We Describe a case of ovarian serous cystadenoma having Sertoli-Leydig cell tumor, well differentiated, in the cystic septum. Well differentiated Sertoli-Leydig cell tumor coexisting with other tumor, including serous tumor, has not yet been described. In all cases of Sertoli-Leydig cell tumor with heterologous components or other tumors, the androblastomatous components are intermediately or poorly differentiated. The present case revealed a well differentiated Sertoli-Leydig cell tumor arising in a septum of serous cystadenoma, as a circumscribed nodule. With these findings, we discuss the possibility of this Sertoli-Leydig cell tumor, considered a mural nodule, which is well established in cystic common epithelial tumors of the ovary.
Adult ; Case Report ; Cystadenoma/*pathology ; Female ; Human ; Leydig Cells/pathology ; Male ; Ovarian Neoplasms/*pathology ; Sertoli Cells/pathology ; Sertoli-Leydig Cell Tumor/*pathology ; Support, Non-U.S. Gov't

Adult ; Diagnosis, Differential ; Female ; Humans ; Ovarian Neoplasms ; pathology ; Sertoli-Leydig Cell Tumor ; pathology

Unclassified type occupies about 5 to 10 percent of all ovarian sex cord stromal tumors. Diagnosis is very difficult and subjective because tumors show insufficient differentiation to ovarian or testicular line or display insufficient findings to diagnose as a gynandroblastoma in spite of divergent differentiation. To our knowledge sixty-two cases have been reported in the pathology literatures as yet. The behavior of this group of tumors has not been adequately studied but is similar to granulose cell tumors or Sertoli-Leydig cell tumors. We present a case of unclassified sex cord-stromal tumor which has been experienced in our hospital with brief review of the literature.
Diagnosis ; Female ; Ovary ; Pathology ; Sertoli-Leydig Cell Tumor ; Sex Cord-Gonadal Stromal Tumors*

Cell Differentiation ; Female ; Humans ; Middle Aged ; Sertoli-Leydig Cell Tumor ; pathology ; Sex Cord-Gonadal Stromal Tumors ; pathology

Mucinous neoplasms occur rarely in association with cystic teratoma, Sertoli-Leydig cell tumor, granulosa cell tumor or carcinoid tumor. Several cases of an ovarian stromal tumor with minor sex-cord elements have been reported in the literatures. However, there has been no report about an ovarian mucinous neoplasm coexisting with a stromal tumor with sex-cord elements yet. We report a case of an ovarian neoplasm composed of both mucinous cystadenoma and stromal tumor with minor sex-cord elements in a 58-yr-old female. The ovary including the mass measured 5 cm in size. On section, it revealed an unilocular cyst (4.5 cm in diameter) filled with mucinous fluid. There was a round, yellow, solid nodule, 1.5 cm in diameter within the wall. Microscopically, the cyst was lined by a single layer of endocervical mucinous epithelium and the nodule was composed of spindle cells showing an intersecting and whorled arrangement. There were cell nests showing polygonal shape with abundant cytoplasm among the spindle cells. They showed immunoreactivity for inhibin and did not have any connection with the adjacent mucinous epithelium. Therefore, we interpret the mucinous cystadenoma as having arisen de novo.
Cystadenoma, Mucinous/chemistry/*pathology ; Female ; Human ; Inhibin/analysis ; Middle Age ; Ovarian Neoplasms/chemistry/*pathology ; Sertoli-Leydig Cell Tumor/pathology ; Stromal Cells/*pathology

Female ; Genes, p53 ; immunology ; Humans ; Ovarian Neoplasms ; genetics ; pathology ; Ovary ; pathology ; Proto-Oncogene Proteins ; immunology ; metabolism ; Proto-Oncogene Proteins p21(ras) ; Proto-Oncogenes ; immunology ; Sertoli-Leydig Cell Tumor ; genetics ; pathology ; ras Proteins ; immunology ; metabolism

A mesothelial cyst of the round ligament is a rare cause of an inguinal mass. Clinically, it is frequently misdiagnosed as one of commoner diseases such as an inguinal hernia, femoral hernia, lipoma, and lymphadenopathy upon physical examination. Some previous reports elaborated the sonographic features of a mesothelial cyst of the round ligament. However, to our knowledge, few reports have described the CT features of a mesothelial cyst. We illustrated here the sonographic and multidetector CT features of a case of a mesothelial cyst of the round ligament that presented as an inguinal palpable mass and mimicked a metastasis in a patient with a Sertoli-Leydig cell tumor of the ovary.
Abdominal Neoplasms/*diagnosis/secondary ; Aged ; Contrast Media/diagnostic use ; Cysts/*radiography/*ultrasonography ; Diagnosis, Differential ; Epithelium/radiography/ultrasonography ; Female ; Humans ; Ovarian Neoplasms/*pathology ; Radiographic Image Enhancement/methods ; Round Ligament/*radiography/*ultrasonography ; Sertoli-Leydig Cell Tumor/*pathology ; Tomography, X-Ray Computed/methods

Adenoma ; metabolism ; pathology ; surgery ; ultrastructure ; Adnexa Uteri ; pathology ; surgery ; Adnexal Diseases ; metabolism ; pathology ; surgery ; Carcinoma, Endometrioid ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Granulosa Cell Tumor ; metabolism ; pathology ; Humans ; Hysterectomy ; Keratins ; metabolism ; Leiomyomatosis ; pathology ; surgery ; Microscopy, Electron ; Middle Aged ; Neoplasms, Multiple Primary ; metabolism ; pathology ; surgery ; ultrastructure ; Sertoli-Leydig Cell Tumor ; metabolism ; pathology ; Uterine Neoplasms ; pathology ; surgery ; Vimentin ; metabolism ; WT1 Proteins ; metabolism

OBJECTIVETo analyze the clinicopathological features of ovarian tumors with endocrine function.

METHODSTwenty-four cases of ovarian tumor with endocrine manifestation were collected from the hospital. Their clinical presentation and histopathologic features were reviewed, along with a panel immunohistochemistry stainings (EnVision method). The antibodies were AE1/AE3, epithelial membrane antibody (EMA), alpha-inhibin, calretini and smooth myoglobin (SMA).

RESULTSThe main clinical endocrinological manifestations were related to an excess production of sex steroids. Histologically, the principle histological subtype of these tumors was ovarian sex cord-stroma tumors, including 13 cases ovarian type (8 granulosa cell tumors, 2 thecofibromas, 3 sclerosing stromal tumors), 7 cases testicular type (1 sertoli cell tumors, 5 sertoli-Leydig cell tumors, 1 Leydig cell tumor, and 2 cases of steroid cell tumor (NOS). Another 2 cases were ovarian epithelial tumors. Grossly, 50% (11/22) ovarian sex cord-stromal tumors were less than 5 cm in diameter. However, 4 tumors were quite larger, up to 18 cm in diameter. Most of these tumors were solid or solid-cystic and their cut surfaces were brown, pink, yellow or grey in color. The 2 primary ovarian epithelial tumors were larger, being 12 cm and 14 cm in diameter, respectively. Immunohistochemically, ovarian sex cord-stromal tumors showed positive staining for alpha-inhibin in all cases (22/22) and for calretinin in majority cases (18/22), and that the intensity of reactivity correlated with the degree of tumor differentiation. The non-neoplastic, luteinized stromal cells in 2 ovarian primary epithelial tumors also showed positive staining. Five cases of fibrothecomas and sclerosing stroma tumors were all positive for SMA. Although 6 of the 22 ovarian sex cord-stromal tumors were AE1/AE3 positive, all were EMA negative.

CONCLUSIONSMost endocrinological syndromes in ovarian neoplasia reflect an overproduction of sex steroids, but the clinical manifestations do not correlate with the tumor histological subtypes. Most functional ovarian tumors are sex cord-stromal tumors and are usually of small to medium in size, but few are larger or giant. The size of the tumor does not correlate with the duration and the degree of clinical manifestations. Ovarian tumors of non-sex cord-stromal type may also be clinically functional. The immunohistochemical results suggests that alpha-inhibin and/or calretinin expression are useful markers in support of a diagnosis of sex cord-stromal tumor of the ovary. Although some of these tumors are AE1/AE3 positive, EMA negativity may be useful for the differential diagnosis with epithelial ovarian tumors.

Adolescent ; Adult ; Aged ; Biomarkers, Tumor ; analysis ; Calbindin 2 ; Female ; Gonadal Steroid Hormones ; secretion ; Granulosa Cell Tumor ; chemistry ; pathology ; secretion ; Humans ; Immunohistochemistry ; Inhibins ; analysis ; Middle Aged ; Ovarian Neoplasms ; chemistry ; pathology ; secretion ; S100 Calcium Binding Protein G ; analysis ; Sertoli-Leydig Cell Tumor ; chemistry ; pathology ; secretion ; Sex Cord-Gonadal Stromal Tumors ; chemistry ; pathology ; secretion

12E7 Antigen ; Antigens, CD ; metabolism ; CD56 Antigen ; metabolism ; Calbindin 2 ; Carcinoma, Endometrioid ; metabolism ; pathology ; Cell Adhesion Molecules ; metabolism ; Cystadenocarcinoma, Serous ; metabolism ; pathology ; Diagnosis, Differential ; Female ; Humans ; Immunohistochemistry ; Inhibins ; metabolism ; MART-1 Antigen ; metabolism ; Neprilysin ; metabolism ; Ovarian Neoplasms ; diagnosis ; metabolism ; S100 Calcium Binding Protein G ; metabolism ; Sertoli-Leydig Cell Tumor ; metabolism ; pathology ; Sex Cord-Gonadal Stromal Tumors ; diagnosis ; metabolism ; Steroidogenic Factor 1 ; metabolism ; WT1 Proteins ; metabolism