Patterns of metastasis in sex cord-stromal tumors of the ovary: Can routine staging lymphadenectomy be omitted?

Objective: Given the paucity of data regarding the patterns of metastasis from ovarian sex cord-stromal tumors (SCSTs), we sought to determine the risk of lymph node metastasis in patients with SCSTs. Methods: A retrospective chart review was performed after clinical and pathology databases were queried for ovarian SCST patients who were treated at our institution between 1985 and 2005. Results: We identified 262 patients with pathology-confirmed ovarian SCSTs; 5 had additional non-stromal histology and were excluded, leaving 257 evaluable patients. Of these patients, 178 had adult granulosa cell tumors, 27 had juvenile granulosa cell tumors, 31 had Sertoli-Leydig cell tumors, 6 had sex cord tumors with annular tubules, 13 had mixed SCSTs, and 2 had SCSTs not otherwise specified. Our evaluation showed that 111 patients underwent a complete or partial staging procedure; 75 had stage I disease, 11 had stage II disease, and 25 had stage III disease. Fifty-eight of these 111 patients (52%) had lymph nodes removed as part of the staging procedure. Of the 58 patients who had lymph nodes sampled during the primary surgery, none had positive nodes. Of 117 patients whose disease eventually recurred, 6 patients (5.1%) had nodal metastases at the time of recurrence. Three of these patients had negative lymph nodes at initial staging. Conclusions: Lymph node metastasis in ovarian SCSTs is rare. These findings suggest that lymphadenectomy may be omitted when staging patients with ovarian SCSTs.