57 y AA women/L ov mass 8x6x4 cm. This is the AFIP case in Jan 1974. Dr. Henry J Nosrr was Chair of Gynecology/breast Department at AFIP. He and his colleques reviewed the case, and also sent the case to MGH for second oppinion. The case was reviewed by Dr. Robert E. Scully and Dr. Stanley J. Robboy. I found the case in 2004 for immunostain research of ovarian sex cord stroma tumors and noticed their original interpretation for this case.Remember that there were no immuno atains in 1974. They had different oppinion and no final conclusion about this case.

I would like to share this case with our Chinese pathologists.

1. Know how difficult for some cases if there is no immunostain

2. To learn the concept of these world leading pathologists.

3. Hope our patholgoists know these greast pathologists. Welcome some ones to write some brief introduction for these pathologists,Robert E. Scully, Henry J Nosrr, Stanley J. Robboy. All of them are alive

4. Try yourself and you may have a better diagnosis than these experts. Ha, ha.

cz

 In 2004, I did the research project of IHC of ovarian sex cord stromal tumor at AFIP and  found this case.

I did many stains and showed you some in the following

 ae1/ae3

CK7

WT`(most sertoli cell tumor, WT1 positive)

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

Dr. Norris: Final Long  Letter to Contributor pathologist (March. 21, 1974).( I copied parts to you)

-In talking to these fellows at a meeting last week, I took the position that the lesion might be a carcinoid, and they got rather upset. They hold their view strongly the lesion is a SCT.

-I think we should keep the diagnosis open and see if we definitely resolve with time whether or not the lesion is a SCT or carcinoid

cz: 

At that time, Dr. Norris though mostly it was an carcinoid case. However most pathologists in the gynecologic department at AFIP were agaist him.

He was at MGH at that time. He reviewed the case and wrote the report:

I have looked at the seven EM photos and believe that the granules differ from those in carcinoid.

cz:

Basically he did not think it was carcinoid.

Dr. Norris sent the case to MGH, Harvard.

The interpretation from Dr. Robert E. Scully (Dr. Robert Young was his fellow) at the MGH: Favor a SCT over a carcinoid because of the very prominent solid tubular architecture. The nuclei do not look exactly right for a SCT, but overall picture is more in favor  of it.

Anyway he though it was sertoli cell tumor.

 This cases is here for a long time. Thank above interpretaion.

Dr. Norris at AFIP signed the case originally in January 14, 1974. His differential diagnosis included sertoli cell tumor (SCT) and carcinoid, but he favorred carcinoid. He had a long discussion in his report. Also the case was discussed in department conference.

Dr. Norris is an excellent gyn/breast pathologist and worked for about 30 years in gyn/breast department  at AFIP and was the Chair of the department for many years(longest chair in the department). He did a lot of important research in the areas of gyn/breast pathology. Dr. Kurman once worked at AFIP and was Dr. Norris's staff pathologist for a few years in the late 1970th. In the early 1990 he retired from AFIP and Worked in a group in Florida. Tavassoli became the Chair after Dr. Norris retired from AFIP. Now Dr. Norris completely retired and enjoys his life in Florida.

Do you agree with Dr. Norris's interpretation for this case?

 Dr. Henry J Nosrr , Dr. Robert E. Scully and Dr. Stanley J. Robboy.

我知道一些，他们都是顶级妇科病理专家，尤其崇敬Scully

我基本同意fangg：环状小管性索肿瘤。

但是Dr.zhao说了，主要结构是前三张图，那么修正一下诊断：Sertoli细胞瘤，部分伴有环状小管结构。

鉴别诊断如Dr.Young以前的一篇经典文献中所述，在此从略。

 哈哈，都试一试谁比世界顶级专家厉害！

形态很善良，良性或低度恶性。乱猜了：类癌。其实如果能选2个，第二个是支持细胞瘤。

 我瞎猜

1.性索间质肿瘤:支持细胞瘤或环小管性索瘤

2.卵巢子宫内膜样癌有时也会表现出性索样结构

 excellent slides!

Sex cord tumor with annular tubules should be considered first.

 There are more than 10 slides for this tumor. Most areas of the tumor look like first three photos, and focal areas like photos 4 and 5 (low and high power). So above photos represent the entire tumor. Now you can guess the diagnosis or have differential diagnosis. Your performance may be better than Drs. Scully, Norris or Robboy.

I will tell you their interpretation in 1974 after you have your oppinion. In the end I will show you the IHC results I did in 2005 (30 years later).