Theca cell tumor

Theca cell tumor is a type of ovarian tumor that originates from the thecal cells of the ovary. These tumors are considered rare and can manifest in a range of clinical presentations, from asymptomatic masses to complex hormonal syndromes. Theca cell tumors are part of the group of sex cord-stromal tumors, which account for a minority of ovarian tumors but are significant for their potential to produce sex steroids, leading to various clinical symptoms.

Classification

Theca cell tumors are classified under sex cord-stromal tumors of the ovary. They can be purely thecomatous, or more commonly, they present as mixed forms, often in combination with fibromas, leading to the designation of thecofibroma. Pure theca cell tumors are less common and are characterized by their ability to secrete estrogen, which can lead to endocrine symptoms.

Symptoms

The clinical presentation of theca cell tumors can vary widely. In premenopausal women, the excess estrogen production can lead to symptoms of estrogen excess, such as abnormal uterine bleeding, endometrial hyperplasia, or even endometrial cancer. In postmenopausal women, the sudden onset of vaginal bleeding can be a sign of the tumor's presence. Additionally, theca cell tumors can cause hormonal imbalance, leading to symptoms such as hirsutism or virilization in more rare cases, depending on the tumor's ability to produce androgens.

Diagnosis

The diagnosis of a theca cell tumor involves a combination of clinical evaluation, imaging, and laboratory tests. Ultrasound is often the first imaging modality used to evaluate an ovarian mass, with theca cell tumors typically appearing as solid, hypoechoic lesions. Magnetic resonance imaging (MRI) can provide further characterization of the tumor. Laboratory tests may show elevated levels of estrogens, and in some cases, androgens. Definitive diagnosis is usually achieved through histopathological examination following surgical removal of the tumor.

Treatment

The primary treatment for theca cell tumors is surgical removal. The extent of surgery depends on the tumor's size, the presence of symptoms, and whether there is suspicion of malignancy. In younger patients desiring to preserve fertility, a unilateral oophorectomy may be sufficient. In postmenopausal women or cases where the tumor is suspected to be malignant, a more extensive surgery including hysterectomy and bilateral salpingo-oophorectomy may be recommended. Adjuvant therapy is not typically required, but in cases of malignant transformation, further treatment may be necessary.

Prognosis

The prognosis for women with theca cell tumors is generally excellent, as these tumors are most often benign and slow-growing. Malignant transformation is rare, but when it occurs, it can significantly impact prognosis. Early detection and treatment are key to a favorable outcome.

Epidemiology

Theca cell tumors are rare, accounting for a small percentage of all ovarian tumors. They can occur at any age but are most commonly diagnosed in postmenopausal women.