Sclerosing Stromal Tumors With Prominent Luteinization During Pregnancy

Abstract

Ovarian tumors encountered during pregnancy can pose a diagnostic challenge due to an abundance of luteinized cells and other changes. We report 8 sclerosing stromal tumors with massive luteinization discovered in pregnant patients. The tumors ranged from 3.1 to 21 cm (mean=8.8 cm) in size and were typically solid and yellow; the neoplasm was bilateral in 1 case. On microscopic examination, the lutein cells, a feature of sclerosing stromal tumor, had more copious eosinophilic cytoplasm and were more numerous than is usually seen in nonpregnant patients and to varying degrees obscured the typical pseudolobular pattern. This resulted in particular diagnostic difficulty in 3 cases, especially when associated with other changes including irregular shapes of tumor cell nests, edema, and/or myxoid change. However, classic features of these tumors: ectatic vessels and admixed luteinized and nonluteinized cells were still focally evident, allowing for accurate classification. The tumors were cytologically bland and with 1 exception had rare mitoses. As sclerosing stromal tumors have been invariably benign, it is important that they not be confused with other tumors, such as steroid cell tumor, which can occasionally be malignant.

Ovarian sex cord-stromal tumours and their mimics

“…One aspect of sclerosing stromal tumour recently highlighted is that, inasmuch as they usually occur in the young, the patient may be pregnant. 37 In that circumstance the tumour cells may be extensively and more robustly luteinised than is the usual case and this may serve to obscure the typical bipartite cellular population and indeed the overall features of the tumour. Other neoplasms such as steroid cell tumour are then more likely to factor in the differential diagnosis but minor foci of typical morphology can usually still be appreciated.…”

Different Presentations of Five Rare Cases of Sclerosing Stromal Tumor of the Ovary

“…Three patients (60%) were nulligravida, one case was single and one was pregnant. Diagnosis of ovarian SST is a challenging issue during pregnancy due to difficult differentiation of it from luteinized cells tumors [13]. The differential diagnoses are thecoma, fibroma, lipoid cell tumor, ovarian granulosa cell tumor, and ovarian mucinous cystadenocarcinoma.…”

Ovarian Sex Cord–Stromal Tumors: Reflections on a 40-Year Experience With a Fascinating Group of Tumors, Including Comments on the Seminal Observations of Robert E. Scully, MD

“…It was the lack of robust luteinization of the cells that Dr Scully used to explain the usual lack of function of these tumors; a more typical luteinized nature with abundant eosinophilic cytoplasm is usually seen in pregnancy. 28 Other neoplasms such as steroid cell tumor are more likely to factor in the differential diagnosis in this situation, but minor foci of typical morphology can usually still be appreciated. An additional feature of the neoplasms worthy of mentioning, as it can cause diagnostic confusion with other tumors, is the presence of ectatic blood vessels (Figure 2, C), but they are only of diagnostic significance when associated with other typical features of the neoplasm.…”