This group of tumors includes a variety of benign tumors and large group of malignant tumors. For some types of tumor the behavior is predicted not by the name but the high-grade features described by pathology. There are unique group because they often secrete hormones and may create other malignancy because of the excess hormones. Not uncommonly an endometrial cancer of the uterus will be created by the high hormone levels created by 1 of these ovarian tumors and in that situation two different cancers may be found at the same time. If they secrete male hormones then patients may experience unusual hair facial and chest hair growth, loss of scalp hair, unusual acne, and voice changes.
Blood levels of several tumor markers and hormones will be measured if a diagnosis is suspected or confirmed. Estradiol and testosterone are often secreted inappropriately and should be measured. Serum alpha-fetoprotein level (AFP), inhibin B levels, and CA 125 are useful tumor markers.
Granulosa cell malignancy originates from ovarian tissue. They represent less than 5% of all malignant ovarian tumors. They may occur after menopause as well as in adolescent girls. They may secrete unusual amounts of estrogen. That may cause vaginal bleeding and in very young person precocious development in early puberty can occur. That same estrogen may cause endometrial cancer or breast cancer to develop. These tumors can become very large and fill the abdomen. They have an unusual tendency to rupture and cause bleeding in the abdominal cavity. Surgical removal of the tumor is the foundation of therapy. The long-term behavior for these tumors is poorly predictable and very late recurrence is common and the pattern of spread is often very different than for typical ovarian cancer. Approximately two thirds of these tumors present as stage I disease confined to the ovary. The granulosa cell malignancy can present with advanced disease involving the abdomen and be associated with very fast spread and continued growth. This type of tumor can be treated with chemotherapy.
Sertoli- Leydig cell tumor is rare and the majority occur in women under age 30. Occasionally they occur after menopause. This tumor is associated with over production of male hormones. The majority of these tumors present as stage I disease. A high-grade tumor of this type can behave as a malignancy. Sertoli-Leydig cell tumor may occasionally secrete alpha-fetoprotein and therefore may make a germ cell tumor.
Advanced disease for malignant stromal tumor would often include chemotherapy. Recipe is often used for germ cell tumors are effective as are regimens commonly used for typical epithelial ovarian cancer. Bevacizumab is a biologic agent active on the blood vessels of the tumor with known treatment benefit for this disease. Hormone therapy can also be of benefit.