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Stromal luteinization has been reported to be associated with benign and malignant epithelial ovarian tumors, predominantly mucinous and often endometrioid ovarian neoplasm. We report here an unusual case of marked ovarian stromal luteinization in a 67-year old post menopausal female with a high-grade serous papillary carcinoma of the ovary. Stromal luteinization was so prominent that the tumor mimicked a Sertoli-Leydig cell tumor of the ovary.
Keywords: Stromal luteinization; Ovarian tumors; Sertoli-Leydig; Carcinoma
Stromal Luteinization has been described to be asso- 2-5 ciated with ovarian mucinous and endometrioid neoplasms.2-5 Rome, et al. observed that stromal luteinization in postmenopausal women with mucinous ovarian tumors often has higher than normal estrogen secretion.2
It has been postulated that a mutation of GT198 protein (a tumor suppressor gene and steroid hormone receptor) in ovarian stromal cell results in stromal activation with resultant luteinization due to the presence of luteinized theca cells at different developmental stage.6
These mutant stromal cells are often found in endometrioid, mucinous, serous, clear cell and granulosa cell tumors, and as well as, endometrial and metastatic gastrointestinal ade- 3,7 nocarcinoma.3,7 A few isolated cases of stromal luteinization has been reported in primary B cell lymphoma of the ovary,8 ovar- 9 10 11 ian carcinoid, ovarian teratomas, ovarian hemangiomas and Brenner tumors.6 However, the significance of these luteinized stromal cells is largely unknown.
High-grade serous carcinoma constitute 60%-80% of ovarian epithelial carcinoma while ovarian cancer in general accounts for only 3% of all cancers in women.12 Despite its high prevalence, the serous carcinoma of the ovary is usually not associated with stromal luteinization. The morphologic appearance of this tumor may be confused with a sertoli-leydig cell tumor of the ovary. At a lower magnification, the admixture of epitheliallike element and luteinized stromal cells created a morphologic appearance that is often seen in Seroli-Leydig cells. However, the strong p53 positivity in the epithelial component of the ovarian tumor differentiated this tumor from a sertoli-leydig cell tumor. This is an important differential diagnosis as the prognosis and treatment of these two entities is vastly different. Immu-
stromal cells. The luteinized stromal cells are positive for alpha Inhibin, Calretinin and Melan A.9
In conclusion, stromal luteinization may be seen in high-grade serous epithelial ovarian tumors as demonstrated in this case and such occurrence should not be overlooked or confused with other tumors by the astute surgical pathologist.
The authors declare that they have no conflicts of interest.
The patient has provided written consent for the use of the images and case presentation for educational and scientific purposes provided unique identification is not revealed.
1. Mopupeola O. Samalia, MBBS: (Fellow in training and wrote the case report)
Fellow, Stuart Lauchlan Fellowship in Gynecologic and Breast Pathology, Women & Infants Hospital/Alpert Medical School of Brown University, Providence, RI 02905, USA.
2. C. James Sung, MD: (Helped writing the case report) Program Director, Stuart Lauchlan Fellowship in Gynecologic and Breast Pathology, Women & Infants Hospital/Alpert Medical School of Brown University, Providence, RI 02905, USA.
3. W. Dwayne Lawrence, MD, MSc (Path) (Reviewed the case and helped in diagnosis) Chief of Pathology, Stuart Lauchlan Fellowship in Gynecologic and Breast Pathology, Women & Infants Hospital/Alpert Medical School of Brown University, Providence, RI 02905, USA.
4. M. Ruhul Quddus, MD, M. Phil (Path) (Attending on the case) Program Co-Director, Stuart Lauchlan Fellowship in Gynecologic and Breast Pathology, Women & Infants Hospital/Alpert Medical School of Brown University, Providence, RI 02905, USA.