Hormonally active ovarian tumors
Ovarian granulocellular tumor is a tumor arising from the granulosa cells of the follicles or from embryonic remnants of granulosa cells that are not associated with the follicles. Tecoma is a tumor arising from a specialized cortical stroma (theca) of the ovaries. Usually, these tumors produce mainly estrogens, but in some cases androgens
Depending on the prevalence of tumor production of estro genes or androgens, estrogen-producing (femme-generating) and androgen-producing (virilizing) ovarian tumors are distinguished.
Granulocytoid tumors and tecom are more common in women older than 40 years. Among all neoplasms of ovarian, the comme occurs in approximately 4–0% of cases, granulose cell tumor, in 10% of cases.
Etiology. The cause of the disease is unknown.
Pathogenesis. Symptoms of the disease are caused by hyperproduction by estrogen or androgen tumors, and in some cases by compression of surrounding organs and tissues.
Pathological anatomy. Ovarian tumors have a smooth or knobby surface. More often they are one-sided. Hemorrhages and hot spots of softening are often seen on the section of a granulosa cell tumor. Takoma on the cut brown with yellowish inclusions.
Histologically, in a granule cell tumor, monomorphic small round cells with a darkly stained nucleus and a thin rim of the cytoplasm, merging with interstitial substance are found. Characteristic of this tumor is the presence of small cavities such as rosettes. Microscopically, the tekoma consists of clusters of cells, some of which have an elongated shape, rich in lipids. Between the cells is a network of thin argyrophil fibers. Malignant degeneration of a granule-cell tumor occurs in 15-20% of cases, and Tacoma – in about 5% of cases. Metastasis occurs most often in the second ovary, liver, peritoneum.
Clinic. Patients complain of menstrual cycle disorders, acyclic uterine bleeding, abdominal pain and irradiation to the groin and back.
With the development of a tumor in childhood, early puberty occurs, in the reproductive period, mensthg / gall cycle disorders (more often, such as menometerorrhagia), and during menopause and in the postmenopausal period, acyclic macular bleeding. Older women are usually young. They do not have age-related atrophy of the genitals.
When androgen-producing tumors develops viril syndrome.
Gynecological examination often reveals a tumor formation of the ovaries of a dense or elastic consistency. In some cases, the comic has an androgenic activity, which leads to the virilization of patients, and sometimes it is hormonally inactive.
Laboratory data. Urinary excretion of estrogen and, in some cases, androgen increased. X-ray diagnosis. A pneumogynecogram reveals an ovarian tumor.
Diagnosis and differential diagnosis. Radiological diagnostics (pneumogynecography) and cytological examination of the tumor are of decisive importance for diagnosis. Tumors of the ovaries are differentiated from tekomatosis of the ovaries, as well as the Stein-Leventhal syndrome. Cases of ectopia are described.
adrenal tissue in the ovary with the development of androsteroma and tumors from chyle cells resembling testicular leidigoma.
Forecast. With early diagnosis and timely operative treatment of benign granular cell or tumor, the prognosis is favorable. In malignant tumors, the prognosis is poor.
Treatment. Treatment is only operative – removal of an ovarian tumor.