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Ovarian Sex Cord Stromal Tumours in Children and Young Girls - A More Than Two Decade Clinicopathological Experience in a Developing Country, Pakistan

  • Haroon, Saroona (Histopathology section, Dept. of Pathology and Microbiology, The Aga Khan University) ;
  • Idrees, Romana (Histopathology section, Dept. of Pathology and Microbiology, The Aga Khan University) ;
  • Zia, Aleena (Medical Student, The Aga Khan University) ;
  • Memon, Aisha (Histopathology section, Dept. of Pathology and Microbiology, The Aga Khan University) ;
  • Fatima, Saira (Histopathology section, Dept. of Pathology and Microbiology, The Aga Khan University) ;
  • Kayani, Naila (Histopathology section, Dept. of Pathology and Microbiology, The Aga Khan University)
  • Published : 2014.02.01

Abstract

Background: Ovarian sex-cord stromal tumours (SCST) are rare, and relatively infrequent in children. These have to be distinguished from more common germ cell tumors in children and also from benign epithelial neoplasms. Objectives: The purpose of our study was to report the clinical and pathological findings in young patients with these tumours in our population. Material and Methods: The present observational cross-sectional study included all subjects <21 years of age diagnosed with ovarian SCST, in Aga Khan University Hospital Histopathology Laboratory, Karachi, Pakistan, from January 1992 till July 2013. Results: Of the total of 513 SCSTs presented during the study period, 39 fulfilled inclusion criteria and were assessed. The age range was 4-250 months. Most of the tumours presented at stage-1 and an abdominal mass was the most common presenting symptom, along with menstrual disturbance. The left side ovary was slightly more affected (53.5%). Of the total, 15 were juvenile granulosa cell tumours (JGCT), 11 sclerosing stromal tumours (SST), 10 of the fibrothecomas spectrum, 2 Sertoli leydig cell tumours (SLCT) and one a sex cord tumour with annular tubules (SCTAT). Detailed immunohistochemical analyses were performed in 33 cases. Recurrence/metastasis was noted in 4/21 cases with follow-up data. Conclusions: Ovarian sex cord stromal tumours are very rare in young age in our population, and usually present at an early stage. Most common among these are juvenile granulosa cell tumours, although surprisingly sclerosing stromal tumours were also common. Clinical symptoms due to hormone secretion in premenstrual girls and menstrual disturbance in menstruating girls are common presenting features.

Keywords

References

  1. Arhan E, Cetinkaya E, Aycan Z, et al (2008). A very rare cause of virilization in childhood: ovarian Leydig cell tumor. J Pediatr Endocrinol Metab, 21, 181-3.
  2. Arisaka O, Matsumoto T, Hosaka A, et al (1992). Cystic adult granulosa cell tumor causing precocious pseudopuberty in a six-year-old girl. Acta Paediatr, 81, 1061-4. https://doi.org/10.1111/j.1651-2227.1992.tb12178.x
  3. Borer JG, Tan PE, Diamond DA (2000). The spectrum of Sertoli cell tumors in children. Urol Clin North Am, 27, 529-41. https://doi.org/10.1016/S0094-0143(05)70100-2
  4. Calaminus G, Wessalowski R, Harms D, Gobel U (1997). Juvenile granulosa cell tumors of the ovary in children and adolescents: results from 33 patients registered in a prospective cooperative study. Gynecol Oncol, 65, 447-52. https://doi.org/10.1006/gyno.1997.4695
  5. Cecchetto G, Ferrari A, Bernini G, et al (2011). Sex cord stromal tumors of the ovary in children: a clinicopathological report from the Italian TREP project. Pediatr Blood Cancer, 56, 1062-7. https://doi.org/10.1002/pbc.22918
  6. Chan LF, Storr HL, Scheimberg I, et al (2004). Pseudo-precocious puberty caused by a juvenile granulosa cell tumour secreting androstenedione, inhibin and insulin-like growth factor-I. J Pediatr Endocrinol Metab, 17, 679-84.
  7. Chin VL, Sheffer-Babila S, Lee TA, Tanaka K, Zhou P (2012). A case of complete androgen insensitivity syndrome with a novel androgen receptor mutation. J Pediatr Endocrinol Metab, 25, 1145-51.
  8. Chu SM, Ming YC, Chao HC, et al (2010). Ovarian tumors in the pediatric age group: 37 cases treated over an 8-year period. Chang Gung Med J, 33,152-6.
  9. Ferrari A, Bisogno G, De Salvo GL, et al (2007). The challenge of very rare tumors in childhood: the Italian TREP Project. Eur J Cancer, 43, 654-9. https://doi.org/10.1016/j.ejca.2006.08.028
  10. Gwin K, Marino-Enriquez A, Martel M, Reyes-Mugica M (2008). Sclerosing stromal tumors: an important differential diagnosis of ovarian neoplasm in childhood and adolescence. Pediatr Dev Pathol, 12, 1.
  11. Isguven P, Yoruk A, Adal E, et al (2003). Adult type granulosa cell tumor causing precocious pseudopuberty in a 6 year-old girl. J Pediatr Endocrinol Metab, 16, 571-3.
  12. King DW, Steinmetz R, Wagoner HA, et al (2003). Differential expression of GRK isoforms in nonmalignant and malignant human granulosa cells. Endocrine, 22, 135-42. https://doi.org/10.1385/ENDO:22:2:135
  13. Leyva-Carmona M, Vazquez-Lopez MA, Lendinez-Molinos F (2009). Ovarian juvenile granulosa cell tumors in infants. J Pediatr Hematol Oncol, 31, 304-6. https://doi.org/10.1097/MPH.0b013e318196a70e
  14. Metwalley KA, Elsers DA, Farghaly HS, Abdel-Lateif H, Abdel-Kader M (2012). Precocious puberty secondary to a mixed germ cell-sex cord-stromal tumor associated with an ovarian yolk sac tumor: a case report. J Med Case Rep, 6, 162. https://doi.org/10.1186/1752-1947-6-162
  15. Moyles K, Chan YF, Hamill J, Massey R (1995). Ovarian Sertoli-Leydig cell tumor with retiform pattern. Pathology, 27, 371-3. https://doi.org/10.1080/00313029500169343
  16. Olivier P, Simoneau-Roy J, Francoeur D, et al (2012). Leydig cell tumors in children: contrasting clinical, hormonal, anatomical, and molecular characteristics in boys and girls. J Pediatr, 161, 1147-52. https://doi.org/10.1016/j.jpeds.2012.05.039
  17. Park SM, Kim YN, Woo YJ, et al (2011). A sclerosing stromal tumor of the ovary with masculinization in a premenarchal girl. Korean J Pediatr, 54, 224-7. https://doi.org/10.3345/kjp.2011.54.5.224
  18. Pastore G, De Salvo GL, Bisogno G, et al (2009). Evaluating Access to Pediatric Cancer Care Centers of Children and Adolescents with Rare Tumors in Italy: the TREP Project. Pediatr Blood Cancer, 53, 152-5. https://doi.org/10.1002/pbc.22049
  19. Paternoster M, Graziano V, Settimi A, et al (2011). Medico-legal observations concerning a mortal case of granulosa cell tumor of the ovary in an 8-month-old infant. J Pediatr Surg, 46, 1679-82. https://doi.org/10.1016/j.jpedsurg.2011.04.021
  20. Schneider DT, Calaminus G, Wessalowski R, et al (2003). Ovarian sex cord stromal tumors in children and adolescents. J Clin Oncol, 21, 2357-63. https://doi.org/10.1200/JCO.2003.05.038
  21. Schneider DT, Ute J, Calaminus G, Gobel U, Harms D (2003). Ovarian sex cord stromal tumors-A clinicopathological study of 72 cases from the Kiel Pediatric Tumor Registry. Virchows Arch, 443, 549-60. https://doi.org/10.1007/s00428-003-0869-0
  22. Schultz KA, Ness KK, Nagarajan R, Steiner ME (2006). Adnexal masses in infancy and childhood. Clin Obstet Gynecol, 49, 464-79. https://doi.org/10.1097/00003081-200609000-00007
  23. Silverman LA, Gitelman SE (1996). Immunoreactive inhibin, mullerian inhibitory substance, and activin as biochemical markers for juvenile granulosa cell tumors. J Pediatr, 129, 918-21. https://doi.org/10.1016/S0022-3476(96)70040-9
  24. Spitzer RF, Wherrett D, Chitayat D, et al (2007). Maternal luteoma of pregnancy presenting with virilization of the female infant. J Obstet Gynaecol Can, 29, 835-40.
  25. Till H, Schmidt H (2005). Juvenile granulosa cell tumour (JGCT) of the ovary in a 6-year-old girl: laparoscopic resection achieves long-term oncological success. Eur J Pediatr Surg, 15, 292-4. https://doi.org/10.1055/s-2005-837607
  26. Toppari J, Kaipia A, Kaleva M, Laato M, et al (1998). Inhibin gene expression in a large cell calcifying Sertoli cell tumour and serum inhibin and activin levels. APMIS, 106, 101-13. https://doi.org/10.1111/j.1699-0463.1998.tb01325.x
  27. Virgone C, Cecchetto G, Ferrari A, et al (2012). GATA-4 and FOG-2 expression in pediatric ovarian sex cord-stromal tumors replicates embryonal gonadal phenotype: results from the TREP project. PLoS One, 7, 45914. https://doi.org/10.1371/journal.pone.0045914
  28. Young RH (2005). Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. Mod Pathol, 18, 81-98. https://doi.org/10.1038/modpathol.3800311

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