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LETTER TO EDITOR  
Year : 2013  |  Volume : 56  |  Issue : 3  |  Page : 327-328
Ovarian sertoliform endometrioid carcinoma: A diagnostic dilemma


Department of Pathology, IGMC, Shimla, Himachal Pradesh, India

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Date of Web Publication24-Oct-2013
 

How to cite this article:
Bakshi N, Gupta N, Mahajan V. Ovarian sertoliform endometrioid carcinoma: A diagnostic dilemma . Indian J Pathol Microbiol 2013;56:327-8

How to cite this URL:
Bakshi N, Gupta N, Mahajan V. Ovarian sertoliform endometrioid carcinoma: A diagnostic dilemma . Indian J Pathol Microbiol [serial online] 2013 [cited 2019 Jun 26];56:327-8. Available from: http://www.ijpmonline.org/text.asp?2013/56/3/327/120419


Sir,

Ovarian endometrioid carcinomas with sertoliform features (SECs) are rare and often misinterpreted as sex cord-stromal tumors. A 54-year-old female presented with pelvic "heaviness" and progressive abdominal enlargement of 2 months duration following a postmenopausal interval of 13 years. Investigations revealed a large, heterogeneous right ovarian mass with multiple space-occupying lesions in the liver. No signs of virilization were noted clinically. Preoperative CA-125 level was 185 U/ml. On gross examination of the total hysterectomy specimen, the right ovary was replaced by an irregular bosselated mass measuring 25 × 13 × 8 cm with a lobulated, friable, predominantly solid, gray-brown to yellow cut surface.

Microscopic examination revealed anastomosing hollow and solid tubules lined by single to pseudostratified columnar lining epithelium showing mild nuclear pleomorphism and focal nuclear rounding separated by thin fibrous stroma [Figure 1], [Figure 2]. Typical areas of endometrioid carcinoma and squamous differentiation were not identified even on extensive sampling. Tumor cells were strongly immunoreactive for epithelial membrane antigen (EMA) but negative for inhibin, thus confirming the diagnosis of SEC ovary.
Figure 1: Anastomosing hollow and solid tubules lined by pseudostratified epithelium and separated by loose connective tissue stroma (hematoxylin and eosin, ×100)

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Figure 2: Anastomosing hollow and solid tubules lined by pseudostratified epithelium and separated by loose connective tissue stroma (hematoxylin and eosin, 400)

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First described by Young et al. and Roth et al. in 1982, SEC of the ovary is a rare entity that assumes particular significance, given its histological similarity to sex cord-stromal tumors of pure Sertoli cell type (SCT) and Sertoli Leydig cell type (SLCT) which may serve as a potential diagnostic pitfall even for experienced pathologists. [1] However, despite histologic similarity, there are important clinical differences between these two entities. Patients with SLCTs tend to be younger, and up to 50% may exhibit hormonal manifestations such as virilization. [2] In contrast, SEC occurs almost exclusively in postmenopausal women with an average age of 68 years. [2] Virilizing symptoms, though uncommon in endometrioid carcinoma, may be encountered in the sertoliform variant, thus compounding the diagnostic difficulty. [3]

Microscopically, typical glands of endometrioid carcinoma, squamous differentiation, or an adenofibroma component are each present in 75% of SECs, facilitating their recognition as an endometrioid carcinoma. [1] Other factors that may favor SEC include ciliated elements, presence of endometriosis, concomitant adenocarcinoma of the endometrium, and mucin at the apical borders of the tumor cells, though occasionally heterologous elements in SCLTs may consist of mucinous glands. [4] Immunohistochemistry is of great value in the differential diagnosis; immunostains for alpha-inhibin and calretinin are positive in most neoplastic Sertoli cells but negative in the cells of endometrioid carcinoma, while positive EMA immunostains favor SEC. [5]

Majority of SECs described in the literature have been originally misdiagnosed as SCT and SLCT. [1] Consequently, before establishing a diagnosis of SCT or SLCT, especially in postmenopausal patients, extensive sampling of the specimen and search for foci of typical endometrioid carcinoma and squamous or clear cell elements is mandatory. To eradicate doubt, the diagnosis can be confirmed by immunohistochemical study. Recognition of this tumor is important as it is a well-differentiated, low-grade malignancy that displays a good prognosis when confined to the ovary. [3],[4]

 
   References Top

1.Young RH, Prat J, Scully RE. Ovarian endometrioid carcinomas resembling sex cord-stromal tumors: A clinicopathological analysis of 13 cases. Am J Surg Pathol 1982;6:513-22.  Back to cited text no. 1
    
2.Remadi S, Ismail A, Tawil A, Mac Gee W. Ovarian sertoliform endometrioid carcinoma. Virchows Arch 1995;426:533-6.  Back to cited text no. 2
    
3.Ordi J, Schammel DP, Rasekh L, Tavassoli FA. Sertoliform endometrioid carcinomas of the ovary: A clinicopathologic and immunohistochemical study of 13 cases. Mod Pathol 1999;12:933-40.  Back to cited text no. 3
    
4.Misir A, Sur M. Sertoliform endometrioid carcinoma of the ovary: A potential diagnostic pitfall. Arch Pathol Lab Med 2007;131:979-81.  Back to cited text no. 4
    
5.Prat J. Ovarian carcinomas, including secondary tumours: Diagnostically challenging areas. Mod Pathol 2005;18:S99-111.  Back to cited text no. 5
    

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Correspondence Address:
Neha Bakshi
Flat no. 2, First floor, Nikunj Bhawan, Anji, Vikasnagar, Shimla - 171 009, Himachal Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.120419

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