Fundamento De Papanicolau

International Journal of Gynecological Pathology 25:199 – 215, Lippincott Williams & Wilkins, Baltimore Ó 2006 International Society of Gynecological Pathologists

Review

Recent Advances in the Pathology and Classification of Ovarian Sex CordYStromal Tumors
Lawrence M. Roth, M.D.

Summary: In recent years, our knowledge of ovarian sex cordYstromal tumors has increased, and theirclassification has evolved. In this review, recent advances in the classification and pathology of ovarian sex cordYstromal tumors are discussed, and the controversy regarding the classification of sex cord tumor with annular tubules is addressed. The current classification is built on those of the past, and future classifications should improve on what is now in place incorporating new knowledge frommore sophisticated clinicopathologic studies and advanced molecular techniques. This review emphasizes articles written in the 21st century as well as those that have significantly advanced our knowledge of sex cordYstromal tumors in past decades. The tumors in this group occur over a wide age range and are often unilateral. In difficult cases, immunocytochemistry provides improved diagnosticaccuracy. The most useful immunohistochemical marker for their identification is >-inhibin, which is positive in most neoplasms in the sex cordYstromal group. The article concludes with a section discussing the pathogenesis of sex cordYstromal tumors. Key Words: Granulosa cell tumor—Theca cell tumor—Sertoli-Leydig cell tumor—Sertoli cell tumor—Sex cord tumor with annular tubules—Steroid celltumor—Leydig cell tumor.

Sex cordYstromal tumors of the ovary occur over a wide age range, with individual tumors occurring in different age groups. Because patients are often young and most tumors are unilateral, accurate diagnosis is necessary for proper treatment and maintenance of fertility, where desirable. In contrast to germ cell tumors, the advent of combination chemotherapy has only modestlyimproved the prognosis. This review is dedicated to Dr. Robert E. Scully, whose efforts were instrumental in the development of the first two World Health Organization (WHO) classifications of ovarian tumors (1,2) and whose advice was essential to the development of the latest classification (3). Many of the advances in this group of tumors are the result of his work and that of his colleagues. Fora more detailed description

From the Department of Pathology, Indiana University School of Medicine, Indianapolis, Indiana. Address correspondence and reprint requests to Lawrence M. Roth, MD, Department of Pathology, Indiana University Hospital, Room 3465, 550 North University Boulevard, Indianapolis, IN 46202-5280. E-mail: lroth@iupui.edu

of the development of the earlier WHOclassifications, one should refer to the recent article on the history of the pathology of the gonads by Young (4). At this point it seems appropriate to review the requirements for an optimal classification. It is expected that classifications will evolve and improve. Proposed changes should not be interpreted as criticism of prior classifications; rather, they should reflect contemporary thinking thatsynthesizes all known information, past and present. Accuracy of terminology is important. It is not enough that pathologists knowledgeable in the field know the meaning of the terms used. The name of the tumor or condition should reflect its biological behavior as accurately as possible. Misleading terms and scientific jargon should be avoided because clinicians may be influenced in their choice oftherapy by the terminology used and lay people may not readily grasp the implications of the diagnosis. Related tumors should be grouped together to allow for better comprehension of their similarities and differences. The classification of a tumor in more than one category should be avoided wherever 199
DOI: 10.1097/01.pgp.0000192271.22289.e6

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