Clinical History:  A 17-year-old high school senior complained of an increase in abdominal girth. She had been lethargic recently and her mother thought she had lost weight, although her abdomen had enlarged. Menses began at age 12, periods were regular and there had been no recent change in their character. Upon physical examination, she had normal breast development, female distribution of pubic hair and normal genitalia with virginal introitus. A mass was present filling the lower abdomen. By rectal examination, the mass was firm and attached to the left adnexa. It was firm, movable and seemed to be arising from the pelvis. Liver and spleen were not palpable.

Laboratory data were within normal limits. An X-ray of the abdomen showed the mass to be filling the lower abdomen and pelvis; it was of uniform density. A laparotomy was performed.

Figure 4a shows the ovarian tumor removed. Note the smooth surface and absence of excrescences. The tumor measured 15 cm. in maximum dimension and weighed 1200 grams.

Figure 4b is a cut surface of the tumor. Notice the solid, fleshy, gray to pink appearance and absence of hemorrhage or necrosis.

Figure 4c is a photomicrograph of the tumor. Notice the large polygonal cells, vesicular nuclei and distinct cell membranes. Foci of lymphocytes and occasionally granulomas may be present in the fibrous septae that separate the tumor cells.

Questions:

1. What is your diagnosis? Are these tumors common? What is their derivation? Are these tumors commonly bilateral?

2. What tumor in males does this resemble? Does this tumor produce any hormonal effects?

3. How are they treated? What is the prognosis?

4. Where does it spread?