These tumors are very rare, accounting for less than 0.2% of malignant ovarian tumors. Androblastomas, or tumors from Sertoli and Leydig cells, usually occur under the age of 40 years, mostly from 25 to 30, but can also be in children.
In most cases, they are highly differentiated malignant tumors. Less differentiated forms characterized by a more aggressive course are less commonly observed. Macroscopically, these tumors are of a solid structure up to 10 cm in diameter, in the section – grayish-yellowish or reddish-brown. Tumor nodes are usually single and one-sided, and the opposite ovary is often atrophic.
Androblastomas usually secrete androgens. Virilization is observed in 70-85% of patients. Oligomenorrhea, and then amenorrhea, a decrease in the mammary glands, clitoral hypertrophy, and the absence of libido are characteristic. Later, the figure loses its female shape, coarsening of the voice and hair growth according to the male type are noted.
In blood serum levels of testosterone and androstenedione are increased, the level of dehydroepiandrosterone is normal or slightly increased. Occasionally, patients with androblastoma have hyperestrogenia, which can be manifested by isosexual premature sexual development, menstrual irregularities or the appearance of bloody discharge from the genital tract in postmenopausal women.
Most androblast proceeds benignly, and after their removal the patient’s appearance is restored.
Treatment with androblast (Sertoli-Leydig tumors)
Androblastomas are bilateral in less than 1% of cases, therefore, in patients of childbearing age, surgery is performed in the amount of unilateral salpingoophorectomy with revision of the contralateral ovary. It is advisable for postmenopausal patients to perform uterine extirpation with appendages.
In the malignant variant (more often in older women) with common stages, low differentiation of the tumor, the presence of mesenchymal elements, as well as when the capsule of the tumor with a moderate degree of differentiation ruptures, radical surgery is indicated followed by adjuvant chemotherapy, as in granulosa cell tumors (PVB, VAC, BEP, VPIC, VI).
Unlike granulosa cell tumors, which can recur after many years, malignant tumors from Sertoli and Leydig cells recur in 60% of cases in the first year. When using postoperative radiation therapy (50-60 Gy in the pelvis), 5-year survival reaches 75% at stage I and 50% at stage II and III of the disease.
Forecast. 5-year survival with androblastomas reaches 70-90%, progression is rare. With low-grade tumors, the prognosis is worse.
Tecoma is a solid tumor with a high lipid content, which consists of cells resembling theca cells of the inner lining of the follicles. Tecomas, like granulosa cell tumors, belong to the group of estrogen-producing neoplasms and are often combined with endometrial adenocarcinoma. Luteinizing tecoms can be non-hormone-active, and in 11% they synthesize androgens. At the same time, masculinization is rarely observed due to the presence of a sufficient amount of aromatases that transform androgens into estrogens. Mostly older women are affected. In most cases, tecoma is a unilateral, solid tumor of various sizes, rounded in shape with a smooth or tuberous surface. It has a whitish capsule, but the section is characterized by staining of solid areas in yellow or orange; carpal cavities, areas of necrosis and hemorrhages are characteristic. Significant calcification of tumor tissue is observed in young patients. Even with benign tecoma there can be ascites, as with ovarian fibromas and Brenner’s tumors. Meigs syndrome occurs, i.e. a combination of ascites with hydrothorax. Treatment : unilateral adnexectomy is considered an adequate method of treatment, but with a mandatory study of the endometrium. It is advisable for elderly patients to perform uterine extirpation with appendages.
Ovarian sarcoma , a neoplasm of connective tissue elements, is characterized by rapid growth, up to 10% of all blasts. The tumor is more often unilateral, usually has an uneven surface, the consistency is much milder than fibromyoma, and prone to decay and hemorrhage. Macroscopically, ovarian sarcoma differs from benign tumors (fibromas) with a soft consistency. In the section, the tumor has a brain-like character, whitish color, signs of necrosis and hemorrhage, various sizes of the cavity and foci of softening.
Histologically , the tumor forms are distinguished: spindle cell, round cell, small cell, and polymorphic cell. Squamous cell sarcoma is especially malignant. The malignancy of the sarcoma is not inferior to cancer.
Clinic for Ovarian Sarcoma
The clinic of the disease at first resembles the clinic of ovarian cancer. In the future, ovarian sarcoma is characterized by rapid growth, the appearance of ascites and metastases.
Ovarian Sarcoma Diagnosis
The diagnosis of ovarian sarcoma, as a rule, is established on the operating table or during histological examination of a removed tumor. The prognosis is determined by the histological structure of the tumor. The softer the consistency of the tumor, the worse the prognosis (rapid metastasis). The tumor very quickly through the bloodstream gives distant metastases to the spinal column, lungs, brain and other organs.
Ovarian Sarcoma Treatment
Surgical treatment – hysterectomy with appendages followed by chemo- or radiation therapy.