.
Etiology. The cause of the disease is unknown.
Pathogenesis. Symptoms of the disease are caused by hyperproduction of androgens (mostly testosterone) by the tumor. An excess of androgens inhibits the production of follicle-stimulating hormone by the pituitary gland, which in turn leads to a decrease in the formation of estrogen in the ovary. As a result, the body first demineralizes, and then virilization.
Pathological anatomy. Arrhenoblastoma is more often one-sided.
Usually it is located under the cortex of the ovary or in the area of its gate. The size of arrhenoblastoma does not exceed 15 cm, but sometimes reaches the size of the head of an adult person. The surface of the tumor is smooth or bumpy. At the section of the tumor is gray, yellow or grayish-yellow color. The histological structure of the tumor is diverse. It may not be of a differentiated, intermediate, or differentiated type.
The undifferentiated arrhenoblastoma consists of single epithelial cords and massive growths of the sarcomatoid puchal stroma with a large number of cells, similar to the leydigovsky cells, producing androgens. Differentiated arrhenoblastoma resembles the structure of the testicular tumor. There are many tubular formations similar to the testicle tubules, which are lined with sertolium type epithelial cells. The latter are able to secrete estrogen. Compared with the undifferentiated arrhenoblastoma, this tumor has significantly fewer Leydigovsky type cells. An intermediate-type arrhenoblastoma is characterized by the presence of both “connective tissue” and “epithelial” components. Tubular formations in it are much smaller than in a tumor of a differentiated type.
Arrhenoblastoma of the undifferentiated type has a more pronounced virilizing effect due to the presence of a large number of cells of the Leydigov type in it. Differentiated arrhenoblastoma, having a smaller number of cells of leydygov ^ th type, causes a weak virilizing effect. In the region of not rare cases with significant functional activity
Sertolium-type cells may cause hyperestrogenism with subsequent feminizing effects.
Malignant degeneration of arrhenoblastoma occurs in 1 5 – 2 5% of cases and depends on the structure of the tumor: with a little differentiated form, it is significant, with a mature small.
Clinic. Clinically, arrhenoblastoma is characterized by impaired menstrual cycle (oligo- and amenorrhea) and virilization phenomena (low coarse voice, hypertrichosis, hirsutism, often male pattern baldness, excessive muscle development, atrophy of the mammary glands, clitoral hypertrophy, etc.).
Laboratory data. Testosterone levels are elevated in the blood. Testosterone excretion with urine is significantly increased, urinary excretion of 17-KS is normal or moderately higher. Excretion with urine of some fractions of androgens – androsterone and etiocholanolone is moderately increased.
Radiodiagnosis. On the pneumogynecogram, you reveal an ovarian tumor.
Diagnosis and differential diagnosis. For diagnosis, the data of X-ray diagnostics and cytological examination of the tumor are of decisive importance. Differential diagnosis – see “Congenital virilizing hyperplasia of the adrenal cortex …”
Forecast. With timely surgical treatment of benign tumors, the prognosis is favorable. In case of malignant arrhenoblastoma, the prognosis is poor (tendency to relapse and metastasis).
Treatment. The only method of treatment is surgical removal of the tumor, followed by radiotherapy for poor quality growth.