Invasive breast carcinoma - IARC

sis. Corpus luteum of pregnancy has a
central cavity and a convoluted bord e r. It
is composed of granulosa-lutein and
theca-lutein layers and contains hyaline or
calcified bodies. Multinodularity of the
tumour or bilaterality favour luteoma of
p re g n a n c y.
Histogenesis
Luteoma of pregnancy appears dependent
on beta-human chorionic gonadotro p i n
for its growth based on its clinical pre s e n-
tation at term and re g ression following the
conclusion of the pre g n a n c y.
Prognosis and predictive factors
The tumours regress after the conclusion
of the pregnancy.
Uncommon tumour-like conditions
associated with pregnancy
Many tumour-like conditions occur during
or subsequent to a pregnancy including
ovarian pre g n a n c y, hyperreactio luteinalis,
large solitary luteinized follicle cyst of
p regnancy and puerperium {513}, granulosa
cell proliferations of pregnancy {524},
hilus cell proliferation of pregnancy and
ectopic decidua {505}.
Stromal hyperthecosis
Definition
Stromal hyperthecosis consists of hyperplastic
ovarian stroma containing clusters
of luteinized stromal cells.
Epidemiology
The lesion typically occurs in women in
the late reproductive years and beyond.
Clinical features
The patients may present with endocrine
manifestations including virilization, obesity,
hypertension and decreased glucose
tolerance and may have elevated
levels of plasma testosterone. Bilateral
ovarian enlargement is typically encountered
at laparotomy .
Macrosocopy
The ovaries are typically enlarged and
may measure up to 7 cm in greatest
dimension {2605}. With rare exceptions,
the lesion is bilateral. The sectioned surface
is predominately solid and white to
yellow. Multiple superficial cysts may be
present in premenopausal women.
Histopathology
On histological examination hyperplastic
stroma is present containing clusters of
luteinized stromal cells. In premenopausal
women the outer cortex may
be thickened and fibrotic with luteinized
follicle cysts as is observed in the polycystic
ovary syndrome.
Differential diagnosis
The lesion is distinguished from the
closely related condition of stro m a l
hyperplasia by the absence of luteinized
stromal cells in the latter. Polycystic ovarian
disease typically occurs in younger
women and is less distinctly virilizing.
The ovaries are more cystic than is typically
seen in stromal hyperthecosis.
Somatic genetics
Patients with acanthosis nigricans and
masculinization (HAIR-AN syndrome) all
had the histologic findings of premenopausal
hyperthecosis in their
ovaries {729}.
Prognosis and predictive factors
The lesion is usually treated by
o o p h o re c t o m y, and the postoperative
course is uneventful.
Stromal hyperplasia
Definition
A tumour-like proliferation of ovarian stromal
cells without the presence of
luteinized stromal cells.
Clinical features
Patients are typically menopausal or
early postmenopausal. It is much less
f requently estrogenic or andro g e n i c
than stromal hyperthecosis, and patients
may occasionally have obesity,
h y p e rtension or abnormal glucose
metabolism {2605}.
Macroscopy
Ill defined white or pale yellow nodules
that sometimes coalesce are present in
the cortical or medullary regions of the
o v a ry or both. In extensive cases the
ovaries may be enlarged, and the arc h i-
t e c t u re re p l a c e d .
Histopathology
The medullary and to a lesser extent the
c o rtical regions are replaced by a nodular
or diffuse densely cellular pro l i f e r a-
tion of small stromal cells with scanty
amounts of collagen. In advanced
cases the ovarian arc h i t e c t u re is completely
replaced and follicle derivatives
a re not observed.
A
Fig. 2.125 Stromal hyperthecosis. A The ovaries are enlarged and solid with a smooth external surface and have a multilobulated sectioned surface with a few follicle
cysts. B Note the clusters of luteinized stromal cells within hyperplastic ovarian stroma.
B
Miscellaneous tumours and tumour-like conditions of the ovary 189