Ovarian melanoma (cqz 4) - 华夏病理网论坛

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楼主发表于 2009-02-07 01:23|举报|关注(0)
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women/about 40 years with a left ovarian mass 13 cm.

Procedure: BSO, hysterectomy, lymph node resection, omentectomy, appendectomy.

Cytomorphology of the tumor is as above photos.

Your interpretations.

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本帖最后由于 2009-02-25 03:02:00 编辑

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1 楼发表于2009-02-25 02:53:00举报|引用
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本帖最后由于 2009-02-25 03:01:00 编辑

Stain for s100, HMB 45, Malan-A

This is an easy case. I showed here because it is rare. Clinically the primary lesion have not be found yet. We still think it is a metastatic lesion. Sometimes we see the metastatic lesions, but cannot find the primary lesions.

Lesson: For unusual cases, always have the differential diagnoses, and then do some IHC to rule out or rule in.

Thank you for reading the case.

cz

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2 楼发表于2009-02-21 05:27:00举报|引用
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以下是引用漫游人在2009-2-20 22:08:00的发言：

Based on H&E, I would consider following differentials
1. small cell carcinoma, hypercalcemic type. However, it is unlikely the diagnosis since epithelial markers are all negative.
2. PNET. CD99 should be positive in most cases. I noticed the current case is negative.
3. endometrioid stromal sarcoma. There are no characteristic vessels in this case as seen in typical stromal sarcoma of endometrium.
4. melanoma. it can look like anything. IHC can easily rule in or out it.
5. lymphoblastic lymphoma/leukemia. Mitosis is not high, IHC results do not support.
6. rhabdomyosarcoma. Although there is no idenitifiable rhadomyoblast and no IHC result, I still think this should be the favoured diagnosis.
Thank you for the many excellent cases and great effort.

Thank for your consideration for this case. This is the way we should use for analysis of these kinds of the cases. Pathologists cannot guess the diagnosis.

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3 楼发表于2009-02-17 10:45:00举报|引用
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No one can make dx by H&E only for this kind of cases. Should have differential dx first, then order the IHC. Rule in or out based on the IHC results.

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4 楼发表于2009-02-14 22:41:00举报|引用
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以下是引用cq1981在2009-2-14 21:33:00的发言：

排除了粒层细胞瘤、小细胞癌，大部分淋巴瘤，那考虑是低分化的支持-间质细胞瘤或者转移至卵巢的粒细胞肉瘤。

What are other differential diagnoses?

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5 楼发表于2009-02-14 19:57:00举报|引用
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以下是引用cq1981在2009-2-11 16:32:00的发言：

仔细看细胞核似乎有核沟，猜一个，Langerhans细胞增生症。

IHC results do not support

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6 楼发表于2009-02-12 19:51:00举报|引用
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以下是引用静静鱼在2009-2-12 19:26:00的发言：

颗粒细胞瘤

But inhibin, CD99 and calretinin are negative. Do you still think it is granulosa cell tumor?

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7 楼发表于2009-02-12 11:06:00举报|引用
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以下是引用sjp在2009-2-11 17:43:00的发言：

粒层细胞瘤

But inhibin and calretinin are negative.

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8 楼发表于2009-02-10 09:45:00举报|引用
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inhibin, nse negative

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9 楼发表于2009-02-09 03:00:00举报|引用
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Epithelial markers, CD45, CD3, Cd20 are negative

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10 楼发表于2009-02-08 06:57:00举报|引用
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以下是引用天山望月在2009-2-7 22:02:00的发言：

谢谢赵博士分享有趣的病例！估计不易诊断。

我试着描述一下：瘤细胞密集弥漫分布，有点网状连接，隐约可见 Call-Exner小体样结构，细胞小圆形，界不清，核圆形，有核仁，偶见核沟，高核分裂像。

考虑较多：1、卵巢成年型粒层细胞瘤（弥漫型）？2、间质肉瘤？3、PNET？4、淋巴瘤？（可见浆细胞）

5、类癌？等，免疫组化有帮助。

切除部位较多，估计病变复杂。期待更多讨论。。。

Only lesion was in this overy. All other orgains showed no significant lesions.

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11 楼发表于2009-02-07 07:13:00举报|引用
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More history: Pt had no any previous malignant history. She presented with vaginal bleeding. U/S indicated the adanexal mass. Clinical examination and imaging did not find other abnormality.

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