Patterns of spread and recurrence of sex cord-stromal tumors of the ovary

Objective.Sex cord-stromal tumors are an uncommon type of ovarian neoplasm and limited data are available in the literature to guide clinical management. Recent published series suggested a lack of lymph node involvement and recommended abandonment of the lymph node dissection as part of the primary surgical staging of these tumors. To confirm these findings, we evaluated pathologic findings in women undergoing surgical management of sex cord-stromal tumors in the Seattle metropolitan area.Methods.A retrospective multi-institutional review of all patients treated with sex cord-stromal tumors at University of Washington Medical Center and Swedish Medical Center in Seattle was conducted. Information was collected on the pathology, evaluation, and treatment of these patients.Results.A total of 87 patients were available for analysis, the majority of whom had adult granulosa cell tumors (82%) and Sertoli–Leydig cell tumors (13%). Of these patients, 68% had complete or partial surgical staging procedures, and 47 patients had some nodal tissue examined as part of the initial or restaging procedure. All nodes examined were negative. Tumor size was significantly associated with risk of recurrent disease, with a 20% increase in the hazard of recurrence for each increase of tumor size of 1 cm (HR, 1.20; 95% CI, 1.11–1.07).Conclusions.This study confirms the finding that lymph node metastasis are rare in sex-cord stromal tumors. These findings support the hypothesis that routine lymphadenectomy provides limited additional information in the management of these patients and can be omitted from the primary surgical staging procedure or secondary restaging procedures.

Research Highlights
► A large series of 87 sex cord-stromal tumors
► Sex cord-stromal tumors rarely exhibit primary nodal metastasis.
► Size is a prognostic factor with tumors less than 7 cm rarely recurring.