Sclerosing stromal tumour: a clinicopathological study of 100 cases of a distinctive benign ovarian stromal tumour typically occurring in the young

Abstract

Aims Since the sclerosing stromal tumour (SST) of the ovary was first described in 1973, few studies have expanded upon its histological features or overlap with other tumours. We thus investigate these aspects based on our experience with 100 cases. Methods and results The patients, 14 of whom were pregnant, ranged from 12 to 63 years (median = 26 years). Ten patients had hormonal manifestations (seven oestrogenic, three androgenic). Bilateral ovarian involvement was present in two cases. Size ranged from 1 to 23 cm (mean = 8.4 cm). Most tumours were solid and white with focal yellow areas; oedema with cystic degeneration (seen in 25 cases) resulted in eight being predominantly cystic. On microscopic examination, alternating cellular and paucicellular areas (pseudolobulation) were prominent in 94 cases but seen to a limited degree in the remaining neoplasms. Admixed spindled and luteinised cells were present in all tumours, but 13 demonstrated mainly spindled cells and 19 demonstrated mainly lutein cells; 14 of the latter were from pregnant patients. The stroma was typically oedematous or collagenous, but in 14 cases was prominently hyalinised and, in four, myxoid. Prominent vascularity was present in most cases. The mitotic rate ranged from 0 to 8/10 high‐power fields (HPF), but most demonstrated <1/10 HPF. Conclusions The differential diagnosis of SST is broad, including fibromas, thecomas, solitary fibrous tumours, pregnancy luteomas, myxomas, other ovarian sex cord‐stromal tumours with sclerosis and, rarely, Krukenberg tumours. Strict adherence to the requirement of pseudolobulation, prominent (usually ectatic) vessels, and lutein cells and fibroblasts admixed in a jumbled manner, will distinguish the neoplasm from others in the differential.

A Rare Ovarian Tumor: The Sclerosing Stromal You Do Not Expect—A Case Series in the Adolescent Population and a Literature Review

“…The macroscopic aspect of the SST of the pediatric population overlaps with the data reported in the literature of the general population. Finally, also the immunohistochemistry of the pediatric population is comparable to the data reported in the adult population [ 7 , 23 ]. All ovarian SSTs reported in the literature were benign and were successfully treated with ovarian cystectomy or unilateral oophorectomy.…”

“…The article includes 100 cases of SST that also affect pediatric patients. Articles in the literature concerning the cases of SST among pediatric patients in the last ten years are also reported in our manuscript [ 23 ]. The typical clinical presentation of SSTs in the pediatric and adolescent populations is pelvic or abdominal pain and non-specific symptoms related to the presence of a pelvic mass.…”

“…Pseudolobulation, prominent vessels, and lutein cells and fibroblasts admixed in a jumbled manner are the main features that should prompt the consideration of a benign diagnosis, differentiating SSTs from other ovarian neoplasms. Comparing the pediatric population with SST and the adult one, the most common symptoms are pelvic or abdominal pain, and menstrual irregularities in both [ 7 , 23 ]. An article by Devins et al 21 reports pleural effusion as a symptom in the general population, but this was not present in our cases nor our, or others’, review [ 7 ].…”

Imaging characteristics of ovarian sclerosing stromal tumor

“…The differential diagnoses of SSTs include other benign SCSTs, such as fibromas or thecomas, metastatic and malignant epithelial ovarian tumors [26]. Most benign SCSTs are cytologically denser and more homogeneous as compared to SST, similar to their differences in imaging.…”

Ultrasonographic and pathological features of sclerosing stromal tumor: a case report

“…Atram et al ( 8 ) noted that tumor resection or salpingo-oophorectomy on the affected side is the best treatment for SST. As the disease mostly occurs in young women with reproductive needs, an intraoperative frozen pathological examination must be performed to determine the scope of surgery to avoid excessive physical and mental harm to patients ( 9 , 10 ).…”