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?

 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.

 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