| Objective:The aim of this study was to investigate the clinicopathologic characteristics of malignant sex cord stromal tumors of the ovary and to analyze the high risk factors affecting lymph node metastasis.Methods:The clinicopathologic and surgical records of 81 patients who were diagnosed as malignant sex cord stromal tumors of the ovary from May 1985 through January 2010 in Qilu Hospital of Shandong University were retrospectively reviewed. Of the 81 patients,56 had granulosa cell tumor (50 had adult type granulosa cell tumor,6 had juvenile type granulosa cell tumor),2 had malignant thecoma,20 had G2 or G3 of Sertoli-Leydig tumor,3 had malignant steroid cell tumor. Of all patients,59 (72.84%) patients had stageâ… disease,7 (8.64%) patients had stageâ…¡disease,14 (17.28%) patients had stageâ…¢disease,1(1.23%) patient had stageâ…£disease. All pathology specimens have been reviewed by two experienced pathologic doctors. The inclusion criteria were as follows:(1)All patients must have received their initial treatments in Qilu Hospital of Shandong University; (2)Before the surgery, none received the chemotherapy, radiation therapy or hormone therapy; (3)The pathology specimens of the patients must have been reviewed again and showed malignant sex cord stromal tumors of the ovary, including adult type granulosa cell tumor, juvenile type granulosa cell tumor, malignant thecoma, G2 or G3 of Sertoli-Leydig tumor, malignant steroid cell tumor, sex cord tumor with annular tubules and other mixed sex cord stromal tumors. Patients were excluded if they had an additional non-stromal malignant tumor. We use SPSS 17.0 to analyze the high risk factors affecting the lymph node metastasis with Fisher Exact Probability.Results:(1) The patients of the malignant sex cord stromal tumors of the ovary are middle-aged in dominant. The median age was 47 years old (mean 44.47 years old, range 2-82 years old). The clinical manifestations were associated with the elevated serum steroid hormone such as estrogen, androgen and so on. The tumors mostly occurred in one-side ovary,and appeared in cystic-solid and solid.Part of patients appeared elevates CA125,but there was no conspicuous specificity(2)Post-operation 51 endometium. specimens were collected.They appeared different degrees of proliferation,and mostly were simple proliferation and complex proliferation.30 patients underwent pelvic lymphadenectomy and 14 patients also underwent paraaortic lymph node sampling.4 patients had lymph node metastasis and the total metastastic rate was 13.33%. Pelvic lymph node metastasis was demonstrated in 3 patients and the metastastic rate was 13.33%(4/30). At the same time, paraaortic lymph node metastasis was demonstrated in1 patient and the metastastic rate was 7.14%(1/14). Of the 4 patients with juvenile type granulosa cell tumor,l had pelvic lymph node metastasis(25%). Of the 16 patients with adult type granulose cell tumor,1 had pelvic lymph node metastasis(6.25%). Of the 9 patients with G2 or G3 of Sertoli-Leydig tumor,1 had pelvic lymph node metastasis and 1 had paraaortic lymph node metastasis(22.22%).(3)The univariate analysis showed that non-menopause, operation-pathologic staging above stage I, and the abrupted capsule were high risk factors affecting lymph node metastasis. The pathologic type and the diameter of tumor, cytology of the ascites and adhesion with other tissue or organ have no relationship with lymph node metastasis.Conclusion:The malignant sex cord stromal tumors of the ovary are rare. Most patients were stage I when they were treated. Usually patients presents clinical manifestations caused by elevated serum hormone. Non-menopause, operation-pathologic staging above stage I, and the abrupted capsule are high risk factors affecting lymph node metastasis. Both juvenile type granulosa cell tumor and G2 or G3 of Sertoli-Leydig tumor have high lymph node metastastic rate, so the surgical procedure must include lymphadenectomy or lymph node sampling. The lymph node metastastic rate of adult type granulosa cell tumor is fairly low, so only when those high risk factors exist, lymphadenectomy or lymph node sampling can be carried out. Lymphadenectomy can be omitted to prevent complications when there is no high risk factors. |
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