Do mucinous ovarian tumors produce estrogen?

Mucinous Ovarian Tumors and Estrogen Production

Mucinous ovarian tumors can produce estrogen, though this occurs through stromal luteinization rather than direct tumor production, and is more common in certain subtypes—particularly mucinous cystadenomas and borderline tumors—while the common invasive mucinous carcinomas of gastrointestinal type typically do not express estrogen receptors.

Mechanism of Estrogen Production

The estrogen production in mucinous ovarian tumors occurs through a specific pathologic mechanism:

• Stromal luteinization and condensation within the tumor tissue is responsible for elevated estrogen levels, not the epithelial tumor cells themselves 1
• In postmenopausal women with mucinous tumors, 70.4% demonstrated elevated estrogen excretion (>9 μg/24 hr), compared to only 4% of serous tumors 1
• The stromal changes (luteinization and/or condensation) were present in 73% of patients with high estrogen excretion versus only 15.8% in those with normal levels 1

Tumor Subtype Variations

The capacity for estrogen production varies significantly by mucinous tumor subtype:

• Mucinous cystadenomas (benign tumors) are documented to sometimes produce estrogens through their stroma 2
• Mucinous borderline tumors can be estrogen-responsive, as evidenced by successful treatment with aromatase inhibitors to prevent recurrence 3
• Invasive mucinous carcinomas of gastrointestinal type are uniformly negative for estrogen and progesterone receptors on immunohistochemistry 4
• Seromucinous (endocervical-like) borderline tumors consistently express estrogen receptors, with all cases showing some degree of ER expression 4

Clinical Manifestations

When estrogen production occurs, it can cause recognizable clinical syndromes:

• In postmenopausal women, manifestations include an enlarged uterus with thick endometrium visible on imaging, even when clinically latent 2
• Postmenopausal bleeding may occur as a presenting symptom 2
• MRI can demonstrate both the ovarian mass and indirect findings of estrogen excess, including endometrial thickening 2

Important Clinical Caveat

The majority of common invasive mucinous carcinomas do not produce estrogen or express hormone receptors 4. When elevated estrogen is detected in a patient with a mucinous ovarian tumor, consider:

• The tumor is likely benign (cystadenoma) or borderline rather than invasive carcinoma 1, 4
• Stromal luteinization should be sought on pathologic examination 1
• The seromucinous subtype is more likely to be hormone-responsive than gastrointestinal-type tumors 4