Sertoli-Leydig cell tumor of ovary with heterologous element: a case report

Sertoli-Leydig cell tumors are uncommon tumors of ovary accounting for about 1% of sex cord stromal tumors. They constitute between 0.1% to 0.5% of all the primary ovarian neoplasms. The majority of reported cases are moderately or poorly differentiated combined Sertoli-Leydig cell tumors. A rare case of Sertoli-Leydig cell tumor with heterologous element in a 14 year girl is described. The heterologous component comprised smooth muscle, an uncommon element, that was seen in 60 to 70% of the tumor area. The epithelial element of the tumor consisted of solid, tubular and foci of retiform pattern. Both these features imply a poor prognosis.     

Granular cell tumor of the gallbladder. Report of a case

A rare case of granular cell tumor of the gallbladder in a 58-year-old Japanese man is presented. This is the third report of such a tumor arising in the gallbladder. The immunohistochemical study demonstrated the localization of the nervous-system-specific protein (S-100 protein) in the granular component cells, thereby supporting the Schwann cell origin of this tumor.     

Sertoli-Leydig cell tumor with heterologous element: a case report and a review of the literature

The patient was a 19-year-old female who presented with a chief complaint of progressive pelvic pain. Preoperative ultrasound of the right ovary revealed an ovarian torsion as the cause of the patient’s progressive pain. Laparoscopy confirmed the torsion and revealed a right ovary measuring 10 cm in greatest diameter. Intraoperative incision into the ovary revealed a simple ovarian cystic mass measuring 3.0 x 1.5 x 0.8 cm. A solid component within the cyst was identified. Histological sections of the cystic mass demonstrated mononuclear and hyperchromatic Sertoli cells with a trabecular growth pattern. Clusters of medium-sized epithelioid cells with abundant eosinophilic cytoplasm consistent with Leydig cells were also identified between the trabeculae of Sertoli cells. In addition, focal areas of intestinal type mucinous epithelium were identified embedded within the trabeculae of Sertoli cells. Immunohistochemical studies revealed that the Sertoli cells were positive for calretinin (bright) while the Leydig cells were positive for calretinin (dim), inhibin, CAM5.2 and AE1&3. CEA showed positivity mainly of the intraluminal contents of the mucinous type intestinal epithelium. The patient had an uneventful post-operative course and was disease-free for 3 years.     

Selective ovarian vein sampling can be crucial to localize a Leydig cell tumor: an unusual case in a postmenopausal woman

Leydig cell tumors of the ovary are very rare, frequently associated with symptoms of virilization in postmenopausal patients. It is sometimes difficult to localize the tumor precisely even with modern imaging techniques. A 62-year-old patient presented with recent onset of rapidly progressive virilization including increased hirsutism, progressive balding, deepening voice and enlargement of the clitoris. Initial laboratory examination revealed a total serum testosterone level of 1330 ng/dL. Serum dehydroepiandrosterone sulfate, androstenedione and 17 hydroxyprogesterone levels were all within normal limits. Extensive pre-operative evaluations included transvaginal ultrasound, abdominal computed tomography and magnetic resonance imaging failed to localize the tumor. Therefore, selective ovarian venous hormonal sampling (SOVHS) was performed and they revealed that the total serum testosterone level was significantly higher in the left than in the right ovarian vein (7000 ng/dL vs. 225 ng/dL). A total abdominal hysterectomy and bilateral salpingo-oophorectomy was performed. Microscopic examination of the left ovary revealed a Leydig cell tumor. In conclusion, when the precise location of the tumor is not determined pre-operatively, SOVHS may be valuable to make accurate diagnosis.     

Malignant giant cell tumor of tendon sheath. Report of a case

In a patient with pigmented villonodular synovitis of the right knee joint, there occurred a malignant giant cell tumor of tendon sheath. There was clinical evidence of metastasis after the second local recurrence and the recurrent tumors were studied enzyme cytochemically and electron microscopically. Ultrastructurally, the malignant tumor consisted of three principal cell types; histiocyte-like cells, fibroblast-like cells, and intermediate cells, with unique attendance of myofibroblasts. This may be the first report of the presence of myofibroblasts in malignant giant cell tumor of tendon sheath. Enzyme cytochemistry revealed various functional properties of histiocytes.     

Serous papillary adenocarcinoma and adult granulosa cell tumor in the same ovary. An unusual case

Surface epithelial-stromal cell tumors are the most common neoplasms of the ovary but occurrence of a serous adenocarcinoma and an adult granulosa cell tumor in the same ovary is an unusual incident. In the present case report we describe this very uncommon occurrence in the ovary of a 50-year-old woman. The patient suffered abdominal distention and was referred to the state hospital where a 5x3 cm multilocular cystic lesion was observed on abdominal CT. Total abdominal hysterectomy with salpingo-oophorectomy and omentectomy was performed. Microscopy revealed an adult granulosa cell tumor and a serous papillary adenocarcinoma in the left ovary. Immunohistochemical staining with inhibin alpha and pancytokeratin confirmed the diagnosis.     

Sertoli-Leydig cell tumor associated with a mature cystic teratoma in a single ovary

Sertoli-Leydig cell tumors of the ovary are rare neoplasms of young women and are best known for their frequent virilizing effects. They have very rarely been reported in association with other ovarian neoplasms. We report such a tumor associated with a mature cystic teratoma in the same ovary. The wide variety of histologic patterns seen in many Sertoli-Leydig cell tumors including the present case, often causing difficulty in diagnosis, is reviewed.     

Case Report: A paradoxical inhibition of androgenic hyperproduction by a Sertoli-Leydig cell tumour ovary

A 17 year old woman was evaluated for amenorrhoea and severehirsutism (Ferriman–Gallway index = 31). Pelvic ultrasounddemonstrated a right unilateral ovarian mass (6x5 cm), whereasthe computed tomography for the adrenal gland was normal. Endocrinologicalfindings revealed normal concentrations of oestradiol, progesterone,dihydroepiandrosterone sulphate, cortisol, prolactin, follicle-stimulatinghormone, luteinizing hormone and adrenocorticotrophic hormone(ACTH). Total testosterone, free testosterone, androstenedioneand 17-hydroxy-progesterone concentrations, already elevatedat basal conditions, did not increase after an ACTH test, whereasthey decreased significantly after dexamethasone administrationand increased after a human chorionic gonadotrophin test. Ofall the tumour markers investigated, tissue polypeptide antigenand ₁-fetoprotein showed an increase in concentration. Selectivevenous ovarian catheterization indicated the presence of anandrogen-producing tumour in the right ovary. The histopathologicaldiagnosis was consistent with a Sertoli–Leydig cell tumourranking between an intermediate and a poor grade of differentiation,with heterologous elements characterized by mucinous epitheliumof the gastro-intestinal type. An endocrine evaluation performedpostoperatively showed a normalization of all serum pathologicalhormones and tumour markers studied. Some particular aspectswere focused on and discussed.     

Spindle cell rhabdomyosarcoma of the retroperitoneum: an unusual case developed in a pregnant woman but obscured by pregnancy

Spindle cell rhabdomyosarcoma (RMS) is an uncommon histiologic variant of RMS that has spindle cell morphology. This tumor occurs almost exclusively in childhood and more rarely in adults. Only a few adult cases, including two retroperitoneal cases in male patients, have been documented previously. We describe a rare case of spindle cell RMS of the retroperitoneum in a 37-year-old woman developed during pregnancy and incidentally discovered after vaginal delivery. Computed tomography showed a huge tumor mass, measured 20 × 20 × 15 cm in size, arising in retroperitoneal space. Histologically, the tumor consisted of spindle cells arranged in a fascicular or herringbone growth pattern, morphologically mimicking adult fibrosarcoma, intermingled with scattered rhabdomyoblasts. Mitotic activity ranged from 20 to 28 mitoses per 10 high-power fields and tumor necrosis was evident. Immunohistochemically, tumor cells were stained diffusely positive for muscle specific actin, desmin, and vimentin, scattered positive for myogenin, MyoD1 and myoglobin, with a Ki-67 (MIB-1) proliferative labeling index of 46.11%. This tumor also stains positively for CD99, strong cytoplasmic WT1, and nuclear p53. Other markers such as S100 protein, smooth muscle specific actin, CD34, cytokeratin, and epithelial membrane antigen were all negative in the tumor cells. On the basis of the findings, a spindle cell RMS was diagnosed. The neoplasm was incompletely excised because of encasement of major vessels and invasion to adjacent structures, and additional chemotherapy was given.     

An unusual squamous cell carcinoma in a sheep: a case report

Squamous cell carcinoma (SCC) is a tumour consisting of squamous epithelial cells. This tumour is common in horses, cows, cats and dogs, but relatively uncommon in sheep, goats and pigs. In this study, we discuss gross, radiological and histopathological features of an oral SCC in a female sheep. A 3-year-old ewe with a progressive mass located in the intraoral cavity and with a history of reduced appetite, weight loss, salivation and halitosis was referred to the veterinary clinic. At clinical examination, a mass was located in the floor of the mouth, its surfaces showed signs of ulceration and haemorrhage. Lateral radiograph of the mandible region near the tumour showed bone destructive changes. Biopsy specimen was taken and histopathologic examination showed moderately differentiated oral SCC.     

Hereditary angioedema: an unusual case in an African-American woman.

Hereditary angioedema is a rare disorder characterized by a localized subepithelial edema and swelling of the gastrointestinal and upper respiratory tract. The disorder is estimated to occur in 1 in 50,000 to 150,000 individuals. However, the prevalence of the disorder among the African-American population is uncertain. This is a case report of hereditary angioedema occurring in an African-American woman whose symptoms persisted for more than a decade prior to diagnosis.     

Ovarian Sertoli-Leydig cell tumor of intermediate grade with heterologous elements of rhabdomyosarcoma. A case report and a review of the literature

Ovarian Sertoli-Leydig cell tumors (SLCTs) are rare sex cord-stromal tumors, and among them, tumors with heterologous mesenchymal elements are exceptional and mainly associated with poorly differentiated tumors and are often fatal. We present the fourth case of an ovarian SLCT of intermediate differentiation with rhabdomyosarcoma and a review of the literature. Surgical treatment was conservative with preservation of the contralateral adnexa and uterus. No adjuvant treatment was given. At 4 years control post surgery, the patient was without evidence of disease. Extensive sampling of SLCTs is important because heterologous elements may be sparse. Immature skeletal muscle cells in SLCTs often reveal only moderate pleomorphism, and as they are closely admixed with the Sertoli cells or immature gonadal stroma, they can be rather difficult to differentiate from the latter ones. Immunohistochemical analysis with a panel of antibodies including antibodies against myogenin and alpha-inhibin is very important to diagnose the rhabdomyosarcoma and to grade the SLCT accurately.