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- 卵巢Sertoliform (or sex cord-like) variant of 子宫内膜样癌 (cqz-3)
说说我的浅显的看法：
60岁，单侧，10cm；细胞梭形，界限不清，染色质致密，细胞条索状位于间质背景中；图1、2细节不明显，但是形态符合Call-Exner小体。因此首先考虑颗粒细胞瘤。
但是真的诊断时候要注意寻找有无其他成分。再者如图所示成分占多少。即使有其他成分，甚至其他成分占多数，只要如图所示部分超过10%仍然诊断颗粒细胞瘤；如果无其他成分且如图所示部分很少，则诊断“伴有少量性索间质的纤维瘤”
还要值得注意的是图3中，核深染，大小不一，虽然部分细胞似有核沟，但不明显，且有核分裂及非典型核分裂（左下、左中、水印中h所覆盖的细胞等），因此应该想到未分化小细胞癌。
请各位老师批评指正……
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Agree. In addition, the upper left photo is typical adenocarcinoma, to my eyes
The upper right and lower left appear similar, same type with low and high power? The right lower looks different again. Could this be a collision tumor of different kinds?
左上图：明确的腺管样结构：支持细胞瘤？类癌？腺癌？
右上图和左下图：同一形态不同倍数，腺管样或CE小体结构：支持细胞瘤？粒层细胞瘤？腺癌？
右下图：梁索结构：支持细胞瘤？粒层细胞瘤？类癌？
综合考虑：1，性索间质肿瘤：（1）支持细胞瘤，（2）两性母细胞瘤，（3）不考虑单纯的粒层细胞瘤。
2，支持细胞瘤与类癌混合性肿瘤。
3，最后需排除宫内膜样腺癌（整体感觉不象腺癌）。
建议标记物：inhibin, EMA, syn,CgA
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本帖最后由 于 2009-08-27 21:17:00 编辑
This tumor demonstrates variety of patterns, including overt glandular differentiation (figure 1) and trabecular pattern (figure 4). The figure 2 and 3 are difficult to define. I favor cribriform pattern over microfollicular pattern. I do not see typical Call-Exner bodies (follicular structures composed of granulosa cells arranged around a central eosinophilic hyaline or fibrillar material) and coffee beans (cells with longitudinal nuclear groove). Granulosa cell tumor is not favored, but cannot be ruled out. Carcinoid tumor and Sertoli cell tumor should also be in differential diangosis. Metastatic tumor cannot be excluded, either. This is a difficult case. It is really above my pay grade.
Thank above a lot of very good analysis.
Summary above discussion:
Differential diagnosis (DDX):
1. Sex cord stromal tumor. If it is sex cord tumor, what type? granulosa tumor vs sertoli cell tumor.
2. Carcinoid tumor.
3. Primary epithelial tumor. What type? Serous, endometrioid
4. Metastatic tumor. From where?
I think this is good DDX. We must work with IHC stains. I have full panel of IHC results and will paste here next week.
