Identification of ovarian sex cord stromal tumours by immunohistochemistry

There are a number of markers with variable sensitivity across the range of sex cord stromal tumours.

Differential diagnosis

Of tumours at the sex-cord stromal end of spectrum(adult granulosa cell tumour, Sertoli cell tumour and Sertoli-Leydig cell tumour):

• primary ovarian carcinoma (particularly endometrioid carcinoma): usually positive for CK7 and EMA, usually negative for inhibin and calretinin
• carcinoid: positive for chromogranin and synaptophysin but negative for inhibin and calretinin
• FATWO: positive for CK8/18, inhibin and calretinin
• metastatic carcinoma (particularly tubular variant of Krukenberg tumour): positive for either CK7 or CK20, positive for EMA, negative for inhibin and calretinin
• small cell carcinoma of hypercalcaemic type: variably positive for EMA, negative for inhibin, some express calretinin

Of steroid cell tumours:

• ovarian clear cell carcinoma: diffuse expression of cytokeratins and EMA
• dysgerminoma: positive for CD117 and OCT4 but negative for inhibin
• metastatic renal cell carcinoma

Of fibromas and fibrothecomas:

• smooth muscle tumours
• metastatic gastrointestinal stromal tumour
• primary or metastatic endometrial stromal sarcoma
• Krukenberg tumour

References

1 Zhao C, Vinh TN, McManus K, Dabbs D, Barner R, Vang R. Identification of the most sensitive and robust immunohistochemical markers in different categories of ovarian sex cord-stromal tumors. Am J Surg Pathol. 2009 Mar;33(3):354-66.

This page last revised 5.4.2010

©SMUHT/PW Bishop