好病例！谢谢分享！

 学习了，好病例

学习了 

学习了， 谢谢分享

 谢谢楼主分享及老师们的讲解

 参见：

http://study.ipathology.cn/article/112.html

华夏病理网络课堂之海外讲坛讲座视频录像，美国沈儒龙医学博士主讲，微囊性间质瘤

 Am J Surg Pathol 2015 Oct;39 (10):1420-6. 

Microcystic Stromal Tumor: A Distinctive Ovarian Sex Cord-Stromal Neoplasm Characterized by FOXL2, SF-1, WT-1, Cyclin D1, and β-catenin Nuclear Expression and CTNNB1 Mutations.

Irving JA , Lee CH , Yip S , Oliva E , McCluggage WG , Young RH .

Abstract

Since our first description of the microcystic stromal tumor (MST) of the ovary, a rare and distinctive neoplasm with a definitional, usually striking microcystic pattern and a CD10+/vimentin+/inhibin-/calretinin- immunophenotype, 3 examples with β-catenin nuclear localization, and CTNNB1 mutation have been reported. We undertook a detailed immunohistochemical study and molecular analysis of CTNNB1 and FOXL2 of 15 cases of MST to further characterize this neoplasm and establish its histogenesis. Diffuse nuclear staining for FOXL2, WT-1, cyclin D1, and β-catenin was present in all tumors tested, and 12/15 were positive for steroidogenic factor-1 (SF-1). Heterozygous missense point mutations in exon 3 of CTNNB1 were detected in 8 of 14 cases, resulting in amino acid changes at codons 32, 34, 35, and 37. There was no correlation between CTNNB1 exon 3 mutation status and tumor immunophenotype. All 14 cases tested showed wild-type FOXL2. Our study establishes that MST of the ovary exhibits a characteristic FOXL2/SF-1/WT-1/cyclin D1/nuclear β-catenin-positive immunohistochemical profile, which may be useful in diagnosis and in the exclusion of histologic mimics. The presence of diffuse nuclear FOXL2 and WT-1 immunostaining in all cases and SF-1 in most supports the classification of MST within the sex cord-stromal category. Aberrant nuclear β-catenin expression, detected in all MSTs, appears to be the result of stabilizing CTNNB1 mutations in 57% of cases, providing further evidence that dysregulation of the Wnt/B-catenin pathway is involved in the tumorigenesis of MST and may involve activation of β-catenin with upregulation of cyclin D1.

PMID: 26200099 [Pubmed - In-Process]

 Am J Surg Pathol 2009 Mar;33 (3):367-75. 

Microcystic stromal tumor of the ovary: report of 16 cases of a hitherto uncharacterized distinctive ovarian neoplasm.

Irving JA , Young RH .

Department of Laboratory Medicine, Pathology, and Medical Genetics, Royal Jubilee Hospital, Victoria, BC, Canada. Julie.Irving@viha.ca

Abstract

We have encountered 16 ovarian neoplasms of probable stromal origin whose most distinctive feature is microcystic change, which is usually conspicuous. On the basis of our extensive experience with ovarian tumors, the neoplasm is unique and warrants separate categorization; we have elected to designate it "microcystic stromal tumor" because of its most striking feature. The patients ranged from 26 to 63 (mean 45) years of age and typically presented with a pelvic mass. Hormonal manifestations were possibly present in only 2. All tumors were unilateral with a mean size of 8.7 (range: 2 to 27) cm and none had evidence of extraovarian spread. The tumors were solid-cystic (11 cases), solid (3 cases), or predominantly cystic (2 cases). The solid component was usually firm and tan or white-tan, but in 1 case was yellowish; soft foci were present in 3 cases and small foci of hemorrhage, necrosis, or both, in 3. On microscopic examination the appearance of the tumors varied according to the relative prominence of their 3 fundamental components: microcysts, solid cellular regions, and fibrous stroma. Microcysts dominated in 9 cases, were roughly equal to noncystic morphology in 5 cases and were minor in 2. The microcystic pattern was characterized by small rounded to oval cystic spaces, in areas coalescing to larger irregular channels; intracytoplasmic vacuoles were also frequently present. The solid cellular areas were usually focally intersected by fibrous bands and hyaline plaques reminiscent of thecoma. The cells contained moderately conspicuous finely granular, lightly eosinophilic cytoplasm, with generally bland, round to oval or spindle-shaped nuclei with fine chromatin and small indistinct nucleoli. Foci of bizarre nuclei were, however, present in 10 cases. Mitotic rate was low in all cases, ranging from 0 to 2 mitoses/10 high-power fields. Immunohistochemical results were as follows: CD10, 16/16 cases positive; vimentin, 16/16 cases positive; inhibin, 1/16 cases weakly positive; calretinin, 1/16 cases positive; cytokeratin, 4/16 cases focally positive; and epithelial membrane antigen, 0/16 cases positive. Microcystic change can be observed in a wide variety of ovarian tumors and the broad potential differential diagnosis is discussed in the text. For tumors which have been well sampled and exhibit (1) a microcystic pattern and regions with lobulated cellular masses with intervening, sometimes hyalinized fibrous stroma, (2) an absence of morphologic features enabling any other specific diagnosis in the sex cord-stromal category, (3) an absence of epithelial elements, and (4) an absence of teratomatous or other germ cell elements, we propose the designation "microcystic stromal tumor." The characteristic immunophenotype is CD10/vimentin+/epithelial membrane antigen-, with focal cytokeratin-positivity in one-quarter of cases; inhibin and/or calretinin are usually negative. Seven patients with available follow-up are without evidence of disease at a mean of 4.25 years (range: 1.5 to 12.5 y) from the time of initial diagnosis. These tumors, to date, have occurred over a wide age range in postpubertal females, are characteristically unilateral, and confined to the ovary at presentation. They represent, in addition to the sclerosing stromal tumor (segregated out 3 decades ago), a distinctive subtype of ovarian tumor, likely also belonging to the stromal category based on current evidence.

PMID: 18971779 [ - ]

 我们的免疫组化结果：CD10弥漫阳性，inhibin和calretinin都阴性，这是微囊性间质瘤的特点之一。CD56阳性，也是性索标记之一。我们的意见是性索间质肿瘤，首先考虑粒层细胞瘤。

曹登峰教授会诊也是这个意见。

 inhibin阴性

 建议的组化什么时候可以有结果？

形态学考虑性索间质肿瘤（幼年性粒层细胞瘤或微囊性间质瘤），但免疫组化性索标记物仅CD56阳性，不太好解释。

 各位老师好：

此前，刘老师远程会诊意见：（左卵巢）初步考虑性索间质肿瘤，微囊性间质瘤可能性大。

建议染组化CD10，CD99，a-inhibin，calretinin，CgA，Syn，CD56，SMA，KI67，CKpan，CK7，EMA，WT-1，b-catinin。

我们提的组化今日出的结果：SALL4(-),ER(-),PAX8(-),WT-1(-),P53散在+（野生型),NapsinA(-),inhibin(-),CR(-),CD56(+),CD99(-),CK(-),KI67(40%+)。

组化提于刘老师会诊之前，当初诊断思路不甚正确，所以组化项目组合不太恰当，请各位谅解！

求各位老师您的宝贵意见！谢谢。

 今天收到了一个数字切片 待后面上传

幼年性颗粒细胞瘤