Department of Obstetrics and Gynecology, Rikshospitalet, University of Oslo, 0027 Oslo, Norway.
Pathol Res Pract. 2010 Nov 15;206(11):744-8. doi: 10.1016/j.prp.2010.07.001. Epub 2010 Aug 8.
In this study, we distinguish two clinical and pathological entities that are similarly named: luteinized thecoma and luteinized thecoma associated with sclerosing peritonitis. Ovarian luteinized thecoma lacks definitive criteria for malignancy. Based on our case study of a mitotically active neoplasm without nuclear atypia in which the patient was living and well 19 years after operation and comparison with prior studies of luteinized thecoma and the closely related entity of cellular fibroma, we propose presumptive criteria for malignancy for this rare neoplasm. Increased mitotic activity in luteinized thecoma without significant nuclear atypia is not an indication of malignant behavior, and such cases should therefore be referred to as mitotically active cellular luteinized thecoma. We also contrast neoplasms in the luteinized thecoma category with the entity originally reported as luteinized thecoma associated with sclerosing peritonitis. In the latter, the ovarian stromal proliferations are typically bilateral, can have an exceedingly high mitotic rate as was seen in our illustrative case, often incorporate non-neoplastic ovarian structures at their periphery, and are responsive to medical therapy. In our patient with sclerosing peritonitis, both the ovarian masses and peritoneal sclerosis underwent complete regression following treatment with gonadotropin-releasing hormone agonist and high doses of steroids, and an ovarian biopsy taken 2 months after therapy showed a histologically normal ovary. The patient subsequently became pregnant and delivered a normal infant. This is, to our knowledge, the first case of successful medically conservative treatment of a young patient with this entity that led to complete relief of symptoms and allowed preservation of fertility. Because recent observations support the non-neoplastic nature of the ovarian stromal proliferations, we advocate use of the previously proposed term luteinized thecomatosis associated with sclerosing peritonitis for this entity.
在这项研究中，我们区分了两种临床和病理上相似命名的实体：黄体化间质细胞瘤和伴有硬化性腹膜炎的黄体化间质细胞瘤。卵巢黄体化间质细胞瘤缺乏明确的恶性标准。根据我们的病例研究，该肿瘤具有活跃的有丝分裂活性，但无核异型性，患者在手术后 19 年仍然存活且状况良好，并且与黄体化间质细胞瘤和密切相关的细胞纤维瘤的先前研究进行比较，我们提出了这种罕见肿瘤恶性的假定标准。黄体化间质细胞瘤中无明显核异型性的有丝分裂活性增加并不表示恶性行为，因此此类病例应被归类为有丝分裂活性的细胞黄体化间质细胞瘤。我们还将黄体化间质细胞瘤类别的肿瘤与最初报道的伴有硬化性腹膜炎的黄体化间质细胞瘤实体进行了对比。在后一种情况下，卵巢间质增生通常是双侧的，有极高的有丝分裂率，就像我们的病例中所见，常常在其周围包含非肿瘤性的卵巢结构，并且对药物治疗有反应。在我们的硬化性腹膜炎患者中，卵巢肿块和腹膜硬化在接受促性腺激素释放激素激动剂和大剂量类固醇治疗后完全消退，并且在治疗后 2 个月进行的卵巢活检显示卵巢组织学正常。患者随后怀孕并分娩了一个正常婴儿。据我们所知，这是首例成功采用药物保守治疗该实体的年轻患者的案例，该治疗完全缓解了症状并保留了生育能力。由于最近的观察结果支持卵巢间质增生的非肿瘤性质，我们提倡将先前提出的术语“伴有硬化性腹膜炎的黄体化间质细胞瘤病”用于该实体。
