Functioning ovarian tumors in postmenopausal women

Estrogen excretion was higher than normal (more than 9 microgram/24 hr) in 40 of 80 postmenopausal women with benign and malignant epithelial tumors of the ovary, including 8 metastatic tumors. High estrogen excretion was noted in 19 of 27 (70.4%) patients with mucinous tumors in only 1 of 25 (4%) patients with serous tumors (P less than .001). Endometrioid and metastatic tumors were also noted to be frequently associated with high estrogen excretion. In the high estrogen excretion group 27 of 37 (73%) patients showed stromal luteinization and/or condensation in the tumor, but in the normal estrogen excretion group these changes were seen in only 6 of 38 (15.8%) patients (P less than .001). A possible mechanism of stromal stimulation in these tumors is discussed. Although there was often evidence of estrogen activity in the endometrium and the tubal epithelium in the high estrogen excretion group, the correlation between these epithelia and estrogen excretion was imperfect. Postoperative estrogen excretion remained elevated in 3 of 16 patients, of whom 1 was obese and 2 had residual tumor. This study emphasizes the importance of identifying epithelial tumors of the ovary as functioning or endocrine tumors.