Chapter 1: Histopathology of gynaecological cancers
Tubo-ovarian tumours – SCSTs
SCSTs are typically unilateral tumours and often hormonally active; the most common type is fibroma, which is benign.
A minority of tumours, granulosa cell tumours and Sertoli–Leydig cell tumours, may be malignant, and may recur many years after oophorectomy (Figure 1.4).
Figure 1.4: Metastasis from adult granulosa cell tumour
Credit: Courtesy of the authors
Tumours are often hormonally active, causing endometrial neoplasia when oestrogens predominate and masculinisation when androgens predominate.
Granulosa cell tumours are classified as adult (more common, present in peri/postmenopausal women) or juvenile (rare, present in first 4 decades); they have different hormonal manifestations.
Tumours stain for inhibin, steroidogenic factor-1 (SF1), FOXL2 and calretinin, and are negative for epithelial membrane antigen (Figure 1.5).
Figure 1.5: Immunostaining of granulosa cell tumour, adult type.
Abbreviations: EMA, epithelial membrane antigen; SF1, steroidogenic factor-1
Credit: Courtesy of the authors
Point mutation in FOXL2 is characteristic of tumours of the adult type, and can aid diagnosis in challenging cases.
Sertoli–Leydig cell tumours have a wide age range at presentation. They can occur as either a combined tumour or be composed solely of Sertoli or Leydig cells (Figure 1.6)
Figure 1.6: Sertoli–Leydig cell tumours
Credit: Courtesy of the authors
Sertoli tumours are morphologically heterogeneous, may contain heterologous elements, and are graded well, moderate or poorly differentiated, indicating increasing aggressiveness.
Tumours express sex cord-stromal immunomarkers and may carry mutations in DICER1 or FOXL2 genes.
Revision Questions
- Are the majority of SCSTs benign or malignant?
- What are the useful diagnostic stains for SCSTs?
- Are there any genetic tests used to classify these tumours?
