TECOMA

From Big Medical Encyclopedia

TECOMA (thecoma; lat. theca, Greek theke a cover + - oma; synonym: teka-cellular tumor, xanthomatous teka-cellular fibroma) — gormonalnoaktivny tumor of an ovary. As an independent nosological form T. E. Loffler and A. Priesel in 1932 allocated. According to the WHO classification of T. carry to tumors of a stroma of a sexual tyazh, to group a tic — fibromas.

Etiology and histogenesis T. are definitely not established. One researchers connect developing of these tumors with preservation in an ovary of the adult woman of an embryonal mesenchyma, others — with cells flow (covers) of a follicle. T meet. more rare than other hormonal and active tumors (see), especially granulocellular, ovary (see), however at women 50 years of a tumor of these types approximately with an identical frequency are more senior. Among the virilizing tumors of an ovary there is a T. are the most often met tumors after androblastomas.

Malignant T. meet seldom, on average in 4 — 5% of cases of tumors of ovaries.

T., generally have the expressed androgenic activity (see Androgens). End products of a hormonogenesis in a tumor most often are androstendion (see. 17 ketosteroids ) and testosterone (see), and T. develop them in so significant amounts that cause changes in the relevant bodies - and target tissues, bringing to virilescences (see).

T., as a rule, represents a benign unilateral tumor of an ovary without the capsule seen approximately, diameter of a tumor from 1 to 5 cm, seldom T. reach 25 — 30 cm. Consistence of T. dense and elastic, color grayish-pink or yellowish, cut surface smooth or melkobugristy. T. with the virilizing effect on a section mostly have okhryanozhelty color, quite often spotty. Dystrophic processes, especially in large tumors, lead to emergence of the smooth-bore cavities filled with serous or jellylike contents, sometimes with impurity of blood. In an ovary, in Krom the tumor is localized, cortical substance mostly remains, but there is in a condition of the expressed atrophy, especially its interstitial fabric. An opposite ovary gipoplastichen though sometimes note a focal hyperplasia of a stroma and (or) a thecomatosis.

The microscopic structure of a tumor is characterized by a considerable variety, a cut depends first of all on the size, a form and a functional condition of tumor cells, and also on a condition of a stroma of a tumor. At the same time for T. two main types of cellular elements are characteristic: epithelioid and spindle-shaped. Variety of T. is explained, generally by a ratio of cells of these types and existence of a large number of transitional forms between them. Histologically distinguish also two main types T., tumors of one of them are formed by the epithelial cells similar to cells internal flow (covers) of follicles (theca interna folliculi), tumors of other type are formed by the spindle-shaped cells giving them looking alike fibroma of an ovary. From fibromas such T. differ first of all in the ability to synthesize sex steroid hormones (see), besides, cells of a ggarenkhima of T. in most cases contain in cytoplasm lipidic inclusions, preferential free or etherified a holester Ying (see), and each cell of a parenchyma of T., unlike cells of fibromas, it is surrounded are Gere about f with ilny fibers (see). Tumors of this type are formed by the intertwining bunches of spindle-shaped cells without clear cellular boundary with rather big, extended, intensively painted kernels, the gentle chromatinic network and accurately distinguishable kernels can be sometimes visible. The stroma of a tumor is presented by friable connecting fabric, sometimes note fibrosis and a hyalinosis of a stroma. Capillary network of such T. it is well developed, but at ordinary microscopic examination it is not evident. Tumors of the second type often contain this or that quantity of the epithelial cells which are located generally on the periphery in the form of nests or tyazhy.

Mikropreparat of a tecoma of epithelioid and cellular type: 1 — epithelial cells of a rounded and polygonal shape; 2 — connective tissue layers; 3 — capillaries; coloring hematoxylin-eosine; X 4 00.

Epithelioid component in both types T. it is presented by the big rounded polygonal cells creating tyazh, fields and nests divided by connective tissue layers with a large number of capillaries (fig). Cellular borders are well distinguishable, cytoplasm plentiful, oxyphilic, fine-grained with different quantity of vacuoles, various by the size. Vacuolation of cytoplasm of these cells is caused by dissolution of lipidic inclusions in the course of histologic processing of fabric. Kernels of epithelial cells mostly roundish, rather big, it is frequent with accurately distinguishable kernels. Localization of kernels and their structure quite often depend on quantity of lipids in cytoplasm: the more the number of lipidsoderzhashchy inclusions in cytoplasm, the closer to the periphery of a cell is located a kernel and the less it by the size more densely on a consistence. In epithelial tumor cells very high activity 3β-гидрокси-Δ5-стероид — dehydrogenases (KF 1.1.1.145), glyukozo-6-phosphate — dehydrogenases (KF 1.1.1.49), OVER - and NADF-tetrazoly-reduktazy and other enzymes is found that reflects high functional activity of these cells. Observe a certain dependence between activity of enzymes of a steroidogenesis and the maintenance of lipids in a cell: the more in cytoplasm, especially esterified cholesterol, the activity of these enzymes is lower than lipidic inclusions, and, on the contrary, the less maintenance of lipids, the is higher activity of enzymes of a steroidogenesis. For ultrastructure of cells of a parenchyma of T. existence of the large number of mitochondrions which is well developed Golgi's complex and a variety of lipidic inclusions is characteristic.

For malignant T. the phenomena of cellular and nuclear polymorphism, atypical figures of a mitosis are histologically characteristic (see) and phenomena of destruiruyushchy growth.

On clinical manifestations distinguish the feminizing and virilizing options a tic. Arise a tecoma at any age though tecoma with feminizing effect observe at women in the postclimacteric period more often. The Virilny syndrome is the leader in a wedge, manifestations of T., formed by epithelial cells. T., formed by preferential spindle-shaped cells, most often are followed by the phenomena of a giperestrogenization though in the blood flowing from an ovary with T., and in the tumor find large numbers of androgens, especially androstendion. High concentration of estrogen (see) in peripheral blood at such patients, as defines feminizing effect of a tumor, it is caused, most likely, by aromatization of androstendion of a tumoral origin on the periphery. T. are quite often combined with granulocellular tumors of ovaries, forming in these cases of a tumor of complex structure. The virilizing effect of tumors such is caused by presence at them of a teka-cellular component.

Feminizing options T. at children lead to premature puberty. The most frequent clinical symptom at patients in a climacteric (see) and the postclimacteric period is the menorrhagia (see. Uterine bleedings). At women at reproductive age the menstrual cycle is broken (see), the secondary amenorrhea (see) which is quite often replaced by uterine bleedings develops. These phenomena are observed at various options of a hyperplasia of an endometria, sometimes at a hysteromyoma and is rare — at endometrial cancer (see the Uterus).

Very seldom T. are clinically shown by the expressed virilny syndrome (the virilizing option T.), development to-rogo begins with the phenomena of defenemination: periods stop, there comes infertility, a hypotrophy of mammary glands, pilosis on a face and a body on men's type appears, the clitoris hypertrophies, the voice becomes rough. In plasma of peripheral blood, as well as in the blood flowing from an ovary on the party of a tumor note sharp increase in content of testosterone.

Preliminary diagnosis of T. put on the basis of existence virilno-go a syndrome or a wedge, pictures of a giperestrogenization and data of a laboratory research, first of all the increased concentration of testosterone, androstendion and estrogen in a blood plasma. For specification of a source it is excessive the formed sex hormones (see) apply test with oppression of function of cortical substance of adrenal glands dexamethasone (see. Dexamethasonal test) and stimulations on this background of function of ovaries a chorionic gonadotrophin of the person (see. Chorionic gonadotrophin ). For topical diagnosis conduct X-ray inspection of bodies of a small pelvis: a pnevmopelviorentgenografiya or a pelvic angiography (see).

To differentiate T. it is necessary with fibroma, tumors of cortical substance of adrenal glands (see), other virilizing and feminizing tumors of ovaries, and also with a thecomatosis of ovaries. In establishment of the diagnosis the histologic research of a remote tumor is decisive.

Treatment operational. Operation shall be sparing, especially at children and at women at reproductive age: delete a tumor, keeping, whenever possible, not changed ovarian fabric. The oncotomy is followed by disappearance of all a wedge, displays of a disease. Only girls with premature puberty quite often remain undersized.

Forecast, as a rule, favorable. Even at malignant T. timely performed operation gives a favorable outcome; a recurrence and metastasises arise seldom.

See also Ovaries, tumors .


Bibliography: Bronstein M. E. The virilizing granulocellular tumors of ovaries, Probl. endocrinins., t. 24, No. 3, page 49, 1978; Glazunov M. F. Tumors of ovaries, page 216, D., 1961; Пато^ logoanatomichesky diagnosis of tumors of the person, under the editorship of N. A. Krayevsky, etc., page 286, M., 1982; Serov S. F., Scully R. E. and With about and N of JI. G. Histologic classification of tumors of ovaries, the lane with English, Geneva, WHO, 1977; Ultrastructure of tumors of the person, the Management for diagnosis, under the editorship of H. T. Raykhli-na, etc., page 260, M., 1981; L about f f 1 e r E. u. Priesel A. Bindgewebige Gewachse des Eierstockes von besonderer Bauart (Fibroma thecocellulare xanthomatodes ovarii), Beitr. path. Anat., Bd 90, S. 199, 1932; Morris J. Scully R. E. Endocrine pathology of the ovary, St Louis, 1958; Norris H. J. a. With h about r 1-t o n I.C. Functioning tumors of the ovary, Clin. Obstet. Gynec., v. 17, p. 189, 1974, bibliogr.; Pathology of the female genital tract, ed. by A. Blaustein, p. 521, N. Y., 1977; Scully R. E. Ovarian tumors, Amer. J. Path., v. 87, p. 686, 1977, bibliogr.


M. E. Bronstein.

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