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Gonadal tumors (Granulosa Cell Tumor (GTC) (Prognostic factors (clinical…
Gonadal tumors
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Thecomas
- account for only 0.5-1% of ovarian tumors.
- affected postmenopausal women in mean age of 59
- In 90% of the cases they are unilateral and very rarely malignant.
- Thecomas may attain size up to 15 cm
- They are usually unilateral solid tumors and there are mostly benign
- In women of procreative age to preserve fertility unilateral adnexectomy is recommended
- due to hormonal activity resulting in endometrial hyperplasia, hysterectomy with bilateral adnexectomy is warranted in premenopausal and postmenopausal woman
- When sparing treatment is considered endometrial biopsy is mandatory to exclude endometrial cancer- risk ratio up to 25%
Fibromas
- commonest solid ovarian tumors.
- They are benign in nature and usually develop in postmenopausal women.
- Their size varies from 3 to even 24 cm and may occur bilaterally
- Fibromas of the ovary may coexist with ascites and hydrothorax (the Meigs syndrome) which resolve after excision
- US: may mimic pedunculated uterine myomas
- „pure” FIBROMA is hormonally inactive
Fibrosarcoma
- extremely rare ovarian tumor
- They may develop as primary tumor or evolve from a preexisting fibroma
- They usually affect postmenopausal women >58
- Consist of epithelial/mesenchymal tissue
- Characterized with rapid growth and abundant vascularization
- Immunohistochemically
- Ki-67 and PCNA mutations as well as high proliferation and mitotic index
- Radical treatment with possible debulking surgery
- no standard adjuvant chemiotherapy: epirubicin + ifosfamide + dacarbazine and paclitaxel + cisplatin
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Classification
- Granulosa-Stroma cell tumors (granulosa cell tumor = FOLLICULOMA, thecoma, fibroma)
- Sertoli-Leydig tumors
- Sertoli-Leydig tumors with annular tubules
- Gynandroblastoma
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GYNANDROBLASTOMA
- EXTREMLY RARE NEOPLASM
- Frequently small and unilateral
- Consist of mixed granulosa and Sertoli-Leydig cells
- Surgery -Unilateral resection of tumor
- Occurance- 30 years old young woman
- rare ovarian malignancies: 5% of all ovarian tumors and for about 7% of malignant tumors of the ovary
- They originate from a female components (granular and thecal cells) and male gonads (Leydig and Sertoli cells), stromal cells and fibroblasts
- principles of management are extrapolated from epithelial malignant ovarian tumors treatment