Gonadotropins and female sex steroid hormones in cyst fluid and serum from patients with ovarian tumors

The objective of the present study was to determine the concentrations of LH, FSH, 17 beta-estradiol and progesterone in ovarian cyst fluid and serum from patients with benign and malignant ovarian tumors and to assess the correlation of the gonadotropin and female sex steroid hormone concentrations with menopausal and tumor status. Ovarian cyst fluid and blood samples were prospectively collected from 103 patients with ovarian tumors. Seventy-four of the patients had benign ovarian tumors while 29 patients had malignant ovarian tumors. Malignant ovarian tumors showed significantly higher LH and FSH cyst fluid concentrations compared to concentrations from patients with benign tumors. Within the malignant subset, LH and FSH concentrations correlated with increasing FIGO stage and grade. Furthermore. LH and FSH cyst fluid concentrations showed strong correlations (r > 0.62) with serum concentrations in case of malignant tumors, especially in postmenopausal women, but not in case of benign tumors. The highest gonadotropin concentrations were observed in cyst fluid from malignant ovarian tumors. The most probable explanation for this is all increased vascular permeability within the cysts. Supportive evidence for such an increased vascular permeability is Our previous finding of significantly higher VEGF concentrations in cyst fluid from malignant ovarian tumors. The possibility of ectopic production of LH and FSH by malignant ovarian tissue cannot completely be ruled out..

Gonadotropins; Female sex steroids; Ovarian tumor; Cyst fluid; Menopausal status

[1] Dietl J., Marzusch K.: “Ovarian surface epithelium and human ovarian cancer”. Gynecol. Obstet. Invest., 1993, 35, 129.

[2] Nicosia S.V., Nicosia R.F.: “Neoplasms of the ovarian mesothelium”. In: Azar H.A. (ed.), Pathology of Human Neoplasm. New York, Raven Press, Ltd, 1988, 435.

[3] Janovski N.A., Paramanandhan T.L.: “Ovarian tumors, tumors and tumor like condition of the ovaries, fallopian tubes and ligaments of the uterus”. Georg Thieme Publishers Stuttgart, 1973, 3.

[4] Nicosia S.V., Saunders B.O., Acevedo-Duncan M.E., Setrakian S., Degregorio R.: “Biopathology of ovarian mesothelium”. In: Familiar G. (ed.). Ultrastructure of the Ovary, Boston, Kluwer Academic Publishers, 1991, 287.

[5] Geier G.R., Strecker J.R.: “Aspiration cytology and E2 content in ovarian tumors”. Acta Cytol., 1981, 25, 400.

[6] Heinonen P.K., Morsky P., Aine R., Koivula T., Pystynen P.: “Hormonal activity of epithelial ovarian tumors in post-menopausal women”. Maturitas, 1988, 9, 325.

[7] Gaetje R., Popp L.W.: “Is differentiation of benign and malignant cystic adnexal masses possible by evaluation of cysts fluids with respect to color, cytology, steroid hormones, and tumor markers?”. Acta Obstet. Gynecol. Scand., 1994, 73, 502.

[8] Reimer T., Gerber B., Kunkel S., Luettich K.: “Estradiol, gonadotropins, and tumor markers in ovarian cyst fluid”. Acta Obstet. Gynecol. Scand., 1997, 76, 478.

[9] Krämer S., Leeker M., Jäger W.: “Gonadotropin levels in ovarian cyst fluids: a predictor of malignancy?”. Int. J. Biol. Markers, 1998, 13, 165.

[10] Reimer T., Gerber B., Muller H., Jeschke U., Krause A., Friese K.: “Differential diagnosis of peri- and postmenopausal ovarian cysts”. Maturitas, 1999, 31, 123.

[11] Krämer S., Jäger W.H., Lang N.: “Growth regulation effects of gonadotropin induced steroidogenic response in human ovarian cancer”. Anticancer Res., 2001, 21, 2005.

[12] Thomas C.M.G., Corbey R.S., Rolland R.: “Assessment of unconjugated oestradiol and progesterone serum levels throughout pregnancy in normal women and in women with hyperprolactinaemia who conceived after bromocryptine treatment”. Acta Endocrinol. (Copenh), 1977, 86, 405.

[13] Boss E.A., Massuger L.F.A.G., Thomas C.M.G., Geurts-Moespot A., Boonstra H., Sweep C.G.J.: “Vascular endothelial growth factor in cyst fluid from ovarian tumors”. Cancer, 2001, 91, 371.

[14] Ivarsson K., Sundfeldt K., Bränström M., Janson P.O.: “Production of steroids by human ovarian surface epithelial cells in culture: possible role of progesterone as growth inhibitor”. Gynecol. Oncol., 2001, 82, 116.

[15] Slotman B.J., Kühnel R., Rao B.R., Dijkhuizen G.H., de Graaf J., Stolk J.G.: “Importance of steroid receptors and aromatase activity in the prognosis of ovarian cancer: high tumor progesterone receptor levels correlate with longer survival”. Gynecol. Oncol., 1989, 33, 76.

[16] Münstedt K., Steen J., Knauf A.G., Buch T., von Georgi R., Franke F.E.: “Steroid hormone receptors and long term survival in invasive ovarian cancer”. Cancer, 2000, 89, 1783.

[17] Emons G., Ortmann O., Teichert H.M., Fassl H., Lohrs U., Kullander S. et al.: “Luteinizing hormone releasing hormone agonist triptorelin combination ith cytotoxic chemotherapy in patients with a ovarian carcinoma. A prospective double blind randomised Decapeptyl Ovarian Cancer Study Group”. Cancer, 1996, 78, 1452.

[18] Hofstra L.S., Mourits M.J., de Vries E.G.., Mulder N.H.,Willemse P.H.: “Combined treatment with goserelin and tamoxifen in patients with advanced chemotherapy resistant ovarian cancer”. Anticancer Res., 1999, 19, 3627.