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Thecoma

Theca Cell Tumor

Thecoma is a rare and almost invariably benign ovarian sex-cord stromal tumor that is predominantly diagnosed in postmenopausal women. In this patient group, an asymptomatic course is frequently observed. Hormone-secreting thecomas are, however, more frequent among younger women and associated with uterine bleeding, abdominal distension, and pain. Clinical findings and imaging studies are needed to make the diagnosis, but the exact tumor type is often determined postoperatively.


Presentation

The ovarian tumor thecoma belongs to a group of sex-cord stromal tumors, and the name stems from its lipid-rich stromal cells that are strikingly similar to theca cells located in the ovarian follicles [1] [2] [3]. Thecoma is virtually always a benign tumor (although rare malignant cases have been reported), and it is principally diagnosed in postmenopausal women [2] [4]. The clinical presentation depends on whether the tumor contains cells that produce steroid hormones (termed luteinized thecoma) or not (typical and rarely calcified thecoma) [2] [5]. Luteinized thecoma has been shown to appear at a slightly younger age and may produce estrogenic, virilizing, or mixed effects [2] [3] [5]. Non-secreting tumors rarely cause symptoms. Certain authors report that more than 60% of post-menopausal women are asymptomatic [6]. Tumors that synthesize estrogen, on the other hand, produce symptoms such as uterine bleeding (and menstrual irregularities in younger women), abdominal pain and/or distension, whereas an abdominal mass might be identified during a physical examination [1] [2]. In addition, between 20-50% of cases suffer from concomitant endometrial carcinoma [2] [5] [6]. Although they can present with worrying symptoms, the clinical course of thecoma is benign and proper surgical treatment results in a cure [6].

Acute Abdomen
  • Unlike the other reported patients with this condition, the patient presented with a short history of secondary amenorrhea, a subsequent acute abdomen, and an absence of abdominal distention and ascites.[ncbi.nlm.nih.gov]
  • Luteinized thecoma with sclerosing peritonitis presenting as an acute abdomen. Gynecol Oncol 1996;61:275-81. [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6][jmidlifehealth.org]
  • Spiegel GW, Swiger FK (1996) Luteinized thecoma with sclerosing peritonitis presenting as an acute abdomen. Gynecol Oncol 61: 275-281. 7. Russell P, Robboy SJ, Anderson MC (2002) Ovary: normal and benign conditions.[gavinpublishers.com]
Lower Abdominal Pain
  • In Case 2, a 48-year-old postmenopausal woman presented with severe lower abdominal pain and an ovarian tumor, 15 x 11 cm in size, was detected.[ncbi.nlm.nih.gov]
  • These symptoms were accompanied by lower abdominal pain for the last four months duration. She did not notice a significant change in her body weight or appetite. There was no postmenopausal bleeding or vaginal discharge.[hindawi.com]
Peritoneal Disease
  • The extensive peritoneal disease along with the high mitotic activity of the ovarian tumor resulted in the diagnosis of peritoneal dissemination of an ovarian cancer in some cases, including the one currently described.[ncbi.nlm.nih.gov]
Hirsutism
  • Although laser treatment helped with her hirsutism, her other virilizing symptoms (deepening of voice, clitoromegaly) did not improve postoperatively.[ncbi.nlm.nih.gov]
  • In contrast to other virilizing ovarian tumors, which present as rapidly progressive hirsutism, ovarian thecoma (like hilus cell tumors of ovary) can present as slowly progressive hirsutism. 1. Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA.[ijem.in]
  • Keywords Thecoma, pregnancy, hirsutism, Virilism About this article Keywords Thecoma pregnancy hirsutism Virilism Authors Małgorzata Kogut Jarosław Janeczko Małgorzata Trzcińska Marek Grzywa[journals.viamedica.pl]
Hirsutism
  • Although laser treatment helped with her hirsutism, her other virilizing symptoms (deepening of voice, clitoromegaly) did not improve postoperatively.[ncbi.nlm.nih.gov]
  • In contrast to other virilizing ovarian tumors, which present as rapidly progressive hirsutism, ovarian thecoma (like hilus cell tumors of ovary) can present as slowly progressive hirsutism. 1. Carmina E, Rosato F, Jannì A, Rizzo M, Longo RA.[ijem.in]
  • Keywords Thecoma, pregnancy, hirsutism, Virilism About this article Keywords Thecoma pregnancy hirsutism Virilism Authors Małgorzata Kogut Jarosław Janeczko Małgorzata Trzcińska Marek Grzywa[journals.viamedica.pl]
Receding Hairline
  • A 49-year-old woman presented with rapidly progressing hirsutism, receding hairline, male-pattern baldness and deepening of voice, which had developed over the past 2 years.[ncbi.nlm.nih.gov]
Increased Hair Growth
  • A 15-year-old Sri Lankan female presented with increasing hair growth, a hoarse voice, and secondary amenorrhea. On physical examination, there was marked hirsutism and clitoromegaly.[ncbi.nlm.nih.gov]
Secondary Amenorrhea
  • Possible ovarian causes of excess androgen secretion should not be overlooked when considering possible causes of hyperandrogenism and secondary amenorrhea.[ncbi.nlm.nih.gov]
  • Ovarian Thecoma with Virilizing Manifestations Abstract A 29-year-old woman presented with secondary amenorrhea, primary infertility, and virilization, which had developed over the past 2 years was suspected to have a virilizing tumor at her left ovary[escholarship.org]
Cesarean Section
  • Delivery by cesarean section at term is recommended in these patients for the best maternal and fetal outcome.[ncbi.nlm.nih.gov]
  • On 29 September 2006, she gave birth to the second baby boy, 3,020 gm in weight (Apgar score 8/9) by cesarean section.[eymj.org]
Testicular Swelling
  • He presented with left testicular swelling and underwent a radical orchiectomy on suspicion of a malignant paratesticular tumor. The tumor arose from the testis exophytically and was diagnosed as a thecoma histopathologically.[ncbi.nlm.nih.gov]
Testicular Mass
  • Definition / general Rare, benign behavior Ages 21 - 74 years, painless testicular masses Sex cord stromal tumors composed of spindle, oval or round cells producing collagen Cellular fibromas have scanty collagen Terminology Synonyms: Benign gonadal stromal[pathologyoutlines.com]

Workup

The presence of abnormal uterine bleeding or menstrual abnormalities should prompt the physician to perform a meticulous clinical and imaging workup. Firstly, a detailed patient history including the onset of symptoms and their progression must be noted, followed by a complete physical examination, with an emphasis on abdominal and pelvic inspection/palpation. As soon as initial suspicion is raised, imaging studies should be employed. Abdominal ultrasonography (US) is a highly useful initial method in the evaluation of abdominal pathologies. The presence of a unilateral adnexal hypoechoic mass possessing clear borders and a weak vascular signal on Doppler imaging are hallmarks of a thecoma [6]. To confirm the diagnosis, however, more advanced studies - computed tomography (CT) and magnetic resonance imaging (MRI), are often necessary. CT shows an isodense or hypodense tumor, whereas isointense signaling on T1- weighted images and either hypointense or isointense signaling T2- weighted images are typical findings (although some authors claim that even hyperintense signals can be encountered on T2, depending on the amount of surrounding edema) [3] [6] [7] [8] [9]. In addition to imaging procedures, the use of ovarian serum tumor marker (CA 125) in the diagnostic workup might also be recommended, as it is frequently elevated in the presence of a neoplastic process in the ovaries [1] [10].

Treatment

  • Diagnosis and treatment of ovarian thecoma occurring during pregnancy are discussed with relevant references.[ncbi.nlm.nih.gov]

Prognosis

  • Prognosis With early detection and treatment the prognosis for thecoma is quite good.[knowcancer.com]
  • LM bland oval or spindled nuclei, abundant cytoplasm that is pale and vaculolated LM DDx ovarian fibroma, fibroma-thecoma IHC alpha-inhibin ve Gross solid yellow mass, usually well-circumscribed Site ovary - see ovarian tumours Prevalence uncommon Prognosis[librepathology.org]
  • Treatment and prognosis Thecomas are almost always benign and have low malignant potential, although there have been isolated reports of malignant thecomas. fibroma low signal on T2 given the fibroid content less enhancement adult granulosa cell tumor[radiopaedia.org]

Etiology

  • The occurrence of an extremely rare testicular thecoma in this case (the second in the literature) suggests that such an etiological association may also exist in the pathogenesis of testicular tumors.[ncbi.nlm.nih.gov]
  • Etiology Thecoma-fibroma tumors are a closely related group of benign tumors that arise from ovarian stroma and are often difficult for the imager and even pathologist to distinguish.[clinicalgate.com]
  • Association of these two conditions is extremely rare and the etiology currently remains unclear.[scielo.br]
  • […] blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology[decs.bvs.br]

Epidemiology

  • English : BS blood supply BL blood CF cerebrospinal fluid CI chemically induced CH chemistry CL classification CO complications CN congenital DI diagnosis DG diagnostic imaging DH diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology[decs.bvs.br]
  • […] with epithelial differentiation Stromal tumor resembling fibroma Testicular fibroma Testicular stromal tumor with myofilaments Theca cell tumor Thecoma-like Sertoli cell tumor Unclassified sex cord stromal tumor with a predominance of spindle cells Epidemiology[pathologyoutlines.com]
  • Sertoli–Leydig cell tumor group Epidemiology Sertoli-Leydig cell tumors are uncommon benign tumors, accounting for less than 0.5% of all ovarian tumors.[emedicine.medscape.com]
  • Epidemiology Benign ovarian tumours occur in 30% of females with regular menses (eg, luteal cysts as incidental findings on pelvic scans) and 50% of females with irregular menses.[patient.info]
Sex distribution
Age distribution

Pathophysiology

  • Different kinases can modify the TTN elasticity in different ways; indeed, it is known that changes in post-translational modification (in particular hypophosphorylation) plays a role in the pathophysiology of heart disease ( 13 ).[frontiersin.org]

Prevention

  • Awareness of this newly described condition, which may be more common than previously thought, may help prevent further misdiagnosis.[ncbi.nlm.nih.gov]
  • […] diet therapy DT drug therapy EC economics EM embryology EN enzymology EP epidemiology EH ethnology ET etiology GE genetics HI history IM immunology ME metabolism MI microbiology MO mortality NU nursing PS parasitology PA pathology PP physiopathology PC prevention[decs.bvs.br]
  • […] eISSN: 2377-4304 Case Report Volume 9 Issue 3 Ioannis K Thanasas, Regret for the inconvenience: we are taking measures to prevent fraudulent form submissions by extractors and page crawlers. Please type the correct Captcha word to see email ID.[medcraveonline.com]
  • […] removal of pelvic and para-aortic lymph nodes and omentum Chemotherapy combination of platinum (i.e. carboplatin) and non-platinum (i.e. paclitaxel) regimen Radiation reserved for palliation or localized persistent disease after chemotherapy Prognosis, Prevention[medbullets.com]
  • Problems associated with all of these are mostly preventable. Change the company law Part of the problem of doing business in Thailand is that, no matter how good you are, you never really own the legal framework that defines your business.[thethaiger.com]

References

Article

  1. Zhang Z, Wu Y, Gao J. CT diagnosis in the thecoma-fibroma group of the ovarian stromal tumors. Cell Biochem Biophys. 2015;71:937-43.
  2. Tanaka YO, Tsunoda H, Kitagawa Y et-al. Functioning ovarian tumors: direct and indirect findings at MR imaging. Radiographics. 2004;24 Suppl: S147-66.
  3. Shanbhogue AK, Shanbhogue DK, Prasad SR, et al. Clinical syndromes associated with ovarian neoplasms: a comprehensive review. Radiographics. 2010;30(4):903-919.
  4. Chen VW, Ruiz B, Killeen JL, et al. Pathology and classification of ovarian tumors. Cancer. 2003;97:2631-42.
  5. Kulkarni YS, Kakade AS, Singh BA. A rare case of ovarian thecoma in a postmenopausal woman. Int J Reprod Contracept Obstet Gynecol 2014;3:242-244.
  6. Chen H, Liu Y, Shen L, et al. Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison. J Ovarian Res. 2016;9:81.
  7. Jung SE, Lee JM, Rha SE, Byun JY, et al. CT and MR imaging of ovarian tumors with emphasis on differential diagnosis. Radiographics. 2002; 22:1305-1325.
  8. Troiano RN, Lazzarini KM, Scoutt LM, et al. Fibroma and fibrothecoma of the ovary: MR imaging findings. Radiology. 1997; 204:795-798
  9. Jeong YY, Outwater EK, Kang HK. Imaging evaluation of ovarian masses. Radiographics. 2000; 20:1445-1470.
  10. Yazdani S, Alijanpoor A, Sharbatdaran M, et al. Meigs’ syndrome with elevated serum CA125 in a case of ovarian fibroma /thecoma. Caspian J Intern Med. 2014;5(1):43-45.

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Last updated: 2019-07-11 22:49