This women had TAH-BSO for leiomyoma and her right ovary shows the above incidental findings, what's your diagnosis? What else should we do?

 伴有环状小管的性索细胞肿瘤，此时需仔细寻找有无粒层细胞瘤成分，核分裂多少，查血CA125、雌激素等，B超检查盆腔及腹腔其它脏器情况，IHC标记：ＣＤ９９，ａ－抑素等，来判断良恶性、治疗方式的选择及预后。

不明白陈博士问的方向，仅仅这样理解，不知对否？请指导！谢谢！

没见过，这些腺样结构和腺腔内结晶体提示什么组织类型？

　　----前列腺？甲状腺？支持细胞小管？其它？

识别基本病变后才能进一步讨论诊断。

免疫组化可能有帮助：

　　前列腺--PSA

　　甲状腺--TTF-1

　　支持细胞--Inhibin

 Most of people get the diagnosis of Sex Cord tumor with Annular tubules (SCTAT). The questions I am asking are:

 1) How big has the tumor to be qualified as SCTAT? remember this is an incidental finding and the focus is <5 mm.

 2) What syndrome is SCTAT associated with (about 33%)? and what you need to inform the clinician to check on this patient?

 支持细胞--Inhibin如果阳性，它可能是环状小管性索瘤（迷你型？），也可能归于未分类的性索-间质肿瘤或病变。

它可散发或伴PJ综合征（口周和皮肤黑色素班，胃肠道多发性息肉），均可有性激素紊乱。

应检测性激素水平和以上PJ综合征表现。

谢谢陈隆文博士分享的好病例，继续学习。

 瘤灶微小，但环管结构典型。图1似可见钙化。很可能是伴有PJS的SCTAT。请结合临床。

good case!!!

 Thank you for all the discussion. Dr. Zhao's comment is very good. This is the third case of SCTAT I have seen and the first two, both had gross mass lesions. This one only has microscopic foci. I showed the case to several of my fellow pathologists who are good at GYN path, someone suggested to call this "SCTAT tumorlet", and others suggested "microscopic SCTAT). I decided to go with the later terminology basically because I was worried that some clinicians would not understand what is exactly SCTAT tumorlet.

 I think abin's post is very good, I did call the gynecologist to discuss the possibility of PSJ, she checked her up completely and there is no evidence of PJS. In the mean time, I asked my resident to submit the whole cervix to make sure that there is no adenoma malignum, and that came back negative. So, I guess that this case was exciting at the beginning and it just turns out to be an incidental finding.