Thecoma of the ovary with uterine myomatosisSudha Y Sane
Department of Pathology, Seth G. S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India
Correspondence Address: Source of Support: None, Conflict of Interest: None PMID: 214550
Source of Support: None, Conflict of Interest: None
Diffuse myomatosis of uterus in a post-menopausal woman developing as a result of ovarian thecoma is reported. A brief review of the literature is Presented.
Thecoma of the ovary is a comparatively rare tumor with estrogenic activity, Endometrial hyperplasia and carcinoma are known to occur in many cases of ovarian thecogranulosal tumors. Estrogen influence on myometrium leading to formation of fibroids is debated. A variant of multiple diffuse leiomyomata in the uterus described as myomatosis uteri is rare. I report below a case of thecoma with myomatosis coexisting in a menopausal woman.
A fifty six year old woman was admitted because of a palpable mass in the hypogastrium of 4 months' duration. She had been bleeding pervaginum off and on for the past 2 months. She had attained menopause four years earlier She was obese and afebrile. The blood pressure was 160/100 mm.Hg. The uterus (24 weeks' size) was palpable through the abdominal wall. The other systems were normal. A clinical diagnosis of uterine fibroid was made and a pan-hysterectomy was performed.
At operation, the uterus was found to be enlarged and had smooth contour. The pelvic ligaments were congested and edematous. The right ovary revealed a small nodule. The postoperative course was uneventful.
Gross Appearance of the Specimen see [Figure 1] on page 192B: The uterus measured 20 x 15 x 14 cm. with a globular contour except for two nodular projections. The wall was markedly thickened and the fibrillary hatching of its cut surface appeared contorted into many foci as is large numbers of small half formed fibroids were present. In addition, some small fully formed fibroids were seen. The endometrium was smooth and about 1 mm thick.
The right ovary see [Figure 2] on page 1928 revealed a well circumscribed nodule about 2 cm. in diameter projecting on the superior surface. The cut surface showed a distinct yellow solid tumour with atrophic ovarian tissue around it. The appearance of the left ovary, the oviducts and the cervix were grossly unremarkable.
Microscopically, the uterine wall was stippled with multiple whorled collections of deeply staining smooth muscle cells which blended with the bundles of normal muscle. These appeared like foci of newly developing fibroids. Scattered larger nodules showed well formed and well circumscribed fibroids. The endometrium showed mild cystoglandular hyperplasia and invasion into the myometrium, forming scattered foci of adenomyosis. The histological diagnosis was myomatosis with adenomyosis.
Sections from the ovarian tumor showed closely packed, plump, faintly eosinophilic cells, interlacing with fibrous and hyalinised areas. Specially strained sections revealed sudanophil and doubly refractile lipids. The ovarian tissue was seen compressed under the capsule. -Section of the other ovary showed many corpora albicantia, moderate stromal hyperplasia and congestion. The histological diagnosis was thecoma of the ovary.
Thecoma is a relatively rare, feminising tumor of ovary other than the granulosa cell tumor but is more frequent in postmenopausal women, The thecoma has stronger estrogenic influence than the granulosa cell tumor. Cystoglandular hyperplasia and endometrial carcinoma arising in these cases are described by many workers. ,,, Sternberg and Gaskill  reviewed thirteen cases of theca cell tumors. Seven of these were postmenopausal.
Leiomyoma of uterus is a very common tumour of reproductive age but tends to regress after menopause. The cause of the fibroids is unknown but excessive unopposed estrogen secretion is stressed by many authors. Lipschutz  could induce subperitoneal fibroids in animals by prolonged administration of estrogens. These tumours regressed after withdrawal of the hormones.
Zeit  studied 408 cases of myomas of uterus above the age of 45. An increase in the size of myoma after monopause was attributed to hemorrhage, degeneration and malignant change.
Six out of 13 cases of thecoma described by Sternberg and Gaskill showed leiomyomas of uterus; two of them were in postmenopausal age, but whether these leiomyomas started after menopause is questionable.
In the present case, an increase in the size of uterus had occurred four years after menopause. The morphology and histology of the uterus showed seedlings of newly forming myomas responsible for marked increase in the size of the uterus. Such an appearance referred to as myomatosis uteri is uncommon and seems to have been described in the past but not recently. Myomatosis in this case can be attributed to the effect of secretion from ovarian thecoma.
The author thanks Dr. C. K. Deshpande, Dean, K.E.M. Hospital and Seth G.S. Medical College, Parel, Bombay 400 012 for giving permission .o publish this case report.
[Figure 1], [Figure 2]