Microcystic stromal tumour of the ovary
Definition
A proposed new category of ovarian stromal tumour with thecoma-like areas plus microcystic change.
Patients are adult women across a wide age range, usually premenopausal. Presentation is usually with an abdominal mass. There is usually not an oestrogenic effect.
Tumours are unilateral. Most are under 10 cm in diameter. The cut surface is usually a mix of solid and cystic areas, white-yellow-tan.
Microcysts usually dominate; they consist of round to oval spaces, sometimes coalescing to irregular channels. There are solid cellular areas and fibrous bands resembling a thecoma. The cells have lightly eosinophilic cytoplasm and round to spindle nuclei with fine chromatin and small nucleoli. There may be bizarre nuclei. The mitotic rate is low. Scattered psammoma bodies may be seen. The contralateral ovary may show stromal hyperthecosis.
| Vimentin | |||
| CD10 | 16/16 | ||
| Cam5.2 | 4/16 | ||
| Calretinin | 1/16 | ||
| Inhibin | 1/16 | ||
| EMA | 0/16 | ||
| a-fetoprotein | 0/4 | ||
Thecoma: occurs in older women, usually postmenopausal; often cause oestrogenic effects withe uterine bleeding; there may be cystic degeneration; bizarre cells are lacking; there is usually positivity for calretinin and inhibin; staining for CD10 is weaker
luteinising thecoma associated with sclerosing peritonitis; occurs in young adult women; tumours are bilateral, cerebriform, reddish-brown; there is often a microcystic pattern; cells are small and fusiform with darkly staining nuclei; there may be marked mitotic activity; there is diffuse positivity for calretinin, inhibin and CD56
Sclerosing stromal tumour: are unilateral, solid-cystic, white-yellow; there are cellular islands but microcysts are lacking; there are slit-like staghorn thin-walled vessels; calretinin and inhibin are usually positive
Steroid cell tumour, oxyphil cells type: are often associated with androgenic, sometimes oestrogenic, effects; the tumour is often bright yellow but may be orange, brown or black due to lipid and lipochrome; degenerative cavities contain red cells; positive for calretinin, inhibin and often for CD10
Signet ring stromal tumour: unilateral, solid or solid-cystic, without hormonally effects; there are bland signet ring cells admixed with fibroblastic cells
Sertoli-Leydig cell tumour: large cysts contain colloid-like material; there may be microcysts; there will be areas of typical Sertoli cells and typical Leydig cells
Juvenile granulosa cell tumour; may have foci of bizarre cells; cysts are larger; inhibin and calretinin are positive, CD10 staining is limited
Yolk sac tumour: occur in women of reproductive age, usually unilateral large tumours, solid-cystic; Schiller-Duval bodies are present; mitotic activity is marked; there is almost always a raised serum a-fetoprotein
Monodermal teratomas:
struma ovarii: may be microcystic; positive for thyroglobulin and TTF-1
meningioma: may be microcystic but also shows whorls: positive for EMA
Brenner tumour with microcystic change
Surface epithelial carcinomas with microcystic change
Ovarian adenomatoid tumour: positive for calretinin and inhibin
Myxoid sarcoma
This tumour is benign.
©SMUHT/PW Bishop