Sex cord stromal tumors

Topic Completed: 1 December 2012

Minor changes: 15 January 2021

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PubMed search: Ovarian thecoma

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Cite this page: Ehdaivand S. Thecoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumorthecoma.html. Accessed May 10th, 2021.
Definition / general
  • Usually > 40 years old, 65% after menopause
  • May be hormonally active, associated with estrogenic and occasionally (if steroid cells present) androgenic symptoms
  • Usually benign
  • Luteinized thecomas: thecoma plus features of steroid hormone secreting cells including edema, focal mitotic activity; may be associated with sclerosing peritonitis and ascites (Am J Surg Pathol 1994;18:1, Arch Pathol Lab Med 1996;120:303)
  • Leydig cell containing thecoma: if Reinke crystalloids are present in cytoplasm
Gross description
  • Unilateral (90%), well defined, firm, solid and covered by intact ovarian serosa
  • Variable size; usually yellow; often a mixture with fibroma (white)
Gross images

AFIP images

Lobulated and yellow

Luteinized tumor in patient with sclerosing peritonitis

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Microscopic (histologic) description
  • Spindle cells with moderate pale cytoplasm containing lipid droplets and central nuclei
  • Intervening stroma has collagen deposition and focal hyaline plaque formation
  • Some tumors are heavily calcified; may have prominent stromal hyperplasia (hyperthecosis)
Microscopic (histologic) images

AFIP images

Vacuolated tumor cells

Hyaline plaques

Stromal calcification

Luteinized tumor

Luteinized tumor in patient with sclerosing peritonitis

Oil Red O stain

Reticulin stain

Positive stains
  • Oil Red O or Sudan black (fat stains) on fresh / frozen tissue
  • Silver stains demonstrate reticulin fibers surrounding individual cells (note: reticulin surrounds clusters of cells in granulosa cell tumors)
Molecular / cytogenetics description
  • Trisomy 12
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