Quanzi, the DDx can be broad with my top three: lutinized granulosa cell tumor, transitional cell carcinoma and metastatic carcinoma. I wish you could add couple more low power photos. IHC should be helpful. I will start with CK7, CK20, inhibin, AE1/3, SMA, CD56 and calretinin. Any other differentials in your mind? Please keep us posted on this case. Thanks lot for sharing.

 Urgly tumor, not like classtic gruanulosa tumor. In addition to Dr. Yang's ddx, high grade serous ca should be considered.  ER, p53, wt1 stains may be added.

感谢杨老师和赵老师!

由于我们现在只有新院区开活检,旧院区只有冰冻和细胞,联网也还没实现,我又要两边轮班,而且图象系统还没完善,我采图有点困难,对焦很模糊,低倍的图象更不容易,希望老师们原谅!

本例肿瘤低倍为实性巢状和微小腺样两种结构(如上图1/2),细胞异型性比较明显,核分裂5个/10HPF,核仁清晰/核膜较厚,偶见核沟,胞浆边界不清,当时我们考虑了低分化的颗粒细胞瘤和腺癌的鉴别,从HE形态看并不象恶性Brenner瘤(没有良性区域)或者"纯粹的"移行细胞癌(腺样结构占有一半面积,核分裂数量不够)

网织染色,巢状分割

先做的免疫组化如下:inhibin  CD99  EMA  AE1/AE3  ER  PR  Vim  Ki-67

 今天又做CK7+  CK20-,片子还没看见呢

无论免疫组化结果如何，从HE看，是低分化的癌，不像粒层细胞瘤。

 有的细胞好像有核沟 

 HE看，是低分化的癌，

 考虑    低分化内膜样癌

 不能确定，有些四不像，还想再多看些图

 结果呢？