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Ovarian Stromal Hyperthecosis


Presentation

  • Abstract A 53-year-old woman presented with hirsutism of long duration and virilization of recent onset. She was gravida 12 para 9.[ncbi.nlm.nih.gov]
  • In this article, we present the first published cases of the magnetic resonance imaging appearance of these conditions, which may mimic that of ovarian neoplasm.[ncbi.nlm.nih.gov]
  • A bound-in CD-ROM contains all the images from the book, downloadable to PowerPoint presentations.[books.google.com]
  • Clinical, laboratory, radiologic and pathologic findings are presented, and a review of the literature pertaining to ovarian hyperthecosis and stromal Leydig cell tumor as etiologies of virilization is performed.[journals.lww.com]
Pathologist
  • Diagnostic Pathology of Ovarian Tumors will be of great value to practicing surgical pathologists, including gynecologic pathologists, pathology residents in training, as well as gynecologic and medical oncologists worldwide.[books.google.com]
  • Edited by four leading surgical pathologists - Noel Weidner, MD, Richard J. Cote, MD, Saul Suster, MD and Lawrence M.[books.google.com]
  • More than 90 preeminent surgical pathologists offer expert advice on the diagnostic evaluation of every type of specimen from every anatomic site. The Fourth Edition contains 3,494 full-color photographs, of which over 1,100 are new.[books.google.com]
  • Henderson Professor of Pathology and Health Sciences and Technology, Department of Pathology, Harvard Medical School, Staff Pathologist, Brigham and Women's Hospital, Boston, Massachusetts Abul K.[books.google.es]
  • The granulosa cell tumor of the ovary is classified as a sex-cord stromal tumor by pathologists.[thedoctorsdoctor.com]
Hirsutism
  • Abstract A 53-year-old woman presented with hirsutism of long duration and virilization of recent onset. She was gravida 12 para 9.[ncbi.nlm.nih.gov]
  • Early obesity, menstrual problems, and hirsutism in their 20s Ovarian Stromal Hyperthecosis. Describe the pathology.[brainscape.com]
  • CASE: A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended.[jhu.pure.elsevier.com]
  • Aquino, A simplified questionnaire for self-assessment of hirsutism in population-based studies, European Journal of Endocrinology, 172, 4, (451), (2015).[doi.org]
  • Women with hyperthecosis often have more markedly elevated testosterone, more hirsutism, and are much more likely to be virilized.[en.wikipedia.org]
Adnexal Mass
  • A transvaginal ultrasound revealed bilateral solid adnexal masses, likely to be ovarian in nature, although no normal ovarian tissue was identified.[endocrine-abstracts.org]
  • Transvaginal ultrasound showed a normal uterus with endometrial thickness of 5 mm and no adnexal masses. Figure 1. Facial features of the patient with frontal balding and prominent facial hair requiring regular shaving Questions: 1.[hkmj.org]
  • Local genital examination showed mild clitoromegaly; per speculum examination showed healthy cervix and vagina; on bimanual examination the uterus was normal in size with no palpable adnexal mass.[jpgo.org]
  • Doppler examination of the left adnexal mass showed rich intratumoral vascularity on color flow mapping with high resistance wave pattern, suggestive of a benign nature (B). Click here to download Figure 4 Figure 4.[asean-endocrinejournal.org]
  • Gynecol Oncol 1996, 61:438-441 3) Gehrig PA, Fowler WC Jr, Lininger RA: Ovarian capillary hemangioma presenting as an adnexal mass with massive ascites and elevated CA-125.[turkjpath.org]

Workup

  • Further workup with transvaginal ultrasonography showed a thickened, hyperechoic endometrium (0.72 cm) at the upper half of the uterus, with minimal intracavitary fluid. The lower endometrium measured 0.37cm.[asean-endocrinejournal.org]
Ovarian Mass
  • At 15 days after the initial MR imaging examination, a second MR imaging demonstrated shrinkage of the bilateral ovarian masses. Change in the peripheries to predominantly isointensity to myometrium on the T2-weighted images was also observed.[ncbi.nlm.nih.gov]
  • CT of the abdomen and pelvis did not show an adrenal or ovarian mass.[healio.com]
  • Most ovarian hemangiomas are of the cavernous type and they may present either as an isolated ovarian mass, usually discovered incidentally, or in conjunction with diffuse abdominopelvic hemangiomatosis 1 - 3.[turkjpath.org]
  • According to Outwater et al. the ovarian masses are isoechogenic (82%) or hypoechogenic (18%) and ascites is an infrequent finding (23%). Only a minority of SCT (14%) are calcified on image studies.[omicsonline.org]

Treatment

  • Make the best clinical decisions with an enhanced emphasis on evidence-based practice and expert opinions on treatment strategies. Zero in on the most relevant and useful references with the aid of a more focused, concise bibliography.[books.google.com]
  • 3 months of treatment. c After 13 months of treatment. d After 8 months of treatment.[dx.doi.org]
  • CASE: A postmenopausal woman sought treatment for progressive hirsutism. Endocrine evaluation revealed androgen excess. Transvaginal ultrasound revealed enlarged ovaries. Hysterectomy and bilateral oophorectomy were recommended.[jhu.pure.elsevier.com]
  • Treatment for hyperthecosis is based upon each case, but may range from pharmacological interventions to surgical. Polycystic Ovary Syndrome[en.wikipedia.org]
  • […] for the treatment of hirsutism in PCOS.[what-when-how.com]

Prognosis

  • Treatment and prognosis postmenopausal women: bilateral oophorectomy is suggested; however, if the patient has multiple comorbidities, then long-term GnRH agonist treatment may be an option when malignancy has been excluded premenopausal women: treatment[radiopaedia.org]
  • TTF-1 meningioma: may be microcystic but also shows whorls: positive for EMA Brenner tumour with microcystic change Surface epithelial carcinomas with microcystic change Ovarian adenomatoid tumour: positive for calretinin and inhibin Myxoid sarcoma Prognosis[e-immunohistochemistry.info]
  • Prognosis is good for most SCT of the ovary, although malignancy has been reported in as high as 28.6- 43 % of cases [ 3, 25 ].[omicsonline.org]

Etiology

  • Clinical, laboratory, radiologic and pathologic findings are presented, and a review of the literature pertaining to ovarian hyperthecosis and stromal Leydig cell tumor as etiologies of virilization is performed.[journals.lww.com]
  • The etiology of hyperthecosis is unknown, however evidence suggests a possibility of genetic transmission. Hyperthecosis has been documented in familiar patterns. Insulin resistance may also play a role in the pathogenesis of hyperthecosis.[en.wikipedia.org]
  • Definition / general Hyperplastic ovarian stroma with clusters of luteinized stromal cells Epidemiology Typically seen in the 6th to 7th decade, less common in reproductive age Etiology Luteinized stromal cells produce androgens Clinical features Similar[pathologyoutlines.com]
  • There are multiple etiologies, and each etiology might also be complicated by the medical condition of insulin resistance which also tends to have some relationship to the liver "fatty liver" condition, NASH.[palpath.com]
  • An Uncommon Etiology For A Common Problem: Hirsutism Emily Winterton, MD; Kathleen Eyster, PhD; Keith A Hansen M.D.[arcfertility.com]

Epidemiology

  • Definition / general Hyperplastic ovarian stroma with clusters of luteinized stromal cells Epidemiology Typically seen in the 6th to 7th decade, less common in reproductive age Etiology Luteinized stromal cells produce androgens Clinical features Similar[pathologyoutlines.com]
  • One epidemiologic study that included a 30-year follow-up of women with PCOS found no increase in mortality from cardiovascular disease.66[what-when-how.com]
  • Diagnosis, epidemiology, and genetics of the polycystic ovary syndrome. Best Pract Res Clin Endocrinol Metab. 2006;20:193-205. Balen AH, Conway GS, Kaltsas G, Techatrasak K, Manning PJ, West C, et al.[har-journal.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology of ovarian hyperthecosis remains poorly understood but the metabolic syndrome observed in most patients suggests that insulin resistance associated with high, postmenopausal LH levels, might play a role as in polycystic ovarian syndrome[ncbi.nlm.nih.gov]
  • Although the exact pathophysiology is not known, disturbances in gonadotropins and reduced insulin sensitivity are known to contribute to the overproduction of androgens.[har-journal.com]
  • Furuya M (2012) Ovarian cancer stroma: pathophysiology and the roles in cancer development. Cancers (Basel) 4: 701-724. Roth LM, Talerman A (2006) Recent advances in the pathology and classification of ovarian germ cell tumors.[omicsonline.org]

Prevention

  • Multivitamins prevent multiple birth defects such as heart and limb defects, neural tube defects, urinary tract anomalies and oral facial clefts.[bionova.co.in]
  • The addition of an oral contraceptive prevents GnRH agonist-induced hypoestrogenism and vasomotor symptoms and preserves bone density.[what-when-how.com]
  • Preventative measures for PCOD are limited. Clinical management is primarily focused on treating symptoms and manifestations and preventing long-term complications.[har-journal.com]
  • Assessment of cardiovascular risk and prevention of cardiovascular disease in women with the polycystic ovary syndrome: A consensus statement by the Androgen Excess and Polycystic Ovary Syndrome (AE-PCOS) Society.[asean-endocrinejournal.org]

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