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| | [[Image:Ovarian carcinoma.JPG|thumb|250px|right|[[Gross pathology|Gross]] photo of a [[malignant]] ovarian tumour. (WC/Doc James)]] |
| The article examines '''ovarian tumours''' including '''ovarian cancer'''. | | The article examines '''ovarian tumours''' including '''ovarian cancer'''. |
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| An introduction to the ovary is in the ''[[ovary]]'' article, which also deals benign cysts. | | An introduction to the ovary is in the ''[[ovary]]'' article, which also deals benign cysts. |
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| | What was labeled "ovarian cancer" in the past may really arise from [[fallopian tube]].<ref name=pmid19574767>{{Cite journal | last1 = Hirst | first1 = JE. | last2 = Gard | first2 = GB. | last3 = McIllroy | first3 = K. | last4 = Nevell | first4 = D. | last5 = Field | first5 = M. | title = High rates of occult fallopian tube cancer diagnosed at prophylactic bilateral salpingo-oophorectomy. | journal = Int J Gynecol Cancer | volume = 19 | issue = 5 | pages = 826-9 | month = Jul | year = 2009 | doi = 10.1111/IGC.0b013e3181a1b5dc | PMID = 19574767 }}</ref> The label ''tubo-ovarian cancer'' |
| | has been advocated to address this change. These tumours are dealt with in this article. |
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| =Clinical= | | =Clinical= |
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| *There are two versions.<ref name=ukguide>URL: [http://www.sign.ac.uk/guidelines/fulltext/75/section3.html http://www.sign.ac.uk/guidelines/fulltext/75/section3.html]. Accessed on: 16 September 2011.</ref> | | *There are two versions.<ref name=ukguide>URL: [http://www.sign.ac.uk/guidelines/fulltext/75/section3.html http://www.sign.ac.uk/guidelines/fulltext/75/section3.html]. Accessed on: 16 September 2011.</ref> |
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| Elements & points (RIM 2):<ref name=ukguide>URL: [http://www.sign.ac.uk/guidelines/fulltext/75/section3.html http://www.sign.ac.uk/guidelines/fulltext/75/section3.html]. Accessed on: 16 September 2011.</ref> | | ====Definition==== |
| | :<math>RMI\ score = ultrasound\ score\ *\ menopausal\ score\ *\ CA125\ level\ [U/ml].</math> |
| | |
| | ====Elements==== |
| | Elements & points (RMI 2):<ref name=ukguide>URL: [http://www.sign.ac.uk/guidelines/fulltext/75/section3.html http://www.sign.ac.uk/guidelines/fulltext/75/section3.html]. Accessed on: 16 September 2011.</ref> |
| #Ultrasound features. | | #Ultrasound features. |
| #*Significant findings: multilocular cyst, solid component, bilateral lesions, ascites, suspected intra-abdominal [[metastases]] (one finding=1 point, two or more findings=4 points). | | #*Significant findings: multilocular cyst, solid component, bilateral lesions, ascites, suspected intra-abdominal [[metastases]] (one finding=1 point, two or more findings=4 points). |
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| #CA-125 (blood test) in ''U/ml''. | | #CA-125 (blood test) in ''U/ml''. |
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| <math>RMI\ score = ultrasound\ score\ x\ menopausal\ score\ x\ CA125\ level\ [U/ml].</math>
| | ====Interpretation==== |
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| Interpretation: | |
| *RMI > 200 -- predicts malignancy. | | *RMI > 200 -- predicts malignancy. |
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| Surface epithelial tumours: | | Surface epithelial tumours: |
| # [[Serous carcinoma of the ovary|Serous carcinoma.]]. | | # [[Serous carcinoma of the ovary|Serous carcinoma]]. |
| | #* High-grade serous carcinoma. † |
| | #* Low-grade serous carcinoma. |
| # [[Endometrioid carcinoma of the ovary|Endometrioid carcinoma]]. | | # [[Endometrioid carcinoma of the ovary|Endometrioid carcinoma]]. |
| # [[Mucinous carcinoma of the ovary|Mucinous carcinoma]]. | | # [[Mucinous carcinoma of the ovary|Mucinous carcinoma]]. |
| # Transitional cell tumours<ref name=Ref_WMSP401>{{Ref WMSP|401}}</ref> ([[Brenner tumour]]).
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| # [[Clear cell carcinoma of the ovary|Clear cell carcinoma]]. | | # [[Clear cell carcinoma of the ovary|Clear cell carcinoma]]. |
| | # [[Brenner tumour]]. |
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| | Note: |
| | * † Transitional cell tumours<ref name=Ref_WMSP401>{{Ref WMSP|401}}</ref> are now grouped with high-grade serous carcinoma.<ref name=pmid23681072>{{Cite journal | last1 = Takeuchi | first1 = T. | last2 = Ohishi | first2 = Y. | last3 = Imamura | first3 = H. | last4 = Aman | first4 = M. | last5 = Shida | first5 = K. | last6 = Kobayashi | first6 = H. | last7 = Kato | first7 = K. | last8 = Oda | first8 = Y. | title = Ovarian transitional cell carcinoma represents a poorly differentiated form of high-grade serous or endometrioid adenocarcinoma. | journal = Am J Surg Pathol | volume = 37 | issue = 7 | pages = 1091-9 | month = Jul | year = 2013 | doi = 10.1097/PAS.0b013e3182834d41 | PMID = 23681072 }}</ref><ref name=pmid23018212>{{Cite journal | last1 = Ali | first1 = RH. | last2 = Seidman | first2 = JD. | last3 = Luk | first3 = M. | last4 = Kalloger | first4 = S. | last5 = Gilks | first5 = CB. | title = Transitional cell carcinoma of the ovary is related to high-grade serous carcinoma and is distinct from malignant brenner tumor. | journal = Int J Gynecol Pathol | volume = 31 | issue = 6 | pages = 499-506 | month = Nov | year = 2012 | doi = 10.1097/PGP.0b013e31824d7445 | PMID = 23018212 }}</ref> |
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| Sex cord stromal tumours: | | Sex cord stromal tumours: |
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| *Silverberg grading system,<ref>{{cite journal |author=Silverberg SG |title=Histopathologic grading of ovarian carcinoma: a review and proposal |journal=Int. J. Gynecol. Pathol. |volume=19 |issue=1 |pages=7-15 |year=2000 |month=January |pmid=10638449 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=19&issue=1&spage=7}}</ref> aka ''universal grading system''. | | *Silverberg grading system,<ref>{{cite journal |author=Silverberg SG |title=Histopathologic grading of ovarian carcinoma: a review and proposal |journal=Int. J. Gynecol. Pathol. |volume=19 |issue=1 |pages=7-15 |year=2000 |month=January |pmid=10638449 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=19&issue=1&spage=7}}</ref> aka ''universal grading system''. |
| *Based on ''pattern'', ''cytologic atypia'' and ''mitotic rate''. | | *Based on ''pattern'', ''cytologic atypia'' and ''mitotic rate''. |
| *System somewhat similar to [[breast]] grading, which can be remembered as: ''TMN'' (tubular formation, mitotic rate, nuclear atypia). | | *System somewhat similar to [[breast]] grading, which can be remembered as: ''TNM'' (tubular formation, [[nuclear atypia]], mitotic rate). |
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| ===Silverberg system=== | | ===Silverberg system=== |
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| *Grade III = 8-9. | | *Grade III = 8-9. |
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| Note 1: | | Note: |
| *Most resident microscopes have an eyepiece diameter of 22 mm. Thus, the approximate field diameter is 0.55 mm (22 mm/40 X = 0.55 mm), at highest magnification, and the field area is 0.23758 mm^2 (pi*(0.55/2)^2=0.23758 mm^2). | | *Most resident microscopes have an eyepiece diameter of 22 mm. Thus, the approximate field diameter is 0.55 mm (22 mm/40 X = 0.55 mm), at highest magnification, and the field area is 0.23758 mm^2 (pi*(0.55/2)^2=0.23758 mm^2). |
| *The number of HPFs should be adjusted if the area per field is different than 0.345 mm^2. | | *The number of HPFs should be adjusted if the area per field is different than 0.345 mm^2. |
| **If the field diameter is 0.55 mm and the sample area is 3.45 mm^2, this is equivalent to 14.52 HPFs (3.45 mm^2 / 0.23758 mm^2 = 14.52); thus, it would be appropriate to use 15 HPFs and the cut points above. | | **If the field diameter is 0.55 mm and the sample area is 3.45 mm^2, this is equivalent to 14.52 HPFs (3.45 mm^2 / 0.23758 mm^2 = 14.52); thus, it would be appropriate to use 15 HPFs and the cut points above. |
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| Note 2:
| | ===Predictive power of Silverberg grading=== |
| *A not-so-good alternative is to adjust the number of mitotic counts a keep the number of HPFs (10) constant.
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| **If the mitotic rate per area is held constant, and the cut points are 9, 10 and 24, the equivalent mitoses per area are:
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| ***0-4 mitoses/((HPF of 0.345 mm^2) x 10) = 1.
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| ***5-11 mitoses/((HPF of 0.345 mm^2) x 10) = 2.
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| ***12+ mitoses/((HPF of 0.345 mm^2) x 10) = 3.
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| ===Value of Silverberg...=== | |
| Good correlation with five year survival (rounded values):<ref name=pmid12496698>{{cite journal |author=Sato Y, Shimamoto T, Amada S, Asada Y, Hayashi T |title=Prognostic value of histologic grading of ovarian carcinomas |journal=Int. J. Gynecol. Pathol. |volume=22 |issue=1 |pages=52-6 |year=2003 |month=January |pmid=12496698 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=22&issue=1&spage=52}}</ref> | | Good correlation with five year survival (rounded values):<ref name=pmid12496698>{{cite journal |author=Sato Y, Shimamoto T, Amada S, Asada Y, Hayashi T |title=Prognostic value of histologic grading of ovarian carcinomas |journal=Int. J. Gynecol. Pathol. |volume=22 |issue=1 |pages=52-6 |year=2003 |month=January |pmid=12496698 |doi= |url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0277-1691&volume=22&issue=1&spage=52}}</ref> |
| *Grade I = 90%. | | *Grade I = 90%. |
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| ==Peritoneal implants== | | ==Peritoneal implants== |
| ===General=== | | ===General=== |
| *In the setting of [[serous borderline tumour]]s there is much ado about implants. | | Applies only to: |
| | *[[Serous borderline tumour]]. |
| | *[[Seromucinous borderline tumour]]. |
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| ====Classification==== | | ====Classification==== |
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| ===IHC=== | | ===IHC=== |
| *Elastin stain. | | *Elastin stain. |
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| | =Staging of ovarian cancer= |
| | *The CAP protocol talks of in the pelvis and outside the pelvis - pT2 versus pT3. |
| | *Omental involvement is considered outside the pelvis; it is pT3.<ref>URL: [http://ovariancancer.about.com/od/testsdiagnosis/a/FIGO_stages.htm http://ovariancancer.about.com/od/testsdiagnosis/a/FIGO_stages.htm]. Accessed on: 8 July 2013.</ref> |
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| =Surface epithelial tumours= | | =Surface epithelial tumours= |
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| '''Where to start when considering a malignant (epithelial) tumour of the ovary:''' | | '''Where to start when considering a malignant (epithelial) tumour of the ovary:''' |
| {| class="wikitable" | | {| class="wikitable sortable" |
| | || '''Serous''' || '''Endometrioid''' || '''Mucinous'''
| | !Features |
| | ! Serous |
| | ! Endometrioid |
| | ! Mucinous |
| |- | | |- |
| |Characteristics || cilia, columnar cells<br>psammoma bodies, papillary arch. || gland forming, endometrium-like || mucinous glands, colon-like | | |Histology |
| | | low grade: cilia, columnar cells, [[psammoma bodies]], papillary arch.; high grade: marked nuclear pleomorphism, prominent [[red nucleoli]], [[psammoma bodies]] |
| | | gland forming - esp. cribriforming, endometrium-like |
| | | mucinous glands, colon-like |
| |- | | |- |
| |Differentiators || cilia, psammoma bodies || squamous metaplasia || mucin, lack of necrosis | | |Differentiators |
| | | cilia, [[psammoma bodies]] |
| | | squamous metaplasia |
| | | mucin, often lack of [[necrosis]] |
| |- | | |- |
| |Associations || atrophy || endometriosis, endometrial hyperplasia || (?) | | |Associations |
| | | atrophy |
| | | [[endometriosis]], [[endometrial hyperplasia]] |
| | | (?) |
| |- | | |- |
| |Typical age || usually 60s+ || 40-60 || varies (?) | | |Typical age |
| | | usually 60s+ |
| | | 40-60 |
| | | varies (?) |
| |- | | |- |
| |Grade || typically high grade || typically low grade || often low | | |Grade |
| | | typically high grade |
| | | typically low grade |
| | | often low |
| |- | | |- |
| |IHC || p53 +ve (diffuse), WT-1 +ve, CA-125 +ve, D2-40 +ve || WT-1 -ve || CK7 +ve, CK20 +ve (other tumours CK7 +ve, CK20 -ve) | | |IHC |
| | | p53 +ve (diffuse), WT-1 +ve, CA-125 +ve, D2-40 +ve |
| | | WT-1 -ve |
| | | CK7 +ve, CK20 +ve (other tumours CK7 +ve, CK20 -ve) |
| |- | | |- |
| |Main DDx || poorly diff. endometrioid || serous || metastatic tumour (usually GI) | | |Main DDx |
| | | poorly diff. endometrioid |
| | | serous |
| | | metastatic tumour (usually GI) |
| |- | | |- |
| |} | | |} |
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| **Columnar. | | **Columnar. |
| *Papillae. | | *Papillae. |
| *[[Psammoma bodies]] (concentric calcifications). | | *[[Psammoma bodies]] (concentric [[calcification]]s). |
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| Note: | | Note: |
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| ==Serous carcinoma of the ovary== | | ==Serous carcinoma of the ovary== |
| *[[AKA]] ''ovarian [[serous carcinoma]]''. | | *[[AKA]] ''ovarian [[serous carcinoma]]''. |
| | | {{Main|Serous carcinoma of the ovary}} |
| ===General===
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| *Most common malignant ovarian tumour in the eldery.
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| *Poor prognosis.
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| ===Microscopic===
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| Features:
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| *Marked nuclear pleomorphism:
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| **Variation in size - usually marked.
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| **Variation in staining.
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| **Variation in shape.
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| *Prominent nucleolus - '''key feature'''.
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| *Eccentric nucleus.
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| *Architecture:
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| **Solid.
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| **Papillary - classic.
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| **Glandular - uncommon.
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| *+/-Psammoma bodies - uncommon.
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| *+/-Necrosis - often extensive.
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| DDx:
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| *[[Clear cell carcinoma of the ovary]] - less nuclear size variation.
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| *[[Endometrioid carcinoma of the ovary]] - usu. lower grade.
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| *[[Primary peritoneal serous carcinoma]] - bulk of tumour in peritoneum, small ovarian tumour.
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| *Other non-ovarian serous carcinomas - ''see [[serous carcinoma]]''.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Serous_carcinoma_cytology.jpg Serous carcinoma - cytology (WC)].
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| ===IHC===
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| *CK7 +ve.
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| *WT-1 +ve.
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| *CA-125 +ve.
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| *ER +ve.<ref name=pmid21164285>{{Cite journal | last1 = DeLair | first1 = D. | last2 = Oliva | first2 = E. | last3 = Köbel | first3 = M. | last4 = Macias | first4 = A. | last5 = Gilks | first5 = CB. | last6 = Soslow | first6 = RA. | title = Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. | journal = Am J Surg Pathol | volume = 35 | issue = 1 | pages = 36-44 | month = Jan | year = 2011 | doi = 10.1097/PAS.0b013e3181ff400e | PMID = 21164285 }}</ref>
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| *p53 +ve.
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| Others:
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| *HNF-1beta -ve.<ref>{{Cite journal | last1 = Tsuchiya | first1 = A. | last2 = Sakamoto | first2 = M. | last3 = Yasuda | first3 = J. | last4 = Chuma | first4 = M. | last5 = Ohta | first5 = T. | last6 = Ohki | first6 = M. | last7 = Yasugi | first7 = T. | last8 = Taketani | first8 = Y. | last9 = Hirohashi | first9 = S. | title = Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma. | journal = Am J Pathol | volume = 163 | issue = 6 | pages = 2503-12 | month = Dec | year = 2003 | doi = | PMID = 14633622 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed }}</ref><ref name=omim189907>{{OMIM|189907}}</ref>
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| **Usually +ve in [[clear cell carcinoma of the ovary]].
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| ==Serous cystadenoma of the ovary== | | ==Serous cystadenoma of the ovary== |
| *[[AKA]] ''ovarian [[serous cystadenoma]]''. | | *[[AKA]] ''ovarian serous cystadenoma''. |
| ===General===
| | *Related to ''adenofibroma'' and ''serous cystadenofibroma''. |
| *Benign.
| | {{Main|Serous cystadenoma of the ovary}} |
| *Very common.
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| *'''Not''' related to the [[serous cystadenoma of the pancreas]]. | |
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| ===Gross=== | | ==Ovarian serous borderline tumour== |
| *Usually unilocular.
| | *[[AKA]] ''serous borderline tumour of the ovary''. |
| | *[[AKA]] ''serous tumour of low malignant potential of the ovary'', abbreviated ''SLMP''.<ref name=pmid10836293>{{Cite journal | last1 = Seidman | first1 = JD. | last2 = Kurman | first2 = RJ. | title = Ovarian serous borderline tumors: a critical review of the literature with emphasis on prognostic indicators. | journal = Hum Pathol | volume = 31 | issue = 5 | pages = 539-57 | month = May | year = 2000 | doi = | PMID = 10836293 }}</ref><ref name=pmid10881733>{{Cite journal | last1 = Dietel | first1 = M. | last2 = Hauptmann | first2 = S. | title = Serous tumors of low malignant potential of the ovary. 1. Diagnostic pathology. | journal = Virchows Arch | volume = 436 | issue = 5 | pages = 403-12 | month = May | year = 2000 | doi = | PMID = 10881733 }}</ref> |
| | {{Main|Serous borderline tumour}} |
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| ===Microscopic=== | | ==Mucinous ovarian tumours== |
| Features:
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| *Simple epithelium with cilia - '''key feature'''.
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| **Cell morphology: columnar, cuboidal or flatted.
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| DDx:
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| *Serous cystadenofibroma.
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| ==Seromucinous borderline tumor of the ovary==
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| *[[AKA]] ''endocervical-type mucinous and mixed cell-type tumour''.<ref name=pmid12459620>{{Cite journal | last1 = Shappell | first1 = HW. | last2 = Riopel | first2 = MA. | last3 = Smith Sehdev | first3 = AE. | last4 = Ronnett | first4 = BM. | last5 = Kurman | first5 = RJ. | title = Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. | journal = Am J Surg Pathol | volume = 26 | issue = 12 | pages = 1529-41 | month = Dec | year = 2002 | doi = | PMID = 12459620 }}</ref>
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| ===General===
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| *Rare.
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| *Associated with [[endometriosis]].
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| ===Gross===
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| *Mucin-filled cysts.
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| Image:
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| *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=009520 Seromucinous borderline tumor of the ovary (unibas.ch)].
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| ===Microscopic===
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| Features:
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| #Simple mucinous epithelium - endocervical type.<ref>{{Cite journal | last1 = Shappell | first1 = HW. | last2 = Riopel | first2 = MA. | last3 = Smith Sehdev | first3 = AE. | last4 = Ronnett | first4 = BM. | last5 = Kurman | first5 = RJ. | title = Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. | journal = Am J Surg Pathol | volume = 26 | issue = 12 | pages = 1529-41 | month = Dec | year = 2002 | doi = | PMID = 12459620 }}</ref>
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| #*Tall columnar epithelium with apical pale cytoplasm.
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| #Simple serous epithelium - with cilia.
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| ==Mucinous tumours - overview==
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| ==General== | | ==General== |
| *Common. | | *Common. |
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| Comparison of mucosa: | | Comparison of mucosa: |
| *Normal endocervical mucosa: [http://pathology.mc.duke.edu/research/Histo_course/endocx.jpg endocervical mucosa]. | | *Normal endocervical mucosa: [http://pathology.mc.duke.edu/research/Histo_course/endocx.jpg endocervical mucosa (duke.edu)]. |
| *Normal colonic mucosa: [http://cellbio.utmb.edu/microanatomy/epithelia/00004493.jpg colonic type mucosa]. | | *Normal gastric mucosa: [http://commons.wikimedia.org/wiki/File:Normal_gastric_mucosa_intermed_mag.jpg gastric mucosa (WC)]. |
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| ===Classification=== | | ===Classification=== |
| *Benign. (Dx: mucinous cystadenoma ''or'' mucinous adenofibroma ''or'' mucinous cystadenofibroma) | | *Benign. (Dx: [[Mucinous_cystadenoma_of_the_ovary|mucinous cystadenoma]] ''or'' mucinous adenofibroma ''or'' mucinous cystadenofibroma) |
| **Single layer of cells. | | **Single layer of cells. |
| *Borderline. (Dx: ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour'') | | *Borderline. (Dx: ''mucinous tumour of uncertain malignant potential'' or ''borderline mucinous tumour'') |
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| **Usually intestinal subtype. | | **Usually intestinal subtype. |
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| ==Mucinous adenocarcinoma of the ovary== | | ==Seromucinous borderline tumour of the ovary== |
| *[[AKA]] ''ovarian mucinous adenocarcinoma''. | | *[[AKA]] ''endocervical-type mucinous and mixed cell-type tumour''.<ref name=pmid12459620>{{Cite journal | last1 = Shappell | first1 = HW. | last2 = Riopel | first2 = MA. | last3 = Smith Sehdev | first3 = AE. | last4 = Ronnett | first4 = BM. | last5 = Kurman | first5 = RJ. | title = Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. | journal = Am J Surg Pathol | volume = 26 | issue = 12 | pages = 1529-41 | month = Dec | year = 2002 | doi = | PMID = 12459620 }}</ref> |
| ===General=== | | ===General=== |
| *Malignant. | | *Rare. |
| *May arise in [[endometriosis]].<ref name=Ref_PBoD1097>{{Ref PBoD |1097}}</ref> | | *Associated with [[endometriosis]]. |
| *Poor response to chemotherapy vis-à-vis serous carcinoma.<ref name=pmid19275957>{{Cite journal | last1 = Shimada | first1 = M. | last2 = Kigawa | first2 = J. | last3 = Ohishi | first3 = Y. | last4 = Yasuda | first4 = M. | last5 = Suzuki | first5 = M. | last6 = Hiura | first6 = M. | last7 = Nishimura | first7 = R. | last8 = Tabata | first8 = T. | last9 = Sugiyama | first9 = T. | title = Clinicopathological characteristics of mucinous adenocarcinoma of the ovary. | journal = Gynecol Oncol | volume = 113 | issue = 3 | pages = 331-4 | month = Jun | year = 2009 | doi = 10.1016/j.ygyno.2009.02.010 | PMID = 19275957 }}</ref>
| | ===Gross=== |
| | *Mucin-filled cysts. |
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| ===Gross===
| | Image: |
| Features:
| | *[http://alf3.urz.unibas.ch/pathopic/e/getpic-fra.cfm?id=009520 Seromucinous borderline tumor of the ovary (unibas.ch)]. |
| *Multiloculated. | |
| *Sticky, gelatinous fluid (glycoprotein).
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| *+/-[[Necrosis]].
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features: |
| *Tall [[columnar cell]]s in glands.
| | #Simple mucinous epithelium - endocervical type.<ref>{{Cite journal | last1 = Shappell | first1 = HW. | last2 = Riopel | first2 = MA. | last3 = Smith Sehdev | first3 = AE. | last4 = Ronnett | first4 = BM. | last5 = Kurman | first5 = RJ. | title = Diagnostic criteria and behavior of ovarian seromucinous (endocervical-type mucinous and mixed cell-type) tumors: atypical proliferative (borderline) tumors, intraepithelial, microinvasive, and invasive carcinomas. | journal = Am J Surg Pathol | volume = 26 | issue = 12 | pages = 1529-41 | month = Dec | year = 2002 | doi = | PMID = 12459620 }}</ref> |
| **Apical mucin.
| | #*Tall columnar epithelium with apical pale cytoplasm. |
| **May vaguely resemble [[colorectal adenocarcinoma]].
| | #Simple serous epithelium - with cilia. |
| *Glands have mucin.
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| *+/-Nuclear atypia.
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| *No [[cilia]]. | |
| *+/-Necrosis.
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| ====Subtypes==== | | ==Mucinous cystadenoma of the ovary== |
| #''Endocervical type''.
| | *[[AKA]] ''ovarian mucinous cystadenoma''. |
| #*Less likely to be malignant.
| | {{Main|Mucinous cystadenoma of the ovary}} |
| #*More common than malignant type.
| |
| #''Intestinal type''.
| |
| #*More likely to be malignant.
| |
| #*[[Goblet cell]]s. (???)
| |
| #**One large clear apical vacuole.
| |
| #*If it doesn't look like intestine to you... it probably isn't.
| |
| #*May vaguely resemble colorectal adenocarcinoma (hyperchromatic, columnar nuclei, nuclear pleomorphism).
| |
| #**Image: [http://www.ispub.com/xml/journals/ijgo/vol9n1/papillary-fig4.jpg]
| |
|
| |
|
| Comparison of mucosa:
| | ==Mucinous borderline tumour of the ovary== |
| *Normal endocervical mucosa: [http://pathology.mc.duke.edu/research/Histo_course/endocx.jpg endocervical mucosa]. | | *[[AKA]] ''ovarian mucinous borderline tumour''. |
| *Normal colonic mucosa: [http://cellbio.utmb.edu/microanatomy/epithelia/00004493.jpg colonic type mucosa].
| | *[[AKA]] ''ovarian mucinous tumour of low malignant potential''.<ref name=pmid21464732>{{Cite journal | last1 = Khunamornpong | first1 = S. | last2 = Settakorn | first2 = J. | last3 = Sukpan | first3 = K. | last4 = Suprasert | first4 = P. | last5 = Siriaunkgul | first5 = S. | title = Mucinous tumor of low malignant potential (borderline or atypical proliferative tumor) of the ovary: a study of 171 cases with the assessment of intraepithelial carcinoma and microinvasion. | journal = Int J Gynecol Pathol | volume = 30 | issue = 3 | pages = 218-30 | month = May | year = 2011 | doi = 10.1097/PGP.0b013e3181fcf01a | PMID = 21464732 }}</ref> |
| | {{Main|Mucinous borderline tumour of the ovary}} |
|
| |
|
| ===IHC=== | | ==Mucinous adenocarcinoma of the ovary== |
| *CK7 +ve. | | *[[AKA]] ''ovarian mucinous adenocarcinoma''. |
| *CK20 +ve. | | *[[AKA]] ''ovarian mucinous carcinoma''. |
| | {{Main|Mucinous adenocarcinoma of the ovary}} |
|
| |
|
| ==Endometrioid carcinoma of the ovary== | | ==Endometrioid carcinoma of the ovary== |
Line 404: |
Line 364: |
| *[[AKA]] ''endometrioid adenocarcinoma of the ovary''. | | *[[AKA]] ''endometrioid adenocarcinoma of the ovary''. |
| *[[AKA]] ''ovarian endometrioid adenocarcinoma''. | | *[[AKA]] ''ovarian endometrioid adenocarcinoma''. |
| | | {{Main|Endometrioid carcinoma of the ovary}} |
| ===General===
| |
| *Associated with [[endometriosis]], i.e. people with endometriosis are more likely to have 'em.
| |
| | |
| ===Gross===
| |
| *Usually solid and cystic.
| |
| | |
| Image:
| |
| *[http://radiology.uchc.edu/eAtlas/GYN/437.htm Endometrioid carcinoma of the ovary (uchc.edu)].
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Tubular glands.
| |
| **Cribriform pattern common.
| |
| * May see mucinous secretion.<ref name=pmid18580313>{{cite journal |author=Baker P, Oliva E |title=A practical approach to intraoperative consultation in gynecological pathology |journal=Int. J. Gynecol. Pathol. |volume=27 |issue=3 |pages=353-65 |year=2008 |month=July |pmid=18580313 |doi=10.1097/PGP.0b013e31815c24fe |url=}}</ref>
| |
| * May have squamous differentiation/squamous metaplasia (useful for differentiating from sex-cord stromal tumours and germ cell tumours).<ref name=pmid18580313/> - very useful feature.
| |
| | |
| DDx:
| |
| *[[Sertoli-Leydig cell tumour]] - also has tubules.
| |
| *[[Serous carcinoma of the ovary]].
| |
|
| |
|
| ==Clear cell carcinoma of the ovary== | | ==Clear cell carcinoma of the ovary== |
| *[[AKA]] ''ovarian clear cell adenocarcinoma''. | | *[[AKA]] ''ovarian clear cell adenocarcinoma'', abbreviated ''OCCC''. |
| *[[AKA]] ''ovarian clear cell carcinoma''. | | *[[AKA]] ''ovarian clear cell carcinoma''. |
| *[[AKA]] ''clear cell adenocarcinoma of the ovary''. | | *[[AKA]] ''clear cell adenocarcinoma of the ovary''. |
| | | {{Main|Clear cell carcinoma of the ovary}} |
| ===General===
| |
| * Thought to be related to endometrioid carcinoma.<ref name=Ref_PBoD1098>{{Ref PBoD |1098}}</ref>
| |
| ** Increased risk of CC adenoca in people with endometriosis.
| |
| * Worse prognosis vs. other surface epithelial tumours<ref>{{cite journal |author=Hauptmann S, Köbel M |title=[Prognostic factors in ovarian carcinoma] |language=German |journal=Verh Dtsch Ges Pathol |volume=89 |issue= |pages=92-100 |year=2005 |pmid=18035678 |doi= |url=}}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Cystic/tubular architecture - important low power feature.
| |
| *Clear cells - cytoplasm is clear - '''key feature'''.
| |
| *[[Hobnail morphology]] - apical surface larger than basal surface.<ref>URL: [http://www.pathologyoutlines.com/ovary.html http://www.pathologyoutlines.com/ovary.html]. Accessed on: 8 February 2011.</ref>
| |
| **"Nuclei bulge into the lumen".
| |
| *Hyaline droplets -- common, as in ''[[clear cell renal cell carcinoma]]''.
| |
| **Eosinophilic bodies within lumen.
| |
| *Nucleoli - prominent.
| |
| | |
| Note:
| |
| *Clear cell adenocarcinoma does not have to have clear cells. Yes, this is stupid; it is like ''[[papillary thyroid carcinoma]]'' -- which often isn't papillary -- see ''[[no truth in names]]''.
| |
| **The ''hobnail morphology'' is important if this is the case.
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Ovarian_clear_cell_carcinoma_-a-_very_high_mag_-_cropped.jpg Clear cell carcinoma - very high mag. - cropped (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Ovarian_clear_cell_carcinoma_-a-_intermed_mag.jpg Clear cell carcinoma - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Ovarian_clear_cell_carcinoma_-_low_mag.jpg Clear cell carcinoma - low mag. (WC)].
| |
| *www:
| |
| **[http://path.upmc.edu/cases/case343.html Clear cell carcinoma of the ovary - several images (upmc.edu)].
| |
| | |
| ===IHC===
| |
| *HNF-1beta +ve.<ref>{{Cite journal | last1 = Tsuchiya | first1 = A. | last2 = Sakamoto | first2 = M. | last3 = Yasuda | first3 = J. | last4 = Chuma | first4 = M. | last5 = Ohta | first5 = T. | last6 = Ohki | first6 = M. | last7 = Yasugi | first7 = T. | last8 = Taketani | first8 = Y. | last9 = Hirohashi | first9 = S. | title = Expression profiling in ovarian clear cell carcinoma: identification of hepatocyte nuclear factor-1 beta as a molecular marker and a possible molecular target for therapy of ovarian clear cell carcinoma. | journal = Am J Pathol | volume = 163 | issue = 6 | pages = 2503-12 | month = Dec | year = 2003 | doi = | PMID = 14633622 | url = http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1892387/?tool=pubmed }}</ref><ref name=omim189907>{{OMIM|189907}}</ref>
| |
| **Usu. -ve in serous carcinoma.
| |
| *WT-1 -ve.
| |
| **Usu. +ve in serous carcinoma.
| |
| | |
| Panel for high grade serous vs. clear cell:<ref name=pmid18830127>{{cite journal |author=Köbel M, Kalloger SE, Carrick J, ''et al.'' |title=A limited panel of immunomarkers can reliably distinguish between clear cell and high-grade serous carcinoma of the ovary |journal=Am. J. Surg. Pathol. |volume=33 |issue=1 |pages=14–21 |year=2009 |month=January |pmid=18830127 |doi=10.1097/PAS.0b013e3181788546 |url=}}</ref>
| |
| *ER (+ve in serous),<ref>{{Cite journal | last1 = DeLair | first1 = D. | last2 = Oliva | first2 = E. | last3 = Köbel | first3 = M. | last4 = Macias | first4 = A. | last5 = Gilks | first5 = CB. | last6 = Soslow | first6 = RA. | title = Morphologic spectrum of immunohistochemically characterized clear cell carcinoma of the ovary: a study of 155 cases. | journal = Am J Surg Pathol | volume = 35 | issue = 1 | pages = 36-44 | month = Jan | year = 2011 | doi = 10.1097/PAS.0b013e3181ff400e | PMID = 21164285 }}</ref> HNF-1beta (+ve in clear cell), WT-1 (+ve in serous).
| |
|
| |
|
| ==Transitional cell carcinoma of the ovary== | | ==Transitional cell carcinoma of the ovary== |
| ===General===
| | {{Main|Transitional cell carcinoma of the ovary}} |
| *Rare.
| |
| *Fits into the ''transistional cell tumours'' category - in the surface epithelial group of ovarian tumours.<ref name=Ref_WMSP401>{{Ref WMSP|401}}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:<ref name=pmid15087664>{{Cite journal | last1 = Eichhorn | first1 = JH. | last2 = Young | first2 = RH. | title = Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis. | journal = Am J Surg Pathol | volume = 28 | issue = 4 | pages = 453-63 | month = Apr | year = 2004 | doi = | PMID = 15087664 }}</ref>
| |
| *Cystic spaces:
| |
| **Small - punched-out border - very common.
| |
| **Large.
| |
| *Papillae, usu. large, blunt.
| |
| **Occasionally small and filiform.
| |
| *+/-Bizarre giant cells (35%)
| |
| *+/-Gland-like tubules.
| |
| *+/-Squamous differentiation.
| |
| *+/-[[Psammoma bodies]].
| |
| *Cells:
| |
| **Moderate basophilic cytoplasm and little intervening stroma.
| |
| **Marked nuclear pleomorphism.
| |
| **Mitoses - common.
| |
| | |
| Notes:
| |
| #Resembles [[urothelial carcinoma]].<ref name=pmid21073751>{{Cite journal | last1 = Tazi | first1 = EM. | last2 = Lalya | first2 = I. | last3 = Tazi | first3 = MF. | last4 = Ahellal | first4 = Y. | last5 = M'rabti | first5 = H. | last6 = Errihani | first6 = H. | title = Transitional cell carcinoma of the ovary: a rare case and review of literature. | journal = World J Surg Oncol | volume = 8 | issue = | pages = 98 | month = | year = 2010 | doi = 10.1186/1477-7819-8-98 | PMID = 21073751 }}</ref>
| |
| #'''No''' Brenner tumour component (benign or malignant) should be present.<ref name=pmid21073751/>
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Transitional_cell_carcinoma_of_the_ovary_-_very_low_mag.jpg TCC - very low mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Transitional_cell_carcinoma_of_the_ovary_-_intermed_mag.jpg TCC - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Transitional_cell_carcinoma_of_the_ovary_-_very_high_mag.jpg TCC - very high mag. (WC)].
| |
| | |
| ===IHC===
| |
| Features:<ref name=pmid21073751>{{Cite journal | last1 = Tazi | first1 = EM. | last2 = Lalya | first2 = I. | last3 = Tazi | first3 = MF. | last4 = Ahellal | first4 = Y. | last5 = M'rabti | first5 = H. | last6 = Errihani | first6 = H. | title = Transitional cell carcinoma of the ovary: a rare case and review of literature. | journal = World J Surg Oncol | volume = 8 | issue = | pages = 98 | month = | year = 2010 | doi = 10.1186/1477-7819-8-98 | PMID = 21073751 }}</ref>
| |
| #Vimentin +ve,
| |
| #CA-125 +ve.
| |
| #WT1 +ve.
| |
| #CK20 -ve.
| |
| #Thrombomodulin -ve.
| |
| #Uroplakin III -ve.
| |
| | |
| Notes:
| |
| *1-6 usu. opposite pattern in urothelial cell carcinoma.
| |
|
| |
|
| ==Brenner tumour== | | ==Brenner tumour== |
| ===General===
| | {{Main|Brenner tumour}} |
| *Fits into the ''transistional cell tumours'' category - in the surface epithelial group of ovarian tumours.
| |
| | |
| ====Epidemiology====
| |
| *Mostly benign clinical course.
| |
| *Thought to arise from [[Walthard cell rest]].
| |
| *Frequently an incidental finding, i.e. oophorectomy was done for another reason.
| |
| *May be malignant.
| |
| | |
| ===Gross===
| |
| Features:<ref name=pmid21897739>{{Cite journal | last1 = Borah | first1 = T. | last2 = Mahanta | first2 = RK. | last3 = Bora | first3 = BD. | last4 = Saikia | first4 = S. | title = Brenner tumor of ovary: An incidental finding. | journal = J Midlife Health | volume = 2 | issue = 1 | pages = 40-1 | month = Jan | year = 2011 | doi = 10.4103/0976-7800.83273 | PMID = 21897739 |PMC = 3156501}}</ref>
| |
| *Classically solid, well-circumscribed, light yellow.
| |
| *May be cystic.
| |
| | |
| Note:
| |
| *Borderline tumours classically solid and cystic with papillary projections into the cystic component.<ref name=pmid21897739/>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Nests of transitional epithelium.<ref name=Ref_PBoD1098>{{Ref PBoD|1098}}</ref>
| |
| *"[[Coffee bean nucleus]]".
| |
| **Elliptical shape (nucleus).
| |
| **Nuclear grooves.<ref name=pathout_brenner>URL: [http://www.pathologyoutlines.com/ovarytumor.html#brennergen http://www.pathologyoutlines.com/ovarytumor.html#brennergen]. Accessed on: 8 February 2011.</ref>
| |
| **Distinct nucleoli.
| |
| *Dense fibrous stroma around nests.
| |
| | |
| Notes:
| |
| *Main DDx of Coffee bean nucleus = [[granulosa cell tumour]].
| |
| *Stromal component may be predominant.
| |
| | |
| DDx:
| |
| *[[Ovarian fibroma]].
| |
| *[[Thecoma]].
| |
| | |
| Images:
| |
| *[http://commons.wikimedia.org/wiki/File:Brenner_tumour_high_mag.jpg "Coffee bean" nuclei (WC)].
| |
| *[http://commons.wikimedia.org/wiki/File:Brenner_tumour_intermed_mag.jpg Brenner tumour - intermed. magnifiction (WC)].
| |
|
| |
|
| =Germ cell tumours= | | =Germ cell tumours= |
Line 605: |
Line 435: |
|
| |
|
| =Metastatic ovarian tumours= | | =Metastatic ovarian tumours= |
| {{Main|Metastases}} | | {{Main|Ovarian metastasis}} |
| ==Generally==
| |
| * Mostly Muellerian origin (uterus, fallopian tube) or pelvic peritoneum.
| |
| | |
| ==Extramuellerian metastatic tumours==
| |
| DDx:
| |
| * [[Breast]].
| |
| * [[Gastrointestinal pathology|Gastrointestinal (GI) tract]].
| |
| ** Pseudomyxoma peritonei, usu. [[appendix|appendiceal]] origin.
| |
| ** Krukenberg tumour = [[signet ring cell]] cancer with mucin production of GI origin.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Predominantly surface involvement and nodular at low power.
| |
| *Signet ring cells (suggestive of GI or breast primary).
| |
| *Lymphovascular invasion.
| |
| | |
| ===Mucinous carcinoma - [[GI tract]] metastasis vs. primary ovarian===
| |
| ====Gross====
| |
| Features favouring metastatic disease:<ref name=pmid18162780>{{Cite journal | last1 = Yemelyanova | first1 = AV. | last2 = Vang | first2 = R. | last3 = Judson | first3 = K. | last4 = Wu | first4 = LS. | last5 = Ronnett | first5 = BM. | title = Distinction of primary and metastatic mucinous tumors involving the ovary: analysis of size and laterality data by primary site with reevaluation of an algorithm for tumor classification. | journal = Am J Surg Pathol | volume = 32 | issue = 1 | pages = 128-38 | month = Jan | year = 2008 | doi = 10.1097/PAS.0b013e3180690d2d | PMID = 18162780 }}</ref>
| |
| *Bilaterality -- both ovaries involved.
| |
| *Small unilateral tumour size -- <10 cm = metastatic.
| |
| **>13 cm = primary ovarian.
| |
| | |
| ====IHC====
| |
| Ovarian tumours:
| |
| *Dipeptidase 1 (DPEP1) +ve.<ref name=pmid21076463>{{Cite journal | last1 = Okamoto | first1 = T. | last2 = Matsumura | first2 = N. | last3 = Mandai | first3 = M. | last4 = Oura | first4 = T. | last5 = Yamanishi | first5 = Y. | last6 = Horiuchi | first6 = A. | last7 = Hamanishi | first7 = J. | last8 = Baba | first8 = T. | last9 = Koshiyama | first9 = M. | title = Distinguishing primary from secondary mucinous ovarian tumors: an algorithm using the novel marker DPEP1. | journal = Mod Pathol | volume = 24 | issue = 2 | pages = 267-76 | month = Feb | year = 2011 | doi = 10.1038/modpathol.2010.204 | PMID = 21076463 }}</ref>
| |
| *CK7 +ve.
| |
|
| |
|
| =Sex cord stromal tumours= | | =Sex cord stromal tumours= |
Line 649: |
Line 452: |
| *Abbreviated ''SCTAT''. | | *Abbreviated ''SCTAT''. |
| *'''NOT''' ''sex cord tumour with angulated tubules''. | | *'''NOT''' ''sex cord tumour with angulated tubules''. |
| | | {{Main|Sex cord tumour with annular tubules}} |
| ===General===
| |
| *Associated with [[Peutz-Jeghers syndrome]].<ref name=pmid7358344>{{Cite journal | last1 = Purohit | first1 = RC. | last2 = Alam | first2 = SZ. | title = Sex cord tumour of the ovary with annular tubules (SCTAT). | journal = Histopathology | volume = 4 | issue = 2 | pages = 147-54 | month = Mar | year = 1980 | doi = | PMID = 7358344 }}</ref>
| |
| **Large tumours more likely sporadic.
| |
| **Small tumours more likely Peutz-Jeghers syndrome and incidental.
| |
| *Usually benign.
| |
| **Malignant cases reported.<ref name=pmid10786816>{{Cite journal | last1 = Lele | first1 = SM. | last2 = Sawh | first2 = RN. | last3 = Zaharopoulos | first3 = P. | last4 = Adesokan | first4 = A. | last5 = Smith | first5 = M. | last6 = Linhart | first6 = JM. | last7 = Arrastia | first7 = CD. | last8 = Krigman | first8 = HR. | title = Malignant ovarian sex cord tumor with annular tubules in a patient with Peutz-Jeghers syndrome: a case report. | journal = Mod Pathol | volume = 13 | issue = 4 | pages = 466-70 | month = Apr | year = 2000 | doi = 10.1038/modpathol.3880079 | PMID = 10786816 }}</ref>
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Well-circumscribed nests of cells with nuclei at the periphery.
| |
| *Annular tubules (ring-shaped tubules) with dense hyaline material.
| |
| | |
| Notes:
| |
| *''Annular'' = shape of a ring.<ref>URL: [http://dictionary.reference.com/browse/annular http://dictionary.reference.com/browse/annular]. Accessed on: 6 August 2011.</ref>
| |
| | |
| DDx:
| |
| *Sertoli-Leydig tumour - has double palisading with overlap of the layers.
| |
| *[[Granulosa cell tumour]] - have Call-Exner bodies, which don't have a well-defined/solid content.
| |
| *[[Brenner tumour]] - [[coffee-bean nuclei]].
| |
| | |
| Images:
| |
| *www:
| |
| **[http://www.gfmer.ch/selected_images_v2/detail_list.php?cat1=10&cat2=120&cat3=1015&cat4=3&stype=n SCTAT - image collection (gfmer.ch)].
| |
| **[http://www.pathology.cn/bbs/forum.php?mod=viewthread&tid=57445 Possible SCTAT (pathology.cn)].
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Sex_cord_tumour_with_annular_tubules_-_intermed_mag.jpg SCTAT - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Sex_cord_tumour_with_annular_tubules_-_2_-_very_high_mag.jpg SCTAT - very high mag. (WC)].
| |
|
| |
|
| ==Juvenile granulosa cell tumour== | | ==Juvenile granulosa cell tumour== |
| ===General===
| | {{Main|Juvenile granulosa cell tumour}} |
| *May secrete estrogen.
| |
| **May present with endometrial pathology, e.g. [[endometrial hyperplasia]] ''or'' endometrioid [[endometrial carcinoma]].
| |
| **May present as precocious puberty.<ref name=pmid21526089>{{Cite journal | last1 = Hashemipour | first1 = M. | last2 = Moaddab | first2 = MH. | last3 = Nazem | first3 = M. | last4 = Mahzouni | first4 = P. | last5 = Salek | first5 = M. | title = Granulosa cell tumor in a six-year-old girl presented as precocious puberty. | journal = J Res Med Sci | volume = 15 | issue = 4 | pages = 240-2 | month = Jul | year = 2010 | doi = | PMID = 21526089 }}</ref>
| |
| *Reported in males.<ref>URL: [http://path.upmc.edu/cases/case631.html http://path.upmc.edu/cases/case631.html]. Accessed on: 26 January 2012.</ref>
| |
| | |
| ===Gross===
| |
| *Classically solid.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| *Microcystic spaces.
| |
| *Moderate-to-marked nuclear atypia.
| |
| *Cuboidal-to-polygonal cell in sheets or stands or cords.
| |
| *Basophilic cytoplasm.
| |
| | |
| Notes:
| |
| *Juvenile variant of GCT has more nuclear pleomorphism.
| |
| | |
| Images:
| |
| *[[WC]]:
| |
| **[http://commons.wikimedia.org/wiki/File:Juvenile_granulosa_cell_tumour_-_intermed_mag.jpg Juvenile granulosa cell tumour - intermed. mag. (WC)].
| |
| **[http://commons.wikimedia.org/wiki/File:Juvenile_granulosa_cell_tumour_-_very_high_mag.jpg Juvenile granulosa cell tumour - very high mag. (WC)].
| |
| | |
| ===IHC===
| |
| * Inhibin positive.<ref name=Ref_PBoD1102>{{Ref PBoD|1102}}</ref>
| |
| ** Inhibin negative in ''[[Brenner tumour]]''.
| |
| *Calretinin +ve.
| |
| | |
| ===Molecular===
| |
| :''Currently '''not''' used for the diagnosis.''
| |
| *Trisomy 12.<ref name=pmid1466394>{{Cite journal | last1 = Schofield | first1 = DE. | last2 = Fletcher | first2 = JA. | title = Trisomy 12 in pediatric granulosa-stromal cell tumors. Demonstration by a modified method of fluorescence in situ hybridization on paraffin-embedded material. | journal = Am J Pathol | volume = 141 | issue = 6 | pages = 1265-9 | month = Dec | year = 1992 | doi = | PMID = 1466394 }}</ref><ref name=pmid12218213>{{Cite journal | last1 = Mayr | first1 = D. | last2 = Kaltz-Wittmer | first2 = C. | last3 = Arbogast | first3 = S. | last4 = Amann | first4 = G. | last5 = Aust | first5 = DE. | last6 = Diebold | first6 = J. | title = Characteristic pattern of genetic aberrations in ovarian granulosa cell tumors. | journal = Mod Pathol | volume = 15 | issue = 9 | pages = 951-7 | month = Sep | year = 2002 | doi = 10.1097/01.MP.0000024290.55261.14 | PMID = 12218213 }}
| |
| </ref>
| |
|
| |
|
| ==Adult granulosa cell tumour== | | ==Adult granulosa cell tumour== |
Line 717: |
Line 461: |
| **Should '''not''' be confused with ''[[granular cell tumour]]''. | | **Should '''not''' be confused with ''[[granular cell tumour]]''. |
| **Ideally, it should be called ''adult granulosa cell tumour'' to avoid confusion with ''[[juvenile granulosa cell tumour]]''. | | **Ideally, it should be called ''adult granulosa cell tumour'' to avoid confusion with ''[[juvenile granulosa cell tumour]]''. |
| | | {{Main| Adult granulosa cell tumour}} |
| ===General===
| |
| *May secrete estrogen.
| |
| **May present with endometrial pathology, e.g. [[endometrial hyperplasia]] ''or'' endometrioid [[endometrial carcinoma]].
| |
| | |
| ===Gross===
| |
| *Classically solid.
| |
| | |
| ===Microscopic===
| |
| Features:
| |
| * Classic appearance includes gland-like structures filled with acidophilic material (Call-Exner bodies).
| |
| * Small cuboidal to polygonal cell in sheets or stands or cords.
| |
| * Nuclear grooves.
| |
| | |
| Note:
| |
| *There is a "10% rule" -- if less than 10% of a SCST is granulosa cells... it isn't granulosa cell tumour.
| |
| *Juvenile variant of GCT has more nuclear pleomorphism.
| |
| | |
| DDx:
| |
| * [[Urothelial cell carcinoma]] (UCC).
| |
| ** UCC usually has extensive necrosis.
| |
| * [[Brenner tumour]].
| |
| * [[Sertoli cell tumour]].
| |
| | |
| ===IHC===
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| * Inhibin positive.<ref name=Ref_PBoD1102>{{Ref PBoD|1102}}</ref>
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| ** Inhibin negative in ''[[Brenner tumour]]''.
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| *Calretinin +ve.
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| ==Fibroma-thecoma group== | | ==Fibroma-thecoma group== |
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| Note: | | Note: |
| *Some discourage the use of the term ''fibrothecoma'' and sugguest calling tumours in the fibrom-thecoma group ''fibroma'' unless there are lipid-laden cells and more than minimal alpha-inhibin positivity.<ref name=pmid16810055/> | | *Some discourage the use of the term ''fibrothecoma'' and sugguest calling tumours in the fibroma-thecoma group ''fibroma'' unless there are lipid-laden cells and more than minimal alpha-inhibin positivity.<ref name=pmid16810055/> |
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| ==Ovarian fibroma== | | ==Ovarian fibroma== |
| ===General===
| | {{Main|Ovarian fibroma}} |
| *May be a part of:
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| *#Meigs syndrome (mnemonic ''FAR'': fibroma, [[ascites]], right pleural [[effusion]]).
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| *#[[Nevoid basal cell carcinoma syndrome]] (NBCCS), AKA ''Gorlin syndrome''.<ref name=Ref_PBoD1103>{{Ref PBoD |1103}}</ref>
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| *#*In NBCCS classically - calcified and bilateral.<ref name=pmid6385289>{{Cite journal | last1 = Tytle | first1 = T. | last2 = Rosin | first2 = D. | title = Bilateral calcified ovarian fibromas. | journal = South Med J | volume = 77 | issue = 9 | pages = 1178-80 | month = Sep | year = 1984 | doi = | PMID = 6385289 }}</ref>
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| *Very rarely transform to [[adult fibrosarcoma|fibrosarcoma]] <1%.<ref>URL: [http://brighamrad.harvard.edu/Cases/bwh/hcache/353/full.html http://brighamrad.harvard.edu/Cases/bwh/hcache/353/full.html]. Accessed on: 4 October 2011.</ref>
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| ===Microscopic===
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| Features:<ref>[http://www.pathologyoutlines.com/ovarytumor.html#fibroma http://www.pathologyoutlines.com/ovarytumor.html#fibroma]</ref><ref name=pmid16810055/>
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| *Spindle-shaped cells.
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| *Central nuclei.
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| *Stainable lipid - minimal or none.<ref name=pmid16810055/>
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Ovarian_fibroma_-_intermed_mag.jpg Ovarian fibroma - intermed mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Ovarian_fibroma_-_high_mag.jpg Ovarian fibroma - high mag. (WC)].
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| | |
| ===IHC===
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| *Inhibin -ve (~75%).<ref name=pmid16810055/>
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| ==Thecoma== | | ==Thecoma== |
| ===General===
| | {{Main|Thecoma}} |
| *Associated with compression & atrophy of ovarian cortex, thought to arise from medulla.<ref name=pmid18164409/>
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| *Approx. 50% have symptoms related to estrogen secretion.<ref name=pmid16810055/>
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| **May also be viralizing.
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| ===Microscopic===
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| Features:<ref name=pmid16810055/>
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| *Nuclei with oval to spindle morphology.
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| *Abundant cytoplasm that is pale, vaculolated -- '''key feature'''.
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| Images:
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| *[http://commons.wikimedia.org/wiki/File:Thecoma_low_mag.jpg Thecoma - low mag. (WC)].
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| *[http://commons.wikimedia.org/wiki/File:Thecoma_high_mag.jpg Thecoma - high mag. (WC)].
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| | |
| ===IHC===
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| *Alpha-inhibin +ve (90%+).<ref name=pmid16810055/>
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| ==Sertoli-Leydig cell tumour== | | ==Sertoli-Leydig cell tumour== |
| *[[AKA]] ''androblastoma''. | | *[[AKA]] ''androblastoma''. |
| | {{Main|Sertoli-Leydig cell tumour}} |
| | |
| | ==Hilus cell tumour== |
| | {{Main|Leydig cell tumour}} |
| | *[[AKA]] ''Leydig cell tumour''.<ref name=pmid19697637>{{Cite journal | last1 = Zafrakas | first1 = M. | last2 = Venizelos | first2 = ID. | last3 = Theodoridis | first3 = TD. | last4 = Zepiridis | first4 = L. | last5 = Agorastos | first5 = T. | last6 = Bontis | first6 = JN. | title = Virilizing ovarian hilus (Leydig) cell tumor with concurrent contralateral hilus cell hyperplasia: a rare diagnosis. | journal = Eur J Gynaecol Oncol | volume = 30 | issue = 3 | pages = 338-40 | month = | year = 2009 | doi = | PMID = 19697637 }}</ref> |
| ===General=== | | ===General=== |
| *Sertoli and leydig cells are normal in the [[testis]]. | | *Rare.<ref name=pmid19697637/> |
| *Poorly differentiated tumours have sarcomatous features.<ref name=Ref_PBoD1103>{{Ref PBoD|1103}}</ref>
| | *May cause virilization. |
| | **Development of male (sexual) characteristics in a female. |
| | *Arise from [[hilus cells]]. |
|
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| ===Microscopic=== | | ===Microscopic=== |
| Features: | | Features - see ''[[Leydig cell tumour]]'': |
| # Sertoli ''or'' Leydig cells.<ref name=Ref_PBoD1103>{{Ref PBoD|1103}}</ref>
| | *Moderate eosinophilic cytoplasm. |
| #* Leydig cells:
| | *+/-Reinke crystalloids (cytoplasmic inclusions). |
| #** Abundant solid eosinophilic cytoplasm.
| |
| #** Round nuclei with fine chromatin and a small or indistinct [[nucleolus]].
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| #** Often in small clusters ~ 5-25 cells/cluster.
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| #* Sertoli cells:
| |
| #** Pale/clear vacuolated cytoplasm.
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| #** Irregular nuclei with irregular/vacuolated-appearing chromatin.
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| #** Architecture: tubules, cords or sheets.
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| # Stroma.
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| # +/- Sarcomatous features (mucinous glands, bone, cartilage).
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|
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| DDx: | | DDx: |
| *[[Endometrioid carcinoma of the ovary]]. | | *Hilus hyperplasia. |
| | | *[[Sertoli-Leydig tumour]]. |
| Images:
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| *[[WC]]:
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| **[http://commons.wikimedia.org/wiki/File:Sertoli-Leydig_cell_tumour_-_intermed_mag.jpg Sertoli-Leydig cell tumour - intermed. mag. (WC)].
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| **[http://commons.wikimedia.org/wiki/File:Sertoli-Leydig_cell_tumour_-_very_high_mag.jpg Sertoli-Leydig cell tumour - very high mag. (WC)].
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| *www:
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| **[http://path.upmc.edu/cases/case270/micro.html Sex cord stromal tumour with Sertoli-Leydig component - several images (upmc.edu)].
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| ==Pure Leydig cell tumour==
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| ===General===
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| *AKA ''Hilus cell tumour''.
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| ===Microscopy===
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| *Reinke crystalloids - in the cytoplasm of Leydig cells - ''[[testis]] article''.
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| =Benign= | | =Benign= |