I am not convinced this is a neoplastic lesion. To me it appears more physiologic than pathologic. Most of photos show an atretic follicle with central vascular structure, a layer of atrophic and splindle granulosa cell layer and a somewhat lutinized theca interna layer which is merging with ovarian stroma. The clue is the prominent eosinophilic and hyalinized so-called "glassy membrane" band in between dark spindle granulosa layer and lutinized theca interna. There are scattered lutinized thecal cells in theca interna with ample pink cytoplasm which are usually seen in childhood or pregnancy. I wonder if this patient has recent pregnancy or abortion history. Please let us know that. In any sense, I will be reluctant to make neoplastic diagnosis based on these photos alone.

On the other hand, there is a large homogenous eosinophilic area in low power photos, but not showing high power pictures. I am curious of the changes in that area and want to make sure we do not miss a spindle cell neoplasm such as ovarian fibroma. Please provide high power photos of those. My guess is that It is most likely just nothing but an area with spindle ovarian stroma.

 Interesting case.

Bin, you have good differential diagnosis.  However I cannot agree with you. I think these cells are neuronal component, but not sex cord stromal components.

The key for this case to dianose immature teratoma or mature solid teratome depends on that the neuroal component is immature and mature.

My feeling is that neuronal component is immature though I am not completely sure that. Need to check books to learn neuronal pathology or get consult from neuropathologists for final diagnosis.

 Chengquan, no offend.  You may be right. But it is so unusual to see an isolated few 'immature neuronal element" in such a clean back ground with no other "teratomatous" changes or components. It is so challenging to render right diagnosis without seeing the whole slide and whole pictures. The view of this case is so focused with lot of high magnifications. I feel there is no way I can call this an "immature teratoma" only based on these pictures. Just my two pennies to arouse further discussion here.

Merry Christmas!

好病例，学习了。请哪位翻译一下。

不确定这是个肿瘤性病变，我认为生理性表现胜过病理性病变。多数照片显示为具中央脉管结构的闭锁卵泡，一层营养层加上梭形粒层细胞以及被卵巢间质吸收融合的某些黄素化卵泡膜内层。诊断线索是明显的嗜酸性胞质和位于暗梭形颗粒细胞层和黄素化卵泡膜之间的透明化的所谓 “透明膜”带，在卵泡膜内层有散在黄素化卵泡膜细胞，胞质淡粉染，这种细胞常见于儿童期或孕期。病人是否有近期怀孕或流产史?请让我们知道。感觉上，我很不愿意仅凭这些照片就诊断为肿瘤。

另一方面，低倍镜下见很多同质嗜酸性细胞区域，但并未显示高倍镜特征，我对这些区域变化很感兴趣，需要确定是否漏诊了象卵巢纤维瘤之类的梭形细胞肿瘤。

请提供这些区域的高倍镜图片，我猜测很可能没问题，只是梭形细胞卵巢间质。

这些图片非常漂亮

如果这些图片代表的是肿瘤全部或绝大部分。可以确诊为单胚层畸胎瘤。

今天专门请教了我们科搞神经病理的桂秋萍教授，那些围绕血管腔的结构是模拟大脑的胚胎发育过程，相当于大脑皮层，以及蛛网膜下腔。所以即不是神经管，也不是室管膜结构。

这一例诊断不成熟畸胎瘤，不是依据原始神经管成分。是单胚层畸胎瘤，但不是室管膜瘤，而是低倍视野中有一区域由成片的小细胞构成，相当于神经母细胞瘤。

好例子，谢谢分享。