Definition: Heterogeneous group of tumors composed entirely of cells with morphologic features indicative of steroid hormone secretion.
Clinical Features
Any age
Most associated with a virilizing syndrome (defeminization and amenorrhea)
Sometimes:
- Cushing’s syndrome
- clinically biologically inactive
- estrogenic or progestogenic manifestations
- associated with endometrioid carcinoma
Pathogenesis
Tumors can arise from any of normal steroid hormone-secreting cells, i.e.:
lutein (thecal or stromal)
Leydig (hilus)
adrenal cortical
Macroscopy
Usually unilateral
Composed of yellow or yellowish brown nodules separated by fibrous trabeculae
Cut surface of ovarian lipid cell tumor. The deep brown color is reminiscent of a renal or thyroid oncocytoma.
The deep brown color is reminiscent of a renal or thyroid oncocytoma.
Malignant tumors tend to:
- be larger (≥cm in diameter)
- have foci of necrosis and hemorrhage
Microscopy
Masses of large rounded or polyhedral cells
clear appearance of the cytoplasm of the tumor cells
acidophilic appearance of the cytoplasm of the tumor cells
Composed entirely of cells with features indicative of steroid hormone secretion:
- cytoplasm:
- abundant
- eosinophilic
- may be vacuolated
- often positive for fat stains
- Malignant tumors tend to exhibit:
- nuclear atypia
- mitotic activity
Reinke’s crystalloids in a few cases:
- tumor can then be categorized as Leydig or hilus cell tumor
In few others, ectopic adrenal origin suggested by: - hormonal profile (presence of Cushing’s syndrome)
- adrenal cortical rests in hilus of ovary and broad ligament (but not within adult ovary itself)
In most cases, exact origin undecided:
- descriptive term lipid cell tumor proposed for entire group, with added designation Leydig cell type or adrenal cortical type if indicated.
Other Investigations
* Variety of androgenic hormones produced in vitro:9 o occasionally, large amounts of adrenal corticoids
Ultrastructure
cytoplasm contains:
- well-developed smooth endoplasmic reticulum
- mitochondria with tubulovesicular cristae
Immunohistochemistry
reactivity for:
- vimentin in 75%
- keratin in 50%
- actin in ≈33%8
consistent reactivity for:
- inhibin
- A103
- Mart-1
Differential Diagnosis
ovarian thecoma
ovarian fibroma
ovarian granulosa cell tumor
ovarian clear cell tumor
Distinguish from lesions in which steroid hormone-producing cell proliferation is secondary event, including:
stromal luteoma
luteinized granulosa cell tumor (particularly juvenile type)
fibrothecoma
stromal–Leydig cell tumor
non-neoplastic proliferation of steroid cells at periphery of other tumors, such as:
- struma ovarii
- strumal carcinoid
- surface epithelial tumors
- metastatic carcinoma
Links
References
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Lipid cell tumor of the ovary: steroid hormone secretory pattern and localization using 75Se-selenomethylcholesterol. Younis JS, Bercovici B, Zlotogorski A, Horne T, Glaser B. Gynecol Obstet Invest. 1989;27(2):110-2. PMID: 2731770
Lipoid cell tumor of the ovary: a cause of virilization in girls. Cleveland RH, Kushner DC, Russell WE, Herman TE, Kim SH, Crawford J. Am J Dis Child. 1987 Jul;141(7):716-8. PMID: 3591756
Lipid cell tumor of the ovary in reference to adult-onset congenital adrenal hyperplasia and polycystic ovary syndrome. A case report. Rosenfield RL, Cohen RM, Talerman A. J Reprod Med. 1987 May;32(5):363-9. PMID: 3598985
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