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Open Access Case Report

Estrogen-producing endometrioid adenocarcinoma resembling sex cord-stromal tumor of the ovary: a review of four postmenopausal cases

Tomomi Katoh1, Masanori Yasuda1*, Kosei Hasegawa2, Eito Kozawa3, Jun-ichi Maniwa4 and Hironobu Sasano5

Author affiliations

1 Departments of Pathology, Saitama Medical University International Medical Center, 1397-1Yamane, Hidaka, Saitama 350-1298, Japan

2 Departments of Gynecological Oncology, Saitama Medical University International Medical Center, 1397-1Yamane, Hidaka, Saitam, 350-1298, Japan

3 Departments of Radiology, Saitama Medical University International Medical Center, 1397-1Yamane, Hidaka, Saitama 350-1298, Japan

4 Division of Pathology, Kumagaya General Hospital, Kumagaya, Saitama, Japan

5 Department of Pathology, Tohoku University Hospital, Sendai, Miyagi, Japan

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Citation and License

Diagnostic Pathology 2012, 7:164  doi:10.1186/1746-1596-7-164

Published: 28 November 2012

Abstract

The 4 present cases with endometrioid adenocarcinoma (EMA) of the ovary were characterized by estrogen overproduction and resemblance to sex cord-stromal tumor (SCST). The patients were all postmenopausal, at ages ranging from 60 to 79 years (av. 67.5), who complained of abdominal discomfort or distention and also atypical genital bleeding. Cytologically, maturation of the cervicovaginal squamous epithelium and active endometrial proliferation were detected. The serum estrogen (estradiol, E2) value was preoperatively found to be elevated, ranging from 48.7 to 83.0 pg/mL (av. 58.4). In contrast, follicle stimulating hormone was suppressed to below the normal value. MR imaging diagnoses included SCSTs such as granulosa cell tumor or thecoma for 3 cases because of predominantly solid growth, and epithelial malignancy for one case because of cystic and solid structure. Grossly, the solid part of 3 cases was homogeneously yellow in color. Histologically, varying amounts of tumor components were arranged in solid nests, hollow tubules, cord-like strands and cribriform-like nests in addition to the conventional EMA histology.

In summary, postmenopausal ovarian solid tumors with the estrogenic manifestations tend to be preoperatively diagnosed as SCST. Due to this, in the histological diagnosis, this variant of ovarian EMA may be challenging and misdiagnosed as SCST because of its wide range in morphology.

http://www.diagnosticpathology.diagnomx.eu/vs/6096841358065394 webcite

Keywords:
Ovary; Postmenopausal; Estrogen (E2) overproduction; Endometrioid adenocarcinoma; Resembling sex cord-stromal tumor