Estrogen-producing endometrioid adenocarcinoma resembling sex cord-stromal tumor of the ovary: a review of four postmenopausal cases

In summary, postmenopausal ovarian solid tumors with the estrogenic manifestations tend to be preoperatively diagnosed as SCST. Due to this, in the histological diagnosis, this variant of ovarian EMA may be challenging and misdiagnosed as SCST because of its wide range in morphology.http://www.diagnosticpathology.diagnomx.eu/vs/6096841358065394 webciteEndometrioid adenocarcinoma (EMA) may occur as a unique variant, irrespective being of ovarian origin or uterine endometrial origin [1]. The patients with ovarian tumors often complain variable and unusual symptoms [2]. Some postmenopausal patients with ovarian tumor present with atypical genital bleeding. In addition to this symptom, when endometrial thickening is detected on the imaging examination, the possibility of estrogen overproduction by the ovarian tumor can be raised. Cervicovaginal cytology also shows an increased maturation of squamous epithelium due to estrogenic effects [3]. As one of the most representative ovarian tumors with estrogen overproduction in postmenopausal women, adult granulose cell tumor is routinely encountered. Theco-fibromatous tumor and Brenner tumor arising in postmenopausal women are also known as having a potential to produce estrogen more than the normal range.Since 3 to 4 decades ago, postmenopausal epithelial ovarian tumors have been found to overproduce estrogen with considerable frequency [4,5]. According to the certain reports, mucinous tumor is most frequently characterized by estrogen overproduction [6-8]. In the other histological types such as serous, endometrioid and clear cell tumors, however, the recognition for their potential to overproduce estrogen seems to be less generalized, not only for pathologists but also for gynecologists.In our institution, endocrinological examination including the serum value of estrogen (E2) and follicle stimulating hormone (FSH) was performed for solid ovarian tumors arising in postmenopausal women, especially when they present with atyp