Hypernephroma of the Ovary

Some authors doubt the occurrence of a primary hypernephroma of the ovary and consider ovarian tumors resembling the classic renal hypernephroma as having arisen from lutein cells. Others, emphasizing the sharp differences between the development and arrangement of lutein cells and those of the socalled ovarian hypernephroma, accept the latter as a tumor entity, without reserve. At the present time the latter view has gained some precedence. Peham ( l ) , in 1899, published the first report of a hypernephroma of the ovary. This was in a multipara, aged forty-five, complaining of malaise, anorexia, and abdominal pain. The growth was a huge cystic tumor, composed of large vacuolated cells containing glycogen granules, and resembling the tissues in the zona glomerulosa of the suprarenal cortex. The tumor seems to have been benign, as there is no mention of recurrence. Although Peham introduced the term “ hypernephroma of the ovary,” Ulrich (2 ) in 1895 had described nodules of tissues in both ovaries which were similar to the accessory nodules of suprarenal gland tissues in the broad ligaments reported in 1883 by Marchand (3). Pick (4), in 1901, described a tumor 9.0 by 7.5 by 7.5 cm. in the right ovary of a woman aged fifty-one. It was multicystic, seemed to arise in the hilum of the ovary, and was considered a primary hypernephroma. The postmortem examination, twenty-one months later, demonstrated tumor tissue in the brain, both kidneys, and the left suprarenal gland. These tumors apparently were malignant and the conditions mentioned suggest the possibility that a renal or suprarenal tumor was the primary growth and the others, including the one in the ovary, were secondary. Robert Meyer ( S ) , in 1903, published an account of a tumor of the ovary which corresponded closely to the description by Pick, and in 1908 he reported another ovarian tumor as hypernephroid in structure. Sternberg ( 6 ) , in 1906, recorded two tumors of hypernephroma structure in a patient aged eighteen, the larger in the left ovary and the other in the left parametrial tissues. Compressed ovarian tissue was seen about the periphery of the larger growth. This tumor probably began centrally and grew into the ovary, which formed a thin capsule. In 1907 Debeyre and Riche ( 7 ) reported the presence of suprarenal tissues in the left ovary of a child, aged four, with precocious puberty, and in 1909 von Rosthorn (8) described a patient with tumors of both ovaries structurally similar to suprarenal gland tissue. Vonwiller (9), in 1911, described a nodular encapsulated tumor as large as a man’s fist in the right ovary. The cut surface showed yellow tissue alternating with gray and hemorrhagic areas. The ovarian stroma stretched over the tumor like a capsule. Vonwiller believed the hypernephrogenic nature of this tumor to be unquestionable. Alamartine and Maurizot ( lo) , in 1912, re-