There are many epithelioid cells embedded in the ovarian stroma. They have very large oval nuclei, vesicular chromatin pattern, prominent nucleoli and, possibly vacuolated cytoplasm in rare cells. I don't see any crystals of Reinke in their granular cytoplasm. Though I do not find mitotic figures, these cells look quite atypical to me. The ovarian size is not very large, and the patient is quite young. Is there truly atypical endometrial glandular hyperplasia in the endometrium? Are there atypical epithelioid cells in the endometrial stroma? How often do you find mitotic figures in the ovary? Two differential diagnoses need to be considered - (1) ovarian thecoma with luteinization, and (2) metastatic adenocarcinoma. I recommend immunohistochemical stains with antibodies against inhibin and cytokeratin (AE1), as well as mucicarmine stain to identify any cytoplasmic mucin in these atypical cells. If these cells are luteinized stromal cells of a thecoma, inhibin would be positive, and AE1 and mucicarmine would be negative. If AE1 and/or mucicarmine are positive, this is a metastatic adenocarcinoma and a through search for its primary origin (breast, pancreas, esophagus and the entire gastrointestinal tract) would ne needed. I am worried that this may be a metastasis. I look forward to reading opinions of others and results of your workup.

 猜一猜：间质黄体瘤或脂质细胞瘤

 富于细胞性卵泡膜细胞瘤伴黄素化。

肿瘤细胞有明显的胶原产生，并呈梭形，应可判定属于卵泡膜纤维细胞成份。有少量的圆形细胞成份，胞浆较多，偏伊红，但部分有梭形细胞过渡，并且没有Reinke结晶，因此可以除外Stromal-Ledyig细胞瘤。同意mjma老师的考虑，要想到转移性癌之可能。但从整个结构特征和较大细胞的分布看，并不支持这一诊断。

由于没有明显的细胞异型性和核分裂，诊断富于细胞的卵泡膜细胞瘤伴黄素化便可。这类肿瘤可以产生雌激素，引发子宫内膜的各类增生过长。

 马老师分析有道理。There are many epithelioid cells embedded in the ovarian stroma. 卵巢间质中藏匿有许多上皮样细胞，They have very large oval nuclei, vesicular chromatin pattern, prominent nucleoli and, possibly vacuolated cytoplasm in rare cells.这些上皮样的细胞核大，卵圆，染色质呈泡状，核仁明显，极少数细胞好象还含有空泡状的泡浆． I don't see any crystals of Reinke in their granular cytoplasm. 但是在颗粒状的泡浆中并无Reinke 氏结晶，Though I do not find mitotic figures, these cells look quite atypical to me. 虽然并未见到核丝分裂，我看这些细胞似乎非常异形，The ovarian size is not very large, and the patient is quite young. 卵巢不是很大，病人也非常年青，Is there truly atypical endometrial glandular hyperplasia in the endometrium? 不知患者有无子宫内膜腺体的非典型性增生？Are there atypical epithelioid cells in the endometrial stroma? 子宫内膜间质里有无非典型增生的上皮样细胞？How often do you find mitotic figures in the ovary? 通常你们在卵巢可见有分裂相吗？Two differential diagnoses need to be considered - (1) ovarian thecoma with luteinization, and (2) metastatic adenocarcinoma. 考虑两个问题１、黄素化的卵巢卵泡膜细胞瘤，２、转移性腺癌。I recommend immunohistochemical stains with antibodies against inhibin and cytokeratin (AE1), as well as mucicarmine stain to identify any cytoplasmic mucin in these atypical cells. 建议做免疫组化用inhibin 、ＣＫ (AE1)和mucicarmine染色（粘液卡红），去标记这些非典型细胞胞浆中的粘蛋白，If these cells are luteinized stromal cells of a thecoma, inhibin would be positive, and AE1 and mucicarmine would be negative. 如果是卵泡膜细胞瘤的黄素化细胞，inhibin 应该是阳性，ＣＫ和mucicarmine（粘液卡红）阴性。If AE1 and/or mucicarmine are positive, this is a metastatic adenocarcinoma and a through search for its primary origin (breast, pancreas, esophagus and the entire gastrointestinal tract) would ne needed. 反之，如果ＣＫ和＼或粘液卡红阳性，应该是转移性腺癌或需要找原发癌的部位如乳腺、胰腺、食管、或整个消化道。I am worried that this may be a metastasis. 需要警惕转移癌的问题。I look forward to reading opinions of others and results of your workup. 我盼望大家的分析和进一步的检查结果。

 谢谢周老师与月新老师，学习了。

以下是引用周先荣 在2007-5-6 21:02:00的发言：  富于细胞性卵泡膜细胞瘤伴黄素化。 肿瘤细胞有明显的胶原产生，并呈梭形，应可判定属于卵泡膜纤维细胞成份。有少量的圆形细胞成份，胞浆较多，偏伊红，但部分有梭形细胞过渡，并且没有Reinke结晶，因此可以除外Stromal-Ledyig细胞瘤。同意mjma老师的考虑，要想到转移性癌之可能。但从整个结构特征和较大细胞的分布看，并不支持这一诊断。 由于没有明显的细胞异型性和核分裂，诊断富于细胞的卵泡膜细胞瘤伴黄素化便可。这类肿瘤可以产生雌激素，引发子宫内膜的各类增生过长。

学习！

 该例我们诊断为：卵巢硬化性间质瘤。

依据：

1.  年轻女性。   

 2.   镜下为分叶状生长，小叶内纤维化，明显的血管化以及存在两种细胞聚集：即产生胶元的梭形细胞和含有脂质的圆形或卵圆形细胞。

 学习

 

 同意：）

 谢谢各位老师，学习了！

 学习了

 单从看图后，支持周老师的观点，结果是卵巢硬化性间质瘤，回顾，也支持。卵巢肿瘤形态不太典型时，不易诊断哦。