AssessmentsSex cord-gonadal stromal tumor
Sex cord-gonadal stromal tumor
USMLE® Step 1 style questions USMLE
A 65-year-old woman comes to the clinic due to pelvic heaviness and discomfort for the past few months. The patient also discloses bloody spotting on her underwear, which has required intermittently changing throughout the day. The patient has had no urinary symptoms or weight loss. She does not smoke or use alcohol or illicit drugs. The patient’s last menstrual cycle was 6 years ago. Her last Pap smear 2 years ago was normal. Vitals are within normal limits. On physical examination, a right-sided adnexal mass is palpated. Pelvic ultrasound shows a thickened endometrial stripe. Endometrial biopsy reveals an early stage, well-differentiated adenocarcinoma. The patient subsequently undergoes excision of the mass. The histopathological analysis is shown below:
Reproduced from: Wikimedia Commons
Which of the following is most likely to be elevated in this patient?
Content Reviewers:Rishi Desai, MD, MPH
The term sex cord refers to an embryonic structures that develops into ovarian follicle cells in a woman.
Stromal cells are the connective tissue of any organ.
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.
A large increase in estradiol triggers ovulation.
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 might do both of those things.
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 tumors are the most common malignant stromal tumors and they’re associated with middle-aged women.
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 benign tumors.
Under the microscope, they look like thin needle-like strands with elongated nuclei that are bundled together.