Definition: Ovarian thecoma is a relatively rare sex cord tumor which occurs before and after menopause.
Clinical synopsis
Age at diagnosis: Usually > 40 years old (65% post-menopausal)
+/- hormonally active (estrogenic or androgenic)
usually benign
unilateral (in 90% of cases)
Rare in childhood
Typically estrogenic manifestations
Some may be androgenic: particularly those containing steroid cells
Nearly always benign
A few malignant examples
Macroscopy:
well defined, firm, solid, covered by intact ovarian serosa;
usually yellow
Usually unilateral
Variable size
Well-defined capsule
Firm consistency
Cut surface:
- largely or entirely solid
- may be cysts
Yellow color
- Cut surface of thecoma showing a predominance of yellow areas alternating with whitish foci.
Microscopy
Fascicles of spindle cells with:
- centrally placed nuclei
- moderate amount of pale cytoplasm
- Bland microscopic appearance of thecoma, with some variability in cellularity.
Intervening tissue may show:
- considerable collagen deposition
- focal hyaline plaque formation
Degree of cellularity varies considerably
Some in young women are heavily calcified
Plump ovoid to spindle cells
Thecomas are inhibin+
The tumor cells have abundant pale cytoplasm.
Hyaline plaques are conspicuous.
spindle cells
- moderate pale cytoplasm containing lipid droplets
- central nuclei
stroma
- collagen deposition
- focal hyaline plaque formation
- +/- heavily calcified
- +/- prominent stromal hyperplasia (hyperthecosis)
fat stains+ (on fresh/frozen tissue)
- Oil red O+: abundant intracytoplasmic neutral fat
- Sudan black + (fat stains)
silver stains
- reticulin fibers surrounding individual cells
- usually reticulin fibers surrounding individual cells
- may be islands devoid of reticulin, especially in areas of luteinization
Estradiol usually limited to a small number of tumor cell
Variants
May be prominent stromal hyperplasia, particularly if postmenopausal.
- transitions may then be seen from focal stromal hyperplasia through diffuse thecomatosis (hyperthecosis) to thecoma, suggesting pathogenetic continuum
- likely that small tumors designated stromal luteomas4,5 are a manifestation of this spectrum
Sometimes, ovarian tumors otherwise typical of thecoma contain cells with features of steroid hormone-secreting cells (lutein, Leydig, and adrenal cortical):
- generally designated luteinized thecoma:
- some associated with peculiar form of sclerosing peritonitis
- stromal–Leydig cell tumor or Leydig cell-containing thecoma
- terms reserved for rare examples with Reinke crystalloids in cytoplasm of these cells
- tend to occur in younger women
- may have an androgenic rather than estrogenic effect
luteinized thecoma
- thecoma with steroid hormone secreting cells
- edema
- focal mitotic activity
Leydig cell containing thecoma
- cytoplasmic Reinke crystalloids
during pregnancy (15327450)
Cytogenetics
trisomy 12
tetrasomy 12 (11148462)
Differential diagnosis
- Yellow color important feature in differential diagnosis with fibroma.
ovarian lipid cell tumor
See also
ovarian sex cord-stromal tumors
INHA
ovarian fibroma
References
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Gaffney EF, Majmudar B, Hewan-Lowe K. Ultrastructure and immunohistochemical localization of estradiol of three thecomas. Hum Pathol. 1984;15:153–160.
Hayes MC, Scully RE. Stromal luteoma of the ovary. A clinicopathological analysis of 25 cases. Int J Gynecol Pathol. 1987;6:313–321.
Scully RE. Stromal luteoma of the ovary. A distinctive type of lipoid-cell tumor. Cancer. 1964;17:769–778.
Zhang J, Young RH, Arseneau J, Scully RE. Ovarian stromal tumors containing lutein or Leydig cells (luteinized thecomas and stromal Leydig cell tumors). A clinicopathologic analysis of fifty cases. Int J Gynecol Pathol. 1982;1:270–285.
Roth LM, Sternberg WH. Partly luteinized theca cell tumor of the ovary. Cancer. 1983;51:1697–1704.
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Iwasa Y, Minamiguchi S, Konishi I, Onodera H, Zhou J, Yamabe H. Sclerosing peritonitis associated with luteinized thecoma of the ovary. Pathol Int. 1996;46:510–514.
Werness BA. Luteinized thecoma with sclerosing peritonitis. Arch Pathol Lab Med. 1996;120:303–306.
Sternberg WH, Roth LM. Ovarian stromal tumors containing Leydig cells. I. Stromal-Leydig cell tumor and non-neoplastic transformation of ovarian stroma to Leydig cells. Cancer. 1973;32:940–951.
Takeuchi S, Ishihara N, Ohbyashi C, Itoh H, Maruo T. Stromal Leydig cell tumor of the ovary: case report and literature review. Int J Gynecol Pathol. 1999;18:178–182.