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- 卵巢Sertoliform (or sex cord-like) variant of 子宫内膜样癌 (cqz-3)
学习了各位前辈的精彩分析，获益匪浅！
除了前辈提到的诊断外，我再提一个：卵巢子宫内膜样腺癌Sertoli样变型（或称为类似性索-间质肿瘤的子宫内膜样腺癌）。依据：1）患者60岁，年龄较大；2）图1显示明确的腺管样结构，大小不等，部分有相互融合；3）图2-图4显示实性片巢状、梁索状结构，但未见明确的Call-Exner小体及咖啡豆或石榴籽样细胞；4）需鉴别类癌、性索间质肿瘤。除仔细寻找子宫内膜样腺癌的其他特征（如有无鳞化）外，需做免疫组化PCK、CK7、EMA、Inhibin、CgA、syn等鉴别。
| 以下是引用Liu_Aijun在2009-8-27 8:52:00的发言：
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 |
Thank Dr. Liu's good analysis. We all should learn from Dr. Liu.
It is correct way to analyze a case-morphology observation, differential diagnosis, immunostains.
For these kinds of cases if you only give one diagnosis even right answer, still it is not correct way.
| 以下是引用quhong在2009-8-27 21:15:00的发言： 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. |
As above mentioned, granulosa cell tumors (GCT) have many growth patterns, frequently mixed. CALL-EXNAL小体 often is present in microfollicular pattern. In fact follicular patterns (micro or macro-) have been emphasized in the literature, but are less common than ther others in aggregates.
What percentage of GCTs have CALL-EXNAL小体. I cannot find the answer. Do Some ones can find the percentage with reference? Please paste here. Thank, cz.
By the way I do not meam this case is a GCT or not
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本帖最后由 于 2009-08-28 01:32:00 编辑
Now we have our DDX. I can tell you this is an ovarian primary tumor,not metastatic one. Also this is one tumor with different growth patterns, not a mixed tumor.
1. Before I show the IHC results, please give one guess diagnosis, only one dx. What dianosis do you favor based on the H&E slide?
2. What IHC stains do you want to order to distinguish sex cord tumor from carcinoid and epithelial tumor?
Thanks,
cz
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.
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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.
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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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?
