Obstetrics and Gynecology - A. M. Gromova 2000

Benign Tumors of the Female Reproductive Organs
Benign Ovarian Tumors
Lipid Cell Tumors of the Ovary

According to the WHO definition, this group of neoplasms includes tumors composed of Cells resembling Leydig cells, lutein cells, and adrenal cortex cells, but which cannot be specifically identified as any of these three types.

Adrenal-like tumors

Synonyms include diffuse arrhenoblastoma, masculinovoblastoma, and hypernephroma.

Adrenal-like ovarian tumors resemble adrenal cortical adenomas in both their macroscopic characteristics and morphological features. They arise from embryonic rests of the adrenal cortex located in the broad ligament, ovarian hilum, and ovarian cortex. The tumor is typically unilateral, ranging in size from a few centimeters up to 20 cm. It presents as a well-circumscribed, round, firm nodule. On cross-section, the tumor is solid, orange, yellow, or brown in color, with areas of Hemorrhage.

Histologically, the tumor resembles the zona reticularis or zona glomerulosa of the adrenal cortex. It is composed of large (20–45 µm) polygonal cells with clear or vacuolated Cytoplasm. Their nuclei are small, basophilic, and centrally located. The cells contain Lipids, and mitoses are extremely rare. Up to 7% of these tumors may be malignant, in which case cellular atypia (nuclear polymorphism and hyperchromasia) and abundant lipids are observed.

The majority of adrenal-like tumors are masculinizing. They most commonly occur in women of reproductive age, girls, and women over 60. Their incidence does not exceed 10%. The endometrium in these tumors typically shows no signs of proliferation and is atrophic. Given that malignant adrenal-like tumors are rare, unilateral oophorectomy is an effective Treatment method, particularly in childhood and reproductive age.

Luteoma

Two Types of tumors are referred to as luteomas: Pregnancy luteoma and stromal luteoma. The former is not a true neoplasm and, according to the WHO Classification, is categorized among tumor-like conditions.

Stromal Luteoma

This condition encompasses small luteomas (no larger than 2–3 cm) located in the cortical or medullary layer of one or both Ovaries. These tumors are typically solitary rather than multiple, lack a capsule, and present a yellow, brown, gray, or white color on cross-section.

Histologically, a stromal luteoma consists of large, polygonal or rounded, tightly packed cells arranged in cords and nests. The nuclei are large and centrally located; the cytoplasm is eosinophilic. The stroma is generally sparse, though occasionally it features broad bundles of hyalinized Collagen dividing the cells into groups. Rich in Blood Vessels, stromal luteoma develops from the theca lutein cells or luteinized stromal cells. The tumor most commonly occurs in postmenopausal women aged 50–70. In the majority of cases, tumor development is accompanied by symptoms of hyperestrogenism, with patients presenting with uterine bleeding and glandular-cystic endometrial hyperplasia. In some patients, the tumor manifests with signs of virilization.

There is no clearly defined treatment protocol for patients with stromal luteoma. It should be kept in mind that the tumor may be bilateral. However, the absence of a tumor in the contralateral Ovary does not rule out the presence of areas of stromal luteinization within it, which could potentially give rise to a stromal luteoma in the future. Therefore, if the stromal luteoma exhibits estrogenic activity and the Uterus has been removed, the contralateral ovary may be preserved. If the uterus is preserved or the luteoma exhibits androgenic activity, removal of the second ovary is recommended.