{"id":1145,"date":"2016-12-05T23:07:50","date_gmt":"2016-12-05T22:07:50","guid":{"rendered":"http:\/\/www.newslab.sk\/2016\/12\/05\/maligny-steroid-cell-tumor-vajecnika\/"},"modified":"2017-10-04T08:32:12","modified_gmt":"2017-10-04T06:32:12","slug":"malignant-cell-steroid-ovarian-tumors","status":"publish","type":"post","link":"https:\/\/www.newslab.sk\/en\/malignant-cell-steroid-ovarian-tumors\/","title":{"rendered":"Malignant cell steroid ovarian tumors"},"content":{"rendered":"
*All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf <\/span><\/strong>\r\n attachment at the end of the paper. <\/span><\/strong><\/pre>\n
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\u00davod<\/strong><\/p>\n
Steroid cell tumory ov\u00e1ri\u00ed patria do skupiny sex cord strom\u00e1lnych tumorov. S\u00fa tvoren\u00e9 bunkami produkuj\u00facimi steroidn\u00e9 horm\u00f3ny, podobn\u00e9 lute\u00ednnym, Leydigov\u00fdm bunk\u00e1m alebo bunk\u00e1m k\u00f4ry nadobli\u010dky. N\u00e1zov steroid cell tumory sa pou\u017e\u00edva od roku 1979, kedy ich zo skupiny p\u00f4vodn\u00fdch lipoid cell tumorov vy\u010dlenil Scully [1]. N\u00e1dory z\u00a0t\u00fdchto buniek s\u00fa relat\u00edvne zriedkav\u00e9 a\u00a0tvoria asi 0,1% v\u0161etk\u00fdch n\u00e1dorov ov\u00e1ria. Rozde\u013eujeme ich na z\u00e1klade ich p\u00f4vodu do dvoch podtypov, patriacich do skupiny lute\u00ednnych alebo Leydigov\u00fdch buniek. Tretiu, najv\u00e4\u010d\u0161iu skupinu tvoria n\u00e1dory kde p\u00f4vod nie je mo\u017en\u00e9 jednozna\u010dne identifikova\u0165 (tab. 1) a\u00a0predstavuj\u00fa asi 60% v\u0161etk\u00fdch steroid cell tumorov ov\u00e1ria [2].<\/p>\n
Sekr\u00e9cia r\u00f4znych steroidn\u00fdch horm\u00f3nov vedie ku charakteristick\u00fdm klinick\u00fdm prejavom. Naj\u010dastej\u0161ie pozorovan\u00e1 produkcia androg\u00e9nov sp\u00f4sobuje viriliz\u00e1ciu a\u00a0hirsutizmus [3, 4]. Produkcia estrog\u00e9nov sa podie\u013ea na vzniku postmenopauz\u00e1lneho krv\u00e1cania, ktor\u00e9 m\u00f4\u017ee by\u0165 jedin\u00fdm prejavom n\u00e1doru u\u00a0star\u0161\u00edch \u017eien [5], m\u00f4\u017ee ale vies\u0165 aj k\u00a0vzniku pred\u010dasn\u00e9ho vagin\u00e1lneho krv\u00e1cania a\u00a0galaktorey u\u00a0det\u00ed [6]. Zriedkavej\u0161ia je hyperkortizol\u00e9mia, ktor\u00e1 sp\u00f4sobuje vznik Cushingovho syndr\u00f3mu [7]. N\u00e1dory m\u00f4\u017eu imitova\u0165 alebo sa vyskytn\u00fa\u0165 s\u00fa\u010dasne s kongenit\u00e1lnou adren\u00e1lnou hyperpl\u00e1ziou v\u00a0mlad\u0161\u00edch vekov\u00fdch skupin\u00e1ch, \u010do m\u00f4\u017ee vies\u0165 k\u00a0nespr\u00e1vnemu diagnostikovaniu pacientky [8]. K \u010dast\u00fdm klinick\u00fdch pr\u00edznakom patr\u00ed aj zv\u00e4\u010d\u0161enie a bolesti brucha. \u010cas\u0165 n\u00e1dorov v\u0161ak m\u00f4\u017ee by\u0165 aj klinicky nem\u00e1, bez vzniku jednozna\u010dn\u00fdch pr\u00edznakov. Asi 25% n\u00e1dorov nevykazuje zv\u00fd\u0161en\u00fa hormon\u00e1lnu produkciu [2, 4, 9, 10].<\/p>\n
Vekov\u00fd v\u00fdskyt steroid cell tumorov je ve\u013emi \u0161irok\u00fd, boli pozorovan\u00e9 u\u00a0pacientiek vo veku od 2 do 80 rokov (priemern\u00fd vek v\u00fdskytu je 43 rokov). Spravidla s\u00fa unilater\u00e1lne (v 6% m\u00f4\u017eu by\u0165 bilater\u00e1lne). Lie\u010dba je preva\u017ene chirurgick\u00e1 [2, 9].<\/p>\n
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Case report<\/strong><\/h3>\n
Materi\u00e1l a\u00a0met\u00f3dy<\/strong><\/p>\n
Opisujeme v bioptickej praxi pomerne vz\u00e1cny typ n\u00e1doru u 59 ro\u010dnej \u017eeny vypl\u0148uj\u00faci oblas\u0165 malej panvy. U pacientky bola pred piatimi rokmi vykonan\u00e1 hysterekt\u00f3mia s obojstrannou adnexekt\u00f3miou. Indik\u00e1cia oper\u00e1cie ako i zisten\u00e9 histopatologick\u00e9 n\u00e1lezy sa nepodarilo zisti\u0165. V\u00a0s\u00fa\u010dasnosti sme dostali k vy\u0161etreniu vzorky n\u00e1doru, ktor\u00fd n\u00e1sledne generalizoval a pacientka zomrela.<\/p>\n
K histologick\u00e9mu vy\u0161etreniu sme dostali v \u0161iestich n\u00e1dob\u00e1ch ulo\u017een\u00e9 \u010dasti n\u00e1doru (najv\u00e4\u010d\u0161ia mala rozmery 24x15x15 cm, ostatn\u00e9 fragmenty mali najv\u00e4\u010d\u0161\u00ed rozmer 2 a\u017e 3 cm). Vzorky boli fixovan\u00e9 vo 4% formaldehyde. N\u00e1dorov\u00e9 tkanivo malo sol\u00eddnu makro\u0161trukt\u00faru, \u0161edo\u017elt\u00fa miestami hned\u00fa farbu s lo\u017eiskami zakrv\u00e1cania.<\/p>\n
Tkanivo bolo spracovan\u00e9 \u0161tandardn\u00fdm sp\u00f4sobom, po zafixovan\u00ed boli vzorky zaliate do paraf\u00ednov\u00fdch blo\u010dkov,\u00a0narezan\u00e9 na 3mm hrub\u00e9 rezy a ofarben\u00e9 hematoxyl\u00ednom-eoz\u00ednom a\u00a0farben\u00edm retikul\u00ednov\u00fdch vl\u00e1kien pod\u013ea Gomoriho. \u010cas\u0165 prepar\u00e1tov bola rutinne spracovan\u00e1 pre imunohistoch\u00e9miu; 3mm hrub\u00e9 rezy boli deparafinizovan\u00e9, rehydratovan\u00e9 vo fosf\u00e1tmi pufrovanom fyziologickom roztoku a inkubovan\u00e9 s protil\u00e1tkami na d\u00f4kaz cytokerat\u00ednov CKAE1\/3, CK8\/18, CK7 a CK20, viment\u00ednu, alfa-inhib\u00ednu, EMA, kalretin\u00ednu, melan A, HMB45, CD99, S-100 proteinu, CD10, WT-1, chromogran\u00ednu A, NSE, AFP, PLAP a CD117. Rezy boli n\u00e1sledne inkubovan\u00e9 so sekund\u00e1rnou protil\u00e1tkou Envision, polym\u00e9rom anti-mouse anti-rabit konjugovan\u00fdm s\u00a0HRP a vizualizovan\u00e9 prostredn\u00edctvom DAB. V\u0161etky chemik\u00e1lie poch\u00e1dzali od v\u00fdrobcu DAKO (Glostrup, Denmark). Farbenia boli zrelizovan\u00e9 na imunoanalyz\u00e1tore BenchMark ULTRA VENTANA pod\u013ea v\u00fdrobcom predp\u00edsan\u00e9ho protokolu.<\/p>\n
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V\u00fdsledky<\/strong><\/p>\n
V \u0161tandardnom farben\u00ed hematoxyl\u00ednom-eoz\u00ednom nach\u00e1dzame stredne ve\u013ek\u00e9 a ve\u013ek\u00e9 okr\u00fahle alebo polygon\u00e1lne n\u00e1dorov\u00e9 bunky s eozinofilnou jemne granulovanou cytoplazmou, fok\u00e1lne so svetl\u00fdmi intracytoplazmatick\u00fdmi vakuolami a so zrete\u013enou kont\u00farou cytoplazmovej membr\u00e1ny. Jadr\u00e1 s\u00fa ulo\u017een\u00e9 centr\u00e1lne, vykazuj\u00fa stredn\u00fd a\u017e \u0165a\u017ek\u00fd stupe\u0148 pleomorfie, maj\u00fa n\u00e1padne zv\u00e4\u010d\u0161en\u00e9 jadierko, miestami s\u00fa zachyten\u00e9 jadrov\u00e9 pseudoinkl\u00fazie. Pr\u00edtomn\u00e9 s\u00fa po\u010detn\u00e9 mit\u00f3zy. Reinkeho kry\u0161t\u00e1ly nie s\u00fa zachyten\u00e9 v\u00a0\u017eiadnej hodnotenej vzorke. Bunky s\u00fa usporiadan\u00e9 do dif\u00fazne rast\u00facich \u0161trukt\u00far, hniezd a povrazcov. Retikul\u00ednov\u00e9 vl\u00e1kna obklopuj\u00fa ka\u017ed\u00fa bunku. Str\u00f3ma n\u00e1doru je pomerne chudobn\u00e1, fibr\u00f3zna, miestami edemat\u00f3zne presiaknut\u00e1. Ku kompletnosti extirp\u00e1cie n\u00e1doru sa z dan\u00e9ho materei\u00e1lu vzh\u013eadom na fragmenty nedalo jednozna\u010dne vyjadri\u0165.<\/p>\n
N\u00e1dorov\u00e9 bunky vykazuj\u00fa imunohistochemick\u00fa pozitivitu na alfa-inhib\u00edn, kalretin\u00edn, CKAE1\/3, viment\u00edn, CD99 a melan A. Imunohistochemicky s\u00fa negat\u00edvne na CEA, EMA, CK8\/18, CK7, CK20, CD10, chromogranin A, NSE, WT-1, S-100, AFP, hepatocyte, HMB45, CD117 a PLAP.<\/p>\n
Makro a\u00a0mikroskopick\u00fd obraz a\u00a0imunohistochemick\u00fd profil zodpoved\u00e1 mal\u00edgnemu steroid cell tumoru vyrastaj\u00faceho z vaje\u010dn\u00edka, pravdepodobne ponechan\u00e9ho v tele pacientky pri predch\u00e1dzaj\u00facej oper\u00e1cii.<\/p>\n
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Diskusia<\/strong><\/p>\n
Ovari\u00e1lne steroid cell tumory s\u00fa relat\u00edvne zriedkav\u00e9 tumory patriace do skupiny sex-cord strom\u00e1lnych tumorov. N\u00e1dory s\u00fa typick\u00e9 preva\u017ene pomal\u00fdm rastom a\u00a0ben\u00edgnym spr\u00e1van\u00edm sa. Do popredia probl\u00e9mov pacienta vystupuj\u00fa najm\u00e4 klinick\u00e9 prejavy s\u00favisiace s\u00a0dlhodobou hormon\u00e1lnou dysbalanciou. Vzh\u013eadom na n\u00edzku \u0161pecifickos\u0165 t\u00fdchto prejavov ale m\u00f4\u017eu \u010dasto zosta\u0165 nepozorovan\u00e9 [11]. Na rozdiel od preva\u017ene ben\u00edgneho spr\u00e1vania sa strom\u00e1lneho lute\u00f3mu a\u00a0Leydig cell tumorov, vykazuj\u00fa steroid cell tumory ov\u00e1ri\u00ed NOS hor\u0161iu progn\u00f3zu [3].<\/p>\n
Hayes a\u00a0spol. analyzovali v\u00a0prospekt\u00edvnej \u0161t\u00fadii celkov\u00fd mal\u00edgny potenci\u00e1l t\u00fdchto n\u00e1dorov. Ako pravdepodobne ben\u00edgne opisuj\u00fa tie tumory, ktor\u00e9 nevykazuj\u00fa zn\u00e1mky \u0161\u00edrenia sa do okolia v\u00a0priebehu minim\u00e1lne 3 rokov od oper\u00e1cie. Autori pozorovali mal\u00edgne spr\u00e1vanie sa n\u00e1dorov u\u00a018 z\u00a050 pacientov. Z\u00a0histopatologick\u00fdch n\u00e1lezov korelovala s mal\u00edgnym spr\u00e1van\u00edm sa n\u00e1doru najlep\u0161ie pr\u00edtomnos\u0165 2 a\u00a0viac mitotick\u00fdch fig\u00far na 10 HRF, pr\u00edtomnos\u0165 nekr\u00f3z v\u00a0hodnotenom prepar\u00e1te, rozmery n\u00e1doru v\u00e4\u010d\u0161ie ako 7 cm, krv\u00e1canie a\u00a0v\u00fdrazn\u00e9 jadrov\u00e9 atypie (tab 2). Okrem zachytenia\u00a0 nekr\u00f3z boli v\u0161etky tieto krit\u00e9ri\u00e1 splnen\u00e9 aj v\u00a0nami opisovanom pr\u00edpade [9].<\/p>\n
N\u00e1dory s\u00fa mikroskopicky tvoren\u00e9 dvomi typmi buniek s\u00a0prekr\u00fdvaj\u00facimi sa \u010drtami. Nach\u00e1dzame bunky s\u00a0bohatou eozinofilnou cytoplazmou resp. bunky s\u00a0jemne vakuol\u00e1rnou cytoplazmou [9]. Steroid cell tumory je potrebn\u00e9 odl\u00ed\u0161i\u0165 o\u00a0in\u00fdch oxyfiln\u00fdch a\u00a0svetlobunkov\u00fdch n\u00e1dorov ov\u00e1ria. Diferenci\u00e1lne diagnosticky treba vyl\u00fa\u010di\u0165 najm\u00e4 luteinizovan\u00fd thek\u00f3m, jasnobunkov\u00fd karcin\u00f3m (clear cell carcinoma), hepatoidn\u00fd karcin\u00f3m, adrenokortik\u00e1lny karcin\u00f3m, hepatoidn\u00fd yolk sack tumor, n\u00e1dor z\u00a0Leydigov\u00fdch buniek, lipid-rich Sertoli cell tumor, extenz\u00edvne luteinizovan\u00fd granulosa cell tumor, strom\u00e1lny lute\u00f3m, metastatick\u00fd karcin\u00f3m z\u00a0ren\u00e1lnych buniek a oxyfiln\u00fd endometrioidn\u00fd karcin\u00f3m [2, 11].<\/p>\n
V\u00fdrazn\u00e1 pozitivita kalretin\u00ednu a\u00a0alfa inhib\u00ednu, zisten\u00e1 aj v\u00a0na\u0161om pr\u00edpade, je typick\u00fdm n\u00e1lezom pozorovan\u00fdm vo viacer\u00fdch \u0161t\u00fadi\u00e1ch [11, 12]. Nami zisten\u00e1 expresia CD99 je v\u00a0s\u00falade s\u00a0pozorovan\u00edm Jones a\u00a0spol. [12], aj ke\u010f in\u00e9 \u0161t\u00fadie preuk\u00e1zali, \u017ee expresia nemus\u00ed by\u0165 kon\u0161tantn\u00e1 a\u00a0 nie v\u0161etky hodnoten\u00e9 n\u00e1dory s\u00fa pozit\u00edvne pri farben\u00ed touto protil\u00e1tkou [11]. N\u00e1dory \u010dasto exprimuj\u00fa melan A (86%), viment\u00edn (75%) a androg\u00e9nov\u00fd receptor (64%). Expresia cytokerat\u00ednov je zriedkavej\u0161ia; Cam 5.2 je opisovan\u00fd v 46%, AE1\/3 v 36-37%, EMA je preva\u017ene negat\u00edvna, aj ke\u010f v\u00a0niektor\u00fdch pr\u00edpadoch bola op\u00edsan\u00e1 fok\u00e1lna EMA pozitivita [5, 11-14]. V\u00fdsledky s\u00fa v\u00a0s\u00falade s\u00a0na\u0161im pozorovan\u00edm.<\/p>\n
Aj ke\u010f v\u00a0s\u00fa\u010dasnosti pou\u017e\u00edvan\u00e1 klasifik\u00e1cia rozde\u013euje n\u00e1dory na z\u00e1klade ich p\u00f4vodu k\u00a0lute\u00ednnym resp. Leydigov\u00fdm bunk\u00e1m, samotn\u00fd p\u00f4vod n\u00e1dorov\u00fdch buniek nie je \u00faplne jasn\u00fd. Molekul\u00e1rno-genetick\u00e9 anal\u00fdzy preuk\u00e1zali v\u00a0n\u00e1doroch pr\u00edtomnos\u0165 mRNA pre steroidog\u00e9nne p450c11 a\u00a0p450c2, \u010do nazna\u010duje mo\u017enos\u0165 mo\u017enos\u0165 ich p\u00f4vodu z\u00a0adren\u00e1lnych zvy\u0161kov [15]. Aj ke\u010f t\u00e1to hypot\u00e9za nie je v\u0161eobecne prij\u00edman\u00e1, zodpovedala by existencii testikul\u00e1rnych n\u00e1dorov z\u00a0adren\u00e1lnych zvy\u0161kov (TART, testicular adrenal rest tumor) u\u00a0mu\u017eov [16-18]. Dispropor\u010dn\u00fd v\u00fdskyt n\u00e1dorov z\u00a0adren\u00e1lnych zvy\u0161kov v\u00a0z\u00e1vislosti od pohlavia m\u00f4\u017ee podporova\u0165 t\u00fato hypot\u00e9zu a\u00a0vy\u017eiada si \u010fal\u0161\u00ed v\u00fdskum a\u00a0objasnenie t\u00fdchto n\u00e1lezov v\u00a0bud\u00facnosti.<\/p>\n
Steroid cell tumory patria medzi zriedkav\u00e9 sex-cord strom\u00e1lne tumory ov\u00e1ria. Pr\u00e1ve ich hormon\u00e1lna produkcia ved\u00faca u\u00a0pacientov k\u00a0prejavom hormon\u00e1lnej dysbalancie, m\u00f4\u017ee by\u0165 rozhoduj\u00faca pre stanovenie spr\u00e1vnej diagn\u00f3zy. Detailn\u00e9 histologick\u00e9 spracovanie a\u00a0imunohistochemick\u00e9 hodnotenie s\u00fa\u010dasne s\u00a0pos\u00faden\u00edm klinick\u00fdch prejavov tumoru je k\u013e\u00fa\u010dov\u00e9 pre stanovenie stup\u0148a malignity a\u00a0odl\u00ed\u0161enie n\u00e1doru od in\u00fdch histopatologick\u00fdch jednotiek a\u00a0m\u00e1 v\u00fdznam pri stanoven\u00ed spr\u00e1vneho terapeutick\u00e9ho postupu.<\/p>\n
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Pou\u017eit\u00e1 literat\u00fara<\/strong><\/p>\n
    \n
  1. Scully, R.E., Tumors of the ovary and maldeveloped gonads.<\/em>, in Atlas of Tumor Pathology.<\/em>, Hartmann, W.H. and Cowan, W.R., Editors. 1979, Armed Forces Institute of Pathology: Washington, DC, USA. p. 215\u2013220.<\/li>\n
  2. Young, R.H., Steroid cell tumors.<\/em>, in Blaustein’s Pathology of the Female Genital Tract. Sixth Edition.<\/em>, Kurman, R.J., Ellenson, L.H., and Ronnett, B.M., Editors. 2011, Springer: New York. p. 826-832.<\/li>\n
  3. Tai, Y.J., Chang, W.C., Kuo, K.T., and Sheu, B.C., Ovarian steroid cell tumor, not otherwise specified, with virilization symptoms.<\/em> Taiwan J Obstet Gynecol, 2014. 53<\/strong>(2): p. 260-2.<\/li>\n
  4. Mizoguchi, M., Minami, S., Yamamoto, M., Tanizaki, Y., Kobayashi, A., and Ino, K., Ovarian steroid cell tumor, not otherwise specified, producing testosterone.<\/em> J Obstet Gynaecol Res, 2014. 40<\/strong>(9): p. 2081-5.<\/li>\n
  5. Wan, J., Chen, X., and Li, X., Ovarian steroid cell tumor, not otherwise specified: A rare case of postmenopausal vaginal bleeding.<\/em> Oncol Lett, 2014. 8<\/strong>(3): p. 1187-1189.<\/li>\n
  6. Ashraf, A., Abdul-Latif, H., Hardin, W., and Kelly, D.B., Vaginal bleeding and galactorrhea in a child with ovarian steroid cell tumor.<\/em> Endocr Pract, 2005. 11<\/strong>(5): p. 346-9.<\/li>\n
  7. Sworczak, K., Blaut, K., Malecha, M., and Lewczuk, A., Ectopic ACTH syndrome associated with ovarian steroid-cell tumor.<\/em> J Endocrinol Invest, 2002. 25<\/strong>(4): p. 369-72.<\/li>\n
  8. Yilmaz-Agladioglu, S., Savas-Erdeve, S., Boduroglu, E., Onder, A., Karaman, I., Cetinkaya, S., and Aycan, Z., A girl with steroid cell ovarian tumor misdiagnosed as non-classical congenital adrenal hyperplasia.<\/em> Turk J Pediatr, 2013. 55<\/strong>(4): p. 443-6.<\/li>\n
  9. Hayes, M.C. and Scully, R.E., Ovarian steroid cell tumors (not otherwise specified). A clinicopathological analysis of 63 cases.<\/em> Am J Surg Pathol, 1987. 11<\/strong>(11): p. 835-45.<\/li>\n
  10. Reedy, M.B., Richards, W.E., Ueland, F., Uy, K., Lee, E.Y., Bryant, C., and van Nagell, J.R., Jr., Ovarian steroid cell tumors, not otherwise specified: a case report and literature review.<\/em> Gynecol Oncol, 1999. 75<\/strong>(2): p. 293-7.<\/li>\n
  11. Haroon, S., Idrees, R., Fatima, S., Memon, A., and Kayani, N., Ovarian steroid cell tumor, not otherwise specified: A clinicopathological and immunohistochemical experience of 12 cases.<\/em> J Obstet Gynaecol Res, 2014.<\/li>\n
  12. Jones, M.W., Harri, R., Dabbs, D.J., and Carter, G.J., Immunohistochemical profile of steroid cell tumor of the ovary: a study of 14 cases and a review of the literature.<\/em> Int J Gynecol Pathol, 2010. 29<\/strong>(4): p. 315-20.<\/li>\n
  13. Seidman, J.D., Abbondanzo, S.L., and Bratthauer, G.L., Lipid cell (steroid cell) tumor of the ovary: immunophenotype with analysis of potential pitfall due to endogenous biotin-like activity.<\/em> Int J Gynecol Pathol, 1995. 14<\/strong>(4): p. 331-8.<\/li>\n
  14. Deavers, M.T., Malpica, A., Ordonez, N.G., and Silva, E.G., Ovarian steroid cell tumors: an immunohistochemical study including a comparison of calretinin with inhibin.<\/em> Int J Gynecol Pathol, 2003. 22<\/strong>(2): p. 162-7.<\/li>\n
  15. Lin, C.J., Jorge, A.A., Latronico, A.C., Marui, S., Fragoso, M.C., Martin, R.M., Carvalho, F.M., Arnhold, I.J., and Mendonca, B.B., Origin of an ovarian steroid cell tumor causing isosexual pseudoprecocious puberty demonstrated by the expression of adrenal steroidogenic enzymes and adrenocorticotropin receptor.<\/em> J Clin Endocrinol Metab, 2000. 85<\/strong>(3): p. 1211-4.<\/li>\n
  16. Zaarour, M.G., Atallah, D.M., Trak-Smayra, V.E., and Halaby, G.H., Bilateral ovary adrenal rest tumor in a congenital adrenal hyperplasia following adrenalectomy.<\/em> Endocr Pract, 2014. 20<\/strong>(4): p. e69-74.<\/li>\n
  17. Thomas, T.T., Ruscher, K.R., Mandavilli, S., Balarezo, F., and Finck, C.M., Ovarian steroid cell tumor, not otherwise specified, associated with congenital adrenal hyperplasia: rare tumors of an endocrine disease.<\/em> J Pediatr Surg, 2013. 48<\/strong>(6): p. E23-7.<\/li>\n
  18. Claahsen-van der Grinten, H.L., Otten, B.J., Takahashi, S., Meuleman, E.J., Hulsbergen-van de Kaa, C., Sweep, F.C., and Hermus, A.R., Testicular adrenal rest tumors in adult males with congenital adrenal hyperplasia: evaluation of pituitary-gonadal function before and after successful testis-sparing surgery in eight patients.<\/em> J Clin Endocrinol Metab, 2007. 92<\/strong>(2): p. 612-5.<\/li>\n<\/ol>\n
     <\/p>\n
    A. Skupina n\u00e1dorov z lute\u00ednnych buniek<\/p>\n
    (1) Strom\u00e1lny lute\u00f3m<\/p>\n
    B. Skupina n\u00e1dorov z Leydigov\u00fdch buniek<\/p>\n
    (1) Leydig cell tumor, ne-hil\u00f3zny typ<\/p>\n
    (2) Leydig cell tumor, hil\u00f3zny typ (hilus cell tumor)<\/p>\n
    C. Steroid cell tumory, NOS<\/p>\n
     <\/p>\n
    Tab. 1 Klasifik\u00e1cia steroid cell tumorov<\/p>\n\n\n\n\n\n\n\n
    2 a\u00a0viac mitotick\u00fdch fig\u00far na 10 HRF<\/td>\n92% mal\u00edgnych n\u00e1dorov<\/td>\n<\/tr>\n
    nekr\u00f3zy<\/td>\n86% mal\u00edgnych n\u00e1dorov<\/td>\n<\/tr>\n
    rozmer n\u00e1doru v\u00e4\u010d\u0161\u00ed ako 7 cm<\/td>\n78% mal\u00edgnych n\u00e1dorov<\/td>\n<\/tr>\n
    fok\u00e1lne krv\u00e1canie<\/td>\n77% mal\u00edgnych n\u00e1dorov<\/td>\n<\/tr>\n
    jadrov\u00e9 atypie grade II a III<\/td>\n64% mal\u00edgnych n\u00e1dorov<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n
     <\/p>\n
    Tab. 2 Znaky malignity steroid cell tumorov ov\u00e1ri\u00ed pod\u013ea Hayes a\u00a0Scully [9]<\/p>\n
     <\/p>\n
     <\/p>\n","protected":false},"excerpt":{"rendered":"
    *All tables, charts, graphs and pictures that are featured in this article can be found in the .pdf attachment at the end of the paper.   \u00davod Steroid cell tumory ov\u00e1ri\u00ed patria do skupiny sex cord strom\u00e1lnych tumorov. S\u00fa tvoren\u00e9 bunkami produkuj\u00facimi steroidn\u00e9 horm\u00f3ny, podobn\u00e9 lute\u00ednnym, Leydigov\u00fdm bunk\u00e1m alebo bunk\u00e1m k\u00f4ry nadobli\u010dky. N\u00e1zov steroid cell<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_mi_skip_tracking":false,"footnotes":""},"categories":[293],"tags":[745,746,747],"class_list":["post-1145","post","type-post","status-publish","format-standard","hentry","category-cytology","tag-ovary","tag-sex-cord-stromal-tumor","tag-steroid-cell-tumor","typ_clanku-review-article"],"acf":{"abstrakt":"
    Steroid cell tumors are a group of sex cord-stromal tumors, which arise from ovarian stroma. Specialized stroma of the genital ridge is derived from sex cords of the embryonal gonads (precursors of Sertoli cells, Leydig cells, granulosa and thecal cells) characterized by hormonal production; oestrogens are produced by thecal cells and androgens by Leydig cells. Steroid cell tumors are composed entirely of cells resembling steroids secreting cells: lutein, Leydig and adrenocortical cells. The hormonal production causes typical clinical symptoms, about half of patients (56-77%) present with androgenic symptoms, virilisation and hirsutism, about 6-23% with oestrogenic symptoms and postmenopausal bleeding. The cortisol secretion in 6-10% of tumors may cause Cushing syndrome. Steroid cell tumors are rare and account for <0.1% of all ovarian neoplasms. They occur at any age, from 2 to 80 years, with the average age of 42 years. Malignant steroid cell tumors are usually accompanied by increased mitotic activity (2 and more mitoses\/HPF), presence of necrosis, hemorrhages and nuclear atypia, the tumor average diameter is usually over 7 cm. Tumors are typically positive for inhibin and calretinin. The appropriate diagnosis should be established based on the correlation of clinical symptoms and detailed microscopical and immunohistochemical assessment.<\/p>\n
     <\/p>\n
    Key words:<\/strong> ovary, sex-cord stromal tumor, steroid cell tumor.<\/p>\n","casopis":[{"ID":1000,"post_author":"7","post_date":"2015-11-21 14:33:24","post_date_gmt":"2015-11-21 13:33:24","post_content":"
    GENETICS<\/strong><\/h4>\r\n
      \r\n \t
    • The laboratory age<\/li>\r\n \t
    • The Odyssey of DNA reading<\/li>\r\n \t
    • Comparative genomic hybridisation: a methodological introduction<\/li>\r\n \t
    • Next generation sequencing and its application in clinical genetics<\/li>\r\n<\/ul>\r\n
      <\/h4>\r\n
      BIOCHEMISTRY<\/strong><\/h4>\r\n
        \r\n \t
      • Determining of the trace elements in blood serum<\/li>\r\n \t
      • Determining of \u03b1-tocopherol (vitamin E) in serum by way of liquid chromatography with tandem mass spectrometry (LC\/MS\/MS)<\/li>\r\n \t
      • Analysis of urinary calculi and its path to Europe<\/li>\r\n<\/ul>\r\n \r\n
        IMMUNOLOGY <\/strong><\/h4>\r\n
          \r\n \t
        • New autoantibodies in diagnosis of autoimmunity myopathies<\/li>\r\n \t
        • Taking advantage of flow-based cytometry in determining prognostic markers<\/li>\r\n<\/ul>\r\nCD38 and ZAP-70 in patients with B-CLL\r\n\r\n \r\n
          CYTOLOGY AND PATHOLOGY <\/strong><\/h4>\r\n
            \r\n \t
          • Mucinous ovarian carcinoma \u2013 news in diagnosis from the pathologist\u2019s perspective<\/li>\r\n<\/ul>","post_title":"newsLab","post_excerpt":"","post_status":"publish","comment_status":"closed","ping_status":"closed","post_password":"","post_name":"newslab-12015","to_ping":"","pinged":"","post_modified":"2017-08-16 21:43:10","post_modified_gmt":"2017-08-16 19:43:10","post_content_filtered":"","post_parent":0,"guid":"http:\/\/www.newslab.sk\/casopis\/newslab-12015\/","menu_order":0,"post_type":"casopis","post_mime_type":"","comment_count":"0","filter":"raw"}],"strana":"51","upload_clanok":{"ID":1146,"id":1146,"title":"medirex_1_2015-veres","filename":"MEDIREX_1_2015-\u2013-Veres.pdf","filesize":216193,"url":"https:\/\/www.newslab.sk\/wp-content\/uploads\/2016\/12\/MEDIREX_1_2015-\u2013-Veres.pdf","link":"https:\/\/www.newslab.sk\/en\/malignant-cell-steroid-ovarian-tumors\/medirex_1_2015-veres\/","alt":"","author":"7","description":"","caption":"","name":"medirex_1_2015-veres","status":"inherit","uploaded_to":1145,"date":"2016-12-05 22:03:03","modified":"2016-12-05 22:03:03","menu_order":0,"mime_type":"application\/pdf","type":"application","subtype":"pdf","icon":"https:\/\/www.newslab.sk\/wp-includes\/images\/media\/document.png"}},"_links":{"self":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1145","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/users\/7"}],"replies":[{"embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/comments?post=1145"}],"version-history":[{"count":0,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/posts\/1145\/revisions"}],"wp:attachment":[{"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/media?parent=1145"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/categories?post=1145"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.newslab.sk\/en\/wp-json\/wp\/v2\/tags?post=1145"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}