About Ovarian Sex Cord Stromal Tumors

The ovary is an important reproductive organ of women and plays a very important role in women's fertility. However, the ovaries are also a part of the body that is extremely prone to disease, and the mortality rate is not low. Women must pay attention to the care of their ovaries in their daily lives. Ovarian sex cord stromal tumor is a term that is rarely heard of. Let’s learn about it together!

What are ovarian sex cord stromal tumors?

Ovarian sex cord-stromal tumors originate from the sex cords and stromal tissues in the primitive gonads, and evolve into different types of cells in males and females, respectively, and form certain tissue structures. The sex cord interstitial cells of females are called granulose cells and theca cells, while those of males are called Sertoli cells and Leydig cells. They can each form granulose cell tumors and theca cell tumors in females, or Sertoli cell tumors and Leydig cell tumors in males. It can also be mixed to form granulosa-thecoma cell tumor or supporting-lesion cell tumor. Because sex cord stroma can differentiate in multiple directions, tumors derived from all of these cell types can be found in the ovary and testis. The theca cells and interstitial cells can produce estrogen and androgen, respectively, and patients often have changes in endocrine function.

Granulosa-stromal cell tumor

It is composed of granulosa cells of the sex cord, derived components of the interstitium, fibroblasts and theca cells. It can be a single component or two tissue components coexist, and the degree of differentiation is also different.

(1) Granular cell tumor is the most common functional tumor. It is a low-grade malignant tumor and is most common in women around 50 years old. Because it can secrete estrogen, it has a feminizing effect. Pseudo-precocious puberty may occur before puberty, menstrual disorders during childbearing age, and endometrial hyperplasia and even adenocarcinoma in postmenopausal women. The tumors are mostly unilateral, of varying sizes, with a smooth or lobed surface, a solid cross-section, and half of them are cystic. The prognosis is generally good. The 5-year survival rate is about 80%. In a few cases, recurrence may occur many years after treatment, so long-term follow-up is necessary.

(2) The incidence of theca cell tumor is half of that of granulosa cell tumor. It is basically benign, but 2-5% is malignant. It usually occurs after menopause and is rare before the age of 40. The tumor is unilateral, of varying sizes, generally medium in size, hard, with a smooth surface, solid cut surface, and off-white color, typically with yellow lipid areas. This tumor can secrete more estrogen, so the feminization symptoms are more significant than those of granulosa cell tumors. It is often accompanied by endometrial hyperplasia and even endometrial cancer. Malignant thecoma can directly infiltrate adjacent tissues and may metastasize to distant sites, but the prognosis is still better than that of general ovarian cancer.

(3) Fibroids are the most common solid ovarian tumors, accounting for 2-5% of ovarian tumors. They are benign tumors and are more common in middle-aged women. The tumors are mostly unilateral, medium in size, smooth or nodular in surface, grayish white in cross section, solid, and extremely hard. Occasionally, fibroma is accompanied by ascites or pleural effusion, which is called Meig's syndrome. The ascites and pleural effusion disappear on their own after surgical resection. Ascites seeps into the chest cavity through the lymphatic pathway or the diaphragmatic channel. The right side of the diaphragm is rich in lymph, so pleural effusion often occurs on the right side.

Sertoli-Leydig cell tumor

Also called testicular blast cells. It is rare, mostly occurring in young women under 40 years old. Most of them are benign and have a masculinizing effect. A few have no endocrine function or show femininity. 10~30% show malignant behavior, and the 5-year survival rate is 70~90%.

Sertoli-Leydig cell tumors occur mainly in the testicles and less frequently in the ovaries. They can occur at any age, but are more common in young women of childbearing age. The tumor can secrete a small amount of androgen, and if it secretes a large amount, it can manifest as masculinization.