GRANULOSA CELL TUMOR OF THE OVARY
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Sex cord-stromal tumors originate from the embryonic gonadal tissue or from the ovarian stroma. These tumors consist of granulosa-theca cell tumors, fibromas, and Sertoli-Leydig cell tumors.


GRANULOSA-THECA CELL TUMORS:

These tumors are most commonly oberved in post-menopausal women
Are usually unilateral.
Granulosa cells are capable of releasing estrogen. The hormone may produce precocious puberty in children and cause endometrial hyperplasia in women.
Ganulosa cell tumors are slow growing tumors. 5-25% of these tumors exhibit malignant behavior. On the other hand, the pure thecomas are benign.
Groslly are solid and have a white-yellow cut surface.
Microscopically, consist of granulosa cells (granulosa cell tumor), theca cells (thecoma) or various proportions of both cells. The tumor cells may be luteinized. The granulosa cells are cuboidal to polygonal cells that are arranged in cords, sheets or strands. The theca cells are spindle cells and are arranged in sheets.


FIBROMAS

One of the common forms of the ovarian tumors.
Are usually unilateral.
Grossly appear as hard, solid, grey-white masses.
Microscopically, consist of fibroblasts.
In 40% of cases, these tumors are associated with hydrothorax usually on the right side and ascites (Meigs' syndrome).

SERTOLI-LEYDIG CELL TUMORS (ANDROBLASTOMAS):

These tumors are usually unilateral.
May release male sex steroid hormones and produce defeminization (breast atrophy, amenorrhea, loss of hair and sterility) to masculinization (hirsutism, voice change and hypertrophy of the clitoris).
The incidence of recurrence or metastasis in these tumors is less than 5%.
Grossly grow as solid tumors and have a white-grey cut surface.
Microscopically, these tumors are composed of Sertoli cells and Leydig cells. In the well-differentiated tumors, these cells are arranged as tubules within a fibroconnenctive stroma. The moderately-differentiated tumors exhibit poorly formed tubules and Leydig cells. In the poorly-differentiated tumors, disorderly arranged epithelial cells are scattered in a sarcomatous stroma. Leydig cells may be absent in these tumors. Some tumors are made purely of the Leydig cells. These so-called Hilus cell tumors, are rare and micoscopically consist of large lipid-laden cells. These cells exhibit the Reinke cystals, ultrastructural structures characteristic of the Leydig cells. The true Leydig cell tumors are benign. These tumors may occur at the non-hilar region of the ovary (non-hilar Leydig cell tumors).