Female 70 years old, with tumours in both ovaries (hysterectomia with bilateral adnexectomia was made).  
MACRO: Greyish, brown with rough surface tumour occupying whole ovary, forming 7cm - in one and ~14 cm mass in another ovary.  
MICRO: various size confluent nodules and diffuse areas of large polygonal, clear cell outlines cells with abundant eosinophilic cytoplasm and round nucleus and alternating zones of smaller spindle-shaped cells. Zonal higher cells polymorphism, necrosis and haemorrhages. There are small groups of smaller eosinofilic monomorphic cells around some nodules. Few high-power fields with 1-2 mitoses.  
IMUNO: Tumour: WT1 (+) 100%, Calretinin (+)~40%, Inhibin (+)~10%, Ki67 (+) 2-3%, ER (++/+++), Hepa (+) single cells. Inhibin ir Calretinin (+)smaller eosinophilic cells.  
 
AFP/CD117/Synaptophysin/ChromograninA/AsmActin/Desmin/MelanA/HMB45/CD10/Cam5.2/PANCK/CK7/CK20/S100 (-).  
Proposal diagnosis: Sex cord-stromal tumour: Leydig cell tumour? Steroid cell tumour?  

LynnHirschowitz 2010-04-15 18:30	From Drs Lynn Hirschowitz and Raji Ganesan.   1. Nodular architecture; mixture of spindled and epithelioid cells (the latter pleomorphic; almost rhabdoid). No trabecular or tubular architecture. Would be helpful to have a reticulin stain (this should show cells in groups).   2. Occasional grooved nuclei. Scant mitotic activity. No necrosis.   3. Immunos exclude epithelial malignancy, GIST, yolk sac tumour (AFP negativity excludes hepatoid ovarian carcinoma).   4. Inhibin, calretinin and WT1 support sex-cord stromal origin.     Preferred diagnosis: luteinised adult granulosa cell tumour; less likely mixed granulosa-sex cord stromal tumour.     attachment: luteinised agct ovary - young ijgp 1994.pdf
ugnius 2010-04-17 19:51	Thank you for the briliant idea. Really we had no definite place for this tumor on WHO stairs...
ugnius 2010-04-17 20:01	It must be pointed out, that after desciption:   1. We have bilateral tumors.   2. S100 is negative.   Maybe we need restain S100 on both tumors if it was not done before.
Indra 2010-04-20 07:56	Thank you for a good idea and added article. Reticulin is on the way.
Indra 2010-04-27 10:47	Please, take a look at some new photos of Reticulin
LynnHirschowitz 2010-04-27 23:25	The reticulin pattern does seem to fit with a granulosa cell tumour - a stronger nuclear counterstain would help, but there do seem to be cells in small groups and nests which is the expected staining pattern.
tzankov 2010-05-31 07:04	I must admit that I have not seen a lot of lautenized garnulosa cell tumors, but consdiering the nuclear architecture of the present case, the focal Inhibn expression and some crysatlline structures on picture 20x 6, I would favor a steroid cell tumor or non-hilar Leydig cell tumor. The macroscopic appeareance and the gae would also be mor in favor of of a steroid cell tumor than of granulosa cell tumor.
ugnius 2010-05-31 10:57	Thanx. The case was sent to dr.Lynn Hirschowitz for re-evaluation.
LynnHirschowitz 2010-06-03 19:17	Dr Ganesan, Prof McCluggage and I have reviewed the histological sections and repeated the marker studies. We have excluded metastatic carcinoma, melanoma, deciduoid mesothelioma, and have concluded that the differential diagnosis is between steroid cell tumour NOS and luteinised adult granulosa cell tumour. The presence of nuclear grooves, the architecture (follicle-like structures, occasional hyalinised areas and reticulin pattern) all favour luteinised adult granulosa cell tumour. There is tumour on the capsular surface of one ovary - this is a poor prognostic indicator.
hurwitz 2010-07-11 13:17	Final Diagnosis:     Luteinized Adult Granulosa Cell Tumor.   Tumor tissue on the capsular surface of one ovary   (poor prognostic indicator)
	» Add comment (Login)