Thecomas are rare and almost invariably benign ovarian sex-cord stromal tumors, made up of cells that correspond to theca cells, fibroblasts, and lutein cells. The tumors are predominantly diagnosed in perimenopause (transition to menopause) or during postmenopausal women in their 50s. However, thecomas have been observed only in 10% of women with a mean age of 30 years or younger. In most cases, the tumors are typically estrogenic. The exception is luteinized thecoma, where the rates differ and are 50% estrogenic and 11% androgenic. Ovarian thecomas usually don’t cause symptoms, but they can sometimes cause pelvic pain or abdominal distress, especially if associated with ovarian twisting.
What is Thecoma?
Thecomas generally occur in postmenopausal (after menopause, the period of time after a woman has experienced 12 consecutive months without menstruation) women. Several cases reported that show the tumorous cells may occur at a mean age of 59, and only 10% of patients are ≤ 30 years of age. These tumors seem to grow very rarely before puberty. Although some may be androgenic, the ovarian tumors are mostly estrogenic, and most of the patients show abnormal vaginal bleeding. Studies showed that around 20% of women develop concurrent endometrial carcinoma.
In general, thecomas range from small neoplasms to large solid cysts of up to 15cm in size. They are rarely cancerous and are often unilateral in >90% of patients. Ovarian thecomas are typically unilateral in approximately 97% of the patients. These tumors usually appear as yellow or orange ovarian masses with soft, smooth, or bosselated outer surfaces.
Usually, the clinical diagnosis of ovarian thecomas is not easy. They are determined mainly when a patient undergoes abnormal uterine bleeding. However, in some cases, the women may not manifest any signs or symptoms. The cases reported having thecomas present in one or both ovaries, with no such symptoms of abdominal pain or bloating, or an endocrine disorder.
The researchers confirmed the most common symptoms of ovarian thecomas are unusual vaginal bleeding, abdominal-pelvic masses or swelling, menometrorrhagia (heavy or prolonged uterine bleeding), infertility, and abdominal distress.
Usual thecomas comprise benign stromal origin tumors that are considered to grow around 1% of the total number of ovarian neoplasms. The tumor cells are mainly formed of lipid-laden cells that resemble theca cells compared with fibroblasts. They most likely occur in middle-aged women. The patients most often have complaints of irregular menstrual cycles and heavy bleeding after menopause. The irregular menstrual cycle includes menorrhagia and oligomenorrhea. Oligomenorrhea refers to a condition when there are fewer and lighter periods than usual, with 35 or more days. At the same time, menorrhagia is the opposite situation. Patients can feel heaviness in their abdominal part with pain and discomfort. As in thecomas estrogen is produced, patients sometimes experience enlarged and sore breasts and increased vaginal discharges.
Ovarian thecomas occur infrequently. There are stages for developing ovarian tumors on how far they’ve grown and whether or not it has spread to other body parts. They are normally diagnosed through blood tests and physical examination. The doctors will do the image testing, including;
Through ultrasound, the initial image is obtained. In the US, thecoma may display echogenic mass, hypoechoic mass, or anechoic lesion. Endometrial thickening may also be seen during the testing.
CT scanning shows thecomas as unilateral, solid ovarian masses.
MRI may simulate more common malignant ovarian tumors.
For a successful treatment process, the diagnostics for this rare pathologic entity is the most significant step. Sonograms have proved to be very helpful in diagnosing theca cell tumor of the ovary. However, the primary treatment approach for virilizing ovarian tumors is normally surgery. The patient’s symptoms usually seem to depart once the tumor is removed as estrogen production stops. Patients who wish to preserve their fertility are often operated via wedge resection. However, oophorectomy is more often performed because patients sometimes possess thecoma mixed with granulosa cell neoplasm, which is less destructive. Alternatively, the surgery involves a complete hysterectomy on patients who need to remove their uterus and ovaries because thecoma cases may possess endometrial carcinoma or endometrial hyperplasia.
To more understand the rarely occurring ovarian tumors, extra genetic investigations are needed to be conducted. Moreover, improved treatment methods should be incorporated that might include high-intensity directed ultrasound and hormonal treatment.