Sex cord-stromal ovarian cancer- causes, symptoms, diagnosis, treatment, pathology

With sex cord-stromal ovarian cancer. Ovarian refers to “ovary”, of which women
have two that sit along either side of the uterus. The term sex cord refers to an embryonic structures
that develops into ovarian follicles and stromal cells are the connective tissue of any organ. So a sex cord-stromal ovarian cancer is a
type of tumor that develops from either ovarian follicle cells or connective tissue cells. Each ovary has multiple follicles. Each follicle is made up of an oocyte, which
is the immature egg, surrounded by two types of cells – theca cells and granulosa cells. Granulosa and theca cells work together to
support follicle development. Luteinizing hormone stimulates theca cells
to generate androgens and follicle stimulating hormone stimulates granulosa cells to convert
those androgens to estradiol using the enzyme aromatase. A large increase in estradiol triggers ovulation. During ovulation, the oocyte pops out of the
ovary, causing a bit of damage to the surface. Fibrocytes detect that damage and differentiate
into fibroblasts and lay down collagen to help repair the damage. If any of those cells starts to divide uncontrollably,
it can either form a benign tumor which means that it does not invade nearby tissue or spread
to other parts of the body, or it can be a malignant tumor which means that it can invade
nearby tissue and spread to other parts of the body. Compared with benign tumor cells, malignant
tumor cells have key features like not having a clearly defined border or like a slightly
less organized nuclei. The first main type of sex-cord stromal tumor
is a granulosa-theca cell tumor. And these are the most common malignant stromal
tumors and they’re associated with middle-aged women. These tumors often end up producing way too
much estradiol, and this can cause very specific hormone associated symptoms like uterine bleeding,
breast tenderness, and early puberty in young girls. Under the microscope, these tumors classically
develop little fluid pockets scattered throughout the tissue that are called Call-Exner bodies. The second type of tumors, fibromas, are made
of fibroblasts and are benign tumors. Under the microscope, they look like thin
needle-like strands with elongated nuclei that are bundled together. Benign fibromas are often seen in combination
with ascites, a fluid buildup in the peritoneal cavity, as well as pleural effusion, a fluid
buildup in the pleural cavity. In fact, the clinical triad of a benign ovarian
tumor with ascites and a pleural effusion, is better known as Meigs syndrome. The exact pathogenesis here, though, is unclear,
but it’s thought that the solid ovarian tumor irritates the peritoneal and pleural
surfaces which leads to a transudative fluid buildup in both spaces. Fibromas can occasionally grow to the size
of an orange and can cause a pulling sensation in the groin when it compresses the round
ligament of the uterus. The third type of tumors are called Sertoli-Leydig
cell tumors because they look like the Sertoli and Leydig cells normally found in men. It turns out that the tumors are actually
made of primitive gonadal stroma, which is so undifferentiated that the cells can secrete
androgens like testosterone. Increased levels of testosterone can cause
women to have more masculine features like hirsutism, which is increased hair growth. Under the microscope, classically there are
Reinke crystals which are pink rod-like crystals in the cytoplasm of the cells, and these look
kinda like bright pink magical crystals you’d collect in a video game. So during ovulation the follicle ruptures
and releases an egg, which inadvertently leads to epithelial cell damage. To fix that damage the epithelial cells have
to undergo cell division to replace and heal the tissue. Each time cells divide there is a chance of
a mutation and the possibility of tumor formation. And this means that with more ovulatory cycles
there’s an increased risk of tumor formation. So things that are associated with a decreased
risk of Ovarian cancer include things that reduce the number of ovulatory cycles like
pregnancy, breastfeeding, and oral contraceptive use. On the flip side, some things that are associated
with an increased risk include certain medical conditions like endometriosis and polycystic
ovarian syndrome. There are also genetic risk factors like having
the BRCA-1 or BRCA-2 mutation, which are both autosomal dominant mutations, which in addition
to ovarian cancer, carry with them an increased risk of breast cancer. There’s also hereditary nonpolyposis colorectal
cancer, also known as Lynch syndrome, which increases the risk of developing a number
of cancers, including ovarian cancer. Generally speaking, symptoms of ovarian cancers
can have subtle and non-specific. Common early symptoms can include abdominal
distension, bloating, as well as abdominal or pelvic pain, which can come from an ovarian
torsion – where the ovary gets twisted. Occasionally, ovarian tumors can cause ascites,
abdominal masses, bowel obstruction, or dyspareunia, which is pain during sexual intercourse. A classic finding is a Sister Mary Joseph
nodule which happens with the cancer metastasizes to the umbilicus. This finding is often linked with a few types
of cancer – one of which is ovarian cancer. Diagnosis of ovarian cancer typically involves
looking for specific tumor markers like B-hCG, and a transvaginal ultrasound. Tumor biopsies are done to figure out whether
a growth is benign or malignant, and imaging with a CT or MRI can be done to identify evidence
of metastasis. Treatment of ovarian cancer typically involves
chemotherapy, surgery, and sometimes radiotherapy. Surgery might be enough for malignant tumors
confined to the ovary, whereas chemotherapy may be needed for disease that spread. Carbohydrate antigen 125, called CA 125, is
a protein made by various types of ovarian tumors, so tracking levels of this biomarker
in the blood can help monitor response to therapy and potential relapse. All right, as a quick recap: sex cord-stromal
ovarian cancers originate from connective tissue in the ovary. Granulosa-theca cell tumors can secrete excess
estradiol as well as develop Call-Exner bodies, fibromas can become large and are associated
with Meigs syndrome, and Sertoli-Leydig cell tumors can secrete excess testosterone and
develop Reinke crystals. Increased risk for developing ovarian cancers
is associated with increased cumulative amount of time a woman spends in ovulation, and therefore
decreased risk is associated with pregnancy, breastfeeding, and oral contraceptives.

39 comments

  1. amico,potresti mettere i sottotitoli in italiano come feci un po' di tempo fa in un video sull' infarto, per permettere anche ai tuoi iscritti italiani di comprendere!

  2. Thank you Osmosis for making the lives of medical students easier! 💛 The explanations are so easy to understand! 👍👍

  3. Osmosis have had always make us happy, I didn't like that last half of this video is the same as epithelial ovarian cancer, it's not well applied and not focused on sex-cord stromal tumors

  4. Hi, i am a doctor from Indonesia. Please make video about cervical cancer.. Because cervical cancer is still giving high mortality number in the world. Thankyou osmosis. (And i hope, osmosis also makes video about anatomy of obs-gyn) 😊

  5. In all three of your videos about ovarian cancer, you have said that ovulation is a cause. This doesn't make sense. I do believe that ovulation–because the ovum must burst through the epithelium–can eventually lead to an epithelial ovarian cancer. But I do not believe that this phenomenon could influence the sex cord-stromal tumor or of the germ cell tumors. Please check your facts.

  6. Very nice explanation in each topic.. making the subject very much easier.. thank you so much for your brilliant effort.

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