考虑颗粒?

 Toss my two pennies thoughts for discussion. Differential diagnosese include:

1) granulosa cell tumor adult type; please run inhibin to confirm

2) small cell carcinoma with hypercalcimium of the ovary: please check calcium level clinically

3) endometrial stromal sarcoma: your CD10 negativity essentially rule out this DDx.

Please provide your differential diagnosis and study to include in or exclude out.

 颗粒细胞瘤 ？

小细胞癌？

 Agree with above, but favor small cell carcinoma of ovary. 

There are morphologic suggestions for small cell carcinoma such as sheets of high grade carcinoma cells with scant cytoplasm, salt and pepper chromatin pattern and nuclear molding (seen better in last photo), mitoses, necrosis, etc.  Synatophysin is only weakly positive which is not surprising in neuroendocrine tumor.  Have you tried chromogranin A and CD57 (Leu-7)?  CD57 is a very good marker for neuroendocrine tumor.   Patient may not have hypercalcimia and other para-neoplastic symdrome in this 61 years old.  There are 2 subtypes of small cell carcinomas divided primarily based on patients' age.  The hypercalcimia type is more common in younger patients.

 肿瘤细胞呈巢状，瘤细胞胞质较少，核染色质粉尘状，核仁不清，核分裂像可见，有坏死。

诊断：小细胞癌。

考虑颗粒细胞癌