Female ; Granulosa Cell Tumor ; diagnosis ; surgery ; Humans ; Infant ; Ovarian Neoplasms ; diagnosis ; surgery

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

12E7 Antigen ; Adnexa Uteri ; surgery ; Adult ; Aged ; Aged, 80 and over ; Antigens, CD ; metabolism ; Cell Adhesion Molecules ; metabolism ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Granulosa Cell Tumor ; drug therapy ; metabolism ; pathology ; surgery ; Humans ; Hysterectomy ; methods ; Inhibins ; metabolism ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Ovarian Neoplasms ; drug therapy ; metabolism ; pathology ; surgery ; Survival Rate ; Vimentin ; metabolism

Adult ; Burkitt Lymphoma ; metabolism ; pathology ; CD3 Complex ; metabolism ; DNA Nucleotidylexotransferase ; metabolism ; Diagnosis, Differential ; Female ; Granulosa Cell Tumor ; metabolism ; pathology ; Humans ; Ki-67 Antigen ; metabolism ; Leukocyte Common Antigens ; metabolism ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Precursor T-Cell Lymphoblastic Leukemia-Lymphoma ; metabolism ; pathology ; surgery ; Sarcoma, Myeloid ; metabolism ; pathology

We report a rare case of a giant ovarian tumor presenting as an incarcerated umbilical hernia. A 61-yr-old woman was admitted to the hospital with severe abdominal pain, an umbilical mass, nausea and vomiting. On examination, a large, irreducible umbilical hernia was found. The woman underwent an urgent operation for a possible strangulated hernia. A large, multilocular tumor was found. The tumor was excised, and a total abdominal hysterectomy and bilateral salphingo-oophorectomy were performed. The woman was discharged 6 days after her admission. This is the first report of incarcerated umbilical hernia containing a giant ovarian tumor within the sac.
Diagnosis, Differential ; Female ; Granulosa Cell Tumor/*diagnosis/pathology/surgery ; Hernia, Umbilical/diagnosis/*etiology/surgery ; Humans ; Middle Aged ; Ovarian Neoplasms/*diagnosis/pathology/surgery

A 65-yr-old woman presented 17 yr status post-hysterectomy with bilateral ovarian salpingo-oophorectomy, attributable to ovarian cancer. She was admitted to our hospital, with multiple cystic liver masses and multiple large seeded masses in her abdomen and pelvic cavity. Histological examination of the pelvic masses demonstrated granulosa cell tumors. After two courses of systemic combination chemotherapy, with paclitaxel and carboplatin, the masses in the abdomen and pelvic cavity increased, and debulking surgery also failed because of peritoneal dissemination with severe adhesion. Finally, she underwent palliative radiotherapy for only the pelvic masses obstructing the urinary and GI tracts, and monthly hormonal therapy with a gonadotrophin-releasing hormone agonist; leuprorelin 3.75 mg IM. Subsequently, multiple masses beyond the range of the radiation as well as those within the radiotherapy field partially decreased. This partial response had been maintained for more than 8 months as of the last follow-up visit. Owing to its long and indolent course and the low metabolic rate of the tumors, advanced or recurrent granulosa cell tumor (GCT) requires treatment options beyond chemotherapy, surgery, and radiotherapy. Hormonal agents may provide another treatment option for advanced or recurrent GCT in those who are not candidates for surgery, chemotherapy, or radiotherapy.
Aged ; Antineoplastic Agents, Hormonal/*therapeutic use ; Female ; Gonadotropin-Releasing Hormone/*agonists/metabolism ; Granulosa Cell Tumor/diagnosis/*drug therapy/radiography ; Humans ; Leuprolide/*therapeutic use ; Ovarian Neoplasms/diagnosis/*drug therapy/radiography ; Recurrence

OBJECTIVETo study the clinicopathological characteristics, immunohistochemical features and histogenesis of primary testicular carcinoid tumor and its differential diagnosis.

METHODSLight microscopy and immunohistochemical stains were performed in 4 cases of primary testicular carcinoid tumor.

RESULTSThe patients sought care for scrotum mass presented from 2 to 36 years, 2 cases accompanied with tender swelling of the testis. The tumors were described as nodular, yellowish-gray in color, 3.0-4.0 cm in the greatest dimensions, and well circumscribed, focal necrosis seen in 1 case. Histologically, they showed insular and trabecular patterns separated by fine fibrous bands. The tumor cells were round or polygonal with regular monomorphic nuclei, stippling chromatin and eosinophilic granular cytoplasm. There were rosette-like and tubuloglandular patterns with eosinophilic secretion in the cavity. Immunohistochemical staining for synaptophysin, chromogranin A, NSE and cytokeratin showed diffusely positive expression in the tumor cells.

CONCLUSIONPrimary testicular carcinoid tumor is extremely rare with good prognosis and its histogenesis remains controversial. Diagnostically it has to be differentiated from seminoma, metastatic carcinoid tumor, Sertoli cell tumor and granulosa cell tumor.

Adult ; Carcinoid Tumor ; diagnosis ; pathology ; Diagnosis, Differential ; Granulosa Cell Tumor ; pathology ; Humans ; Male ; Neoplasm Metastasis ; Seminoma ; pathology ; Sertoli Cell Tumor ; pathology ; Testicular Neoplasms ; diagnosis ; pathology

OBJECTIVETo study the clinicopathologic features, diagnostic criteria, differential diagnosis and treatment options of ovarian steroid cell tumor, not otherwise specified (NOS).

METHODSLight microscopy and immunohistochemical study was carried out in 8 cases of ovarian steroid cell tumor, NOS. The literature was reviewed.

RESULTSThe 7 cases of benign ovarian steroid cell tumor, NOS were composed mainly of polygonal cells with granular eosinophilic cytoplasm and larger cells with vacuolated cytoplasm. They resembled the architecture of normal adrenal gland, with formation of cell nests and trabeculae. The single case of malignant ovarian steroid cell tumor had evidence of significant cellular pleomorphism, haemorrhage and coagulative tumor necrosis. The mitotic count measured about 7 per 10 high-power fields. Immunohistochemical study showed that the tumor cells expressed calretinin and alpha-inhibin. Differential diagnosis included oxyphilic granulosa cell tumor, thecoma, Sertoli cell tumor and clear cell carcinoma. The treatment options of benign ovarian steroid cell tumor, NOS was local excision or ipsilateral salpingo-oophorectomy, while the malignant counterpart should be treated with a combination of surgery and chemotherapy, including administration of GnRH agonist.

CONCLUSIONSOvarian steroid cell tumor, NOS, is the most common type of ovarian steroid cell tumors. Most of which are associated with a benign clinical outcome. Immunohistochemistry is an important adjunct for diagnosis. The treatment options of ovarian steroid cell tumor, NOS depend on its malignant potential.

Adolescent ; Adult ; Calbindin 2 ; Diagnosis, Differential ; Female ; Granulosa Cell Tumor ; pathology ; Humans ; Inhibins ; metabolism ; Ovarian Neoplasms ; metabolism ; pathology ; surgery ; Ovariectomy ; methods ; Ovary ; pathology ; S100 Calcium Binding Protein G ; metabolism ; Sertoli Cell Tumor ; pathology ; Sex Cord-Gonadal Stromal Tumors ; metabolism ; pathology ; surgery ; Thecoma ; pathology ; Young Adult

OBJECTIVE: The purpose of this study was to evaluate the patients' characteristics and treatment results for 31 granulosa cell tumors (GCTs) of the ovary. METHODS: We retrospectively reviewed the medical records of 31 patients with GCT who received treatment from January, 1997 to April, 2005. They were grouped into 21 adult types, 4 juvenile types and 6 recurrent GCTs. Clinicopathological characteristics, treatment results and follow-up data were investigated from medical records and/or telephone surveys. RESULTS: In adult types, the median age of patients was 42 years (20 to 81 years). The most common present symptom was vaginal bleeding (10/21, 47.6%). All patients with adult type had FIGO stage I with median follow-up of 32 months (5-103 months). No recurrence developed in this group. In juvenile types, the median age was 8 years (2-14 years). Precocious puberty was presented in 2 of 4 (50%). Three had FIGO stage I and one had FIGO stage IIIa. Two patients were given adjuvant chemotherapy with bleomycin, etoposide, cisplatin (BEP) regimens for six cycles. No recurrence was found during median follow-up of 20.5 months (16-27 months). In recurrent GCTs, cytoreductive surgery and adjuvant chemotherapy were given to 5 patients. One patient, who had a disease with multiple liver and multiple lung metastases, was given palliative chemotherapy. All patients were alive, two were clinically in complete response. CONCLUSION: There was no recurrence in adult types and juvenile types, and no dead of disease in recurrent group. However, because of the propensities of GCT to recur years after initial diagnosis and to grow slowly with indolent course, prolonged surveillance with serial physical examination and imaging studies is reasonable.
Adult ; Bleomycin ; Chemotherapy, Adjuvant ; Cisplatin ; Diagnosis ; Drug Therapy ; Etoposide ; Female ; Follow-Up Studies ; Granulosa Cell Tumor* ; Granulosa Cells* ; Humans ; Liver ; Lung ; Medical Records ; Neoplasm Metastasis ; Ovarian Neoplasms ; Ovary* ; Physical Examination ; Puberty, Precocious ; Recurrence ; Retrospective Studies ; Telephone ; Uterine Hemorrhage

Mullerian inhibiting substance (MIS) is a glycoprotein hormone produced by fetal Sertoli cells that causes regression of the Mullerian ducts in males during sexual differentiation. Cell lines derived from human ovarian epithelium and rodent Leydig cell tumors, which respond to MIS in growth inhibition assays and express the MIS type II receptors (MISR II). But the pathophysiological role of MIS in human ovarian neoplasia development has not yet been fully established. In order to understand its role in pathogenesis of ovarian neoplasia, the expression and localization of the MIS and MISR II were studied in 5 normal ovaries, 11 benign tumors, 9 borderline ovarian malignancies, 40 ovarian malignancies in paraffin embedded tissue and tissue microarrays by using immunohistochemical stain. The results were as follows; 1. The first staining for MIS and MISR II were detected in granulosa cells in primary follicles of normal ovary. Among the growing follicles, larger developing follicles stained more intensely than smaller follicles. 2. In benign ovarian tumors, 8 (72.73%) in MIS and 5 (45.45%) in MISR II out of 11 cases were stained. The intensity scores of staining were 1.18 in MIS and 0.64 in MISR II. 3. In borderline malignancies, 6 (66.67%) in MIS and 7 (77.78%) in MISR II out of 9 cases were stained. The intensity scores of staining were 0.89 in MIS and 1.22 in MISR II. 4. In ovarian malignancies, the expression of MIS and MISR II were 50% (9/18) and 50% (9/18) in epithelial, 92.30% (12/13) and 76.72% (10/13) in germ cell, and 88.9% (8/9) and 100% (9/9) in sex-cord stromal tumors. The intensity scores of MIS and MISR II expression were 0.72 and 0.72 in epithelial, 1.45 and 1.62 in germ cell, and 1.78 and 1.67 in sex-cord stromal tumors. 5. There was significant high expression of MIS and MISR II in non-epithelial (90.91%, 86.36%) than epithelial ovarian cancers (50%, 50%). The scores of expression intensity was also higher in non-elithelial cancers (MIS: 1.67 +/- 0.16 vs 0.72 +/- 0.20, p=0.003, MISR II: 1.64 +/- 0.20 vs 0.72 +/- 0.21, p=0.022). In conlusion, the expression of MIS and MISR II were not different according to the differentiation, but tissue type specific. The frequency of MIS and MISR II expression was higher in non-epithelial cancers, especially in sex-cord stromal tumors. The results of this experiment could be utilized as scientific basis of researches, furthermore clinical applications in diagnosis and treatment of non-epithelial ovarian malignancies.
Anti-Mullerian Hormone* ; Cell Line ; Diagnosis ; Epithelium ; Female ; Germ Cells ; Glycoproteins ; Granulosa Cells ; Humans ; Leydig Cell Tumor ; Male ; Mullerian Ducts ; Ovarian Neoplasms ; Ovary ; Paraffin ; Rodentia ; Sertoli Cells ; Sex Differentiation