Indian Journal of Pathology and Microbiology

LETTER TO EDITOR
Year
: 2018  |  Volume : 61  |  Issue : 3  |  Page : 459--460

Sertoliform endometrioid carcinoma of the ovary in a young female


Bhayekar Dinesh Pallavi, Kulkarni Mandar Maithili, Siddhi G Sinai Khandeparkar, Amruta B Jadhav 
 Department of Pathology, Shrimati Kashibai Navale Medical College and General Hospital, Pune, Maharashtra, India

Correspondence Address:
Bhayekar Dinesh Pallavi
Flat No 306, Pratham, Kumthekar Road, Sadashiv Peth, Pune - 411 030, Maharashtra
India




How to cite this article:
Pallavi BD, Maithili KM, Sinai Khandeparkar SG, Jadhav AB. Sertoliform endometrioid carcinoma of the ovary in a young female.Indian J Pathol Microbiol 2018;61:459-460


How to cite this URL:
Pallavi BD, Maithili KM, Sinai Khandeparkar SG, Jadhav AB. Sertoliform endometrioid carcinoma of the ovary in a young female. Indian J Pathol Microbiol [serial online] 2018 [cited 2022 Jan 23 ];61:459-460
Available from: https://www.ijpmonline.org/text.asp?2018/61/3/459/236625


Full Text



Editor,

Sertoliform endometrioid carcinoma (SEC) of the ovary is a rare variant of endometrioid carcinoma. It was separately described byYoung et al. and Roth et al. in the ovary, in 1982.[1] The first case of uterine SEC was reported in 1988.[1] Incidence of endometrioid carcinoma of the ovary is 10%–20%.[2] SEC is a rare variant of it. Incidence of SEC is very low and about 80 cases have been reported in the literature.[1] It affects mostly postmenopausal females in the age group of 60–70 years.[3] Histopathological diagnosis of SEC is often difficult due to the presence of sertoliform cells arranged in tubular pattern and its close resemblance to the Sertoli-Leydig cell tumors (SLTs) of the ovary. Immunohistochemical (IHC) study is often needed to arrive at the final diagnosis. Here, we report a case of SEC of the ovary in a young 22-year-old female. After extensive search in the literature, we could not found such a case in reproductive age group. Hence, to the best of our knowledge, this is the first case in younger age.

A 22-year-old female presented to gynecology outpatient department complaining of pain in the abdomen for 8 days. The patient was nulligravida and she had severe dysmenorrhea. No signs of virilization were noted clinically. Ultrasound sonography abdomen and pelvis revealed a large solid cystic mass measuring 15 cm in diameter in the pelvis and extending up to the umbilicus. Laboratory investigations showed raised CA 125 levels (174U/ml). The patient underwent exploratory laparotomy. No regional lymphadenopathy noted. Left salpingo-oophorectomy was done, and specimen was sent to the histopathology section.

Grossly, mass was measuring 12 cm × 11 cm × 6 cm with attached left fallopian tube, 6 cm in length. Externally, mass was smooth with the presence of dilated and congested blood vessels. Cut surface revealed variegated appearance comprising of solid and cystic areas with extensive areas of hemorrhage and necrosis. Microscopically, tumor was arranged in glands and trabeculae and at places in cords and hollow tubules. Tumor cells were columnar with basal hyperchromatic nuclei and prominent nucleoli. Increased stratification noted. Cells lining cords and tubules were elongated having basal nuclei (sertoliform cells). Brisk mitotic activity was seen. Foci of squamous differentiation were identified. Surrounding areas of adenofibroma were noted. Extensive areas of hemorrhage and necrosis were seen. Tumor was confined to the ovary without omental metastasis. Based on these histomorphological features, differential diagnosis of SEC and SLT was made. IHC study was done to confirm the diagnosis. Panel of markers including estrogen receptor (ER) (clone 6F11, Novocastra), progesterone receptor (PR) (clone PGR-312, Novocastra), PAN Cytokeratin (clone AE1/AE3, Dako), epithelial membrane antigen (EMA) (clone E29, Dako), inhibin (AMY82, LabIndia), calretinin (5A5, LabIndia), and Wilms' Tumor 1 (WT1) (clone 6F-H2, Dako) were done. ER, PR, PANCK, and EMA were positive in epithelial cells. Sertoliform cells were negative for inhibin, calretinin, and WT1. Hence, based on histopathological and IHC findings, the final diagnosis of sertoliform variant of endometrioid carcinoma of the ovary was given [Figure 1].{Figure 1}

SEC is a rare entity. It assumes particular significance because of its histopathological resemblance to SLTs which may serve as a potential diagnostic pitfall.

The mean age group for this tumor has been reported as 60 years.[4] It affects postmenopausal females in the age group of 50–70 years in contrast to SLTs which are common in younger females.[3],[5] In a study of 13 cases of SEC ovary, the age of 41 years was found to be the youngest age affected while others reported this entity in a 55-year-old female.[3],[4] Interestingly, our patient was 22 years adding to further diagnostic dilemma. Usually, patients with SLTs present with endocrine manifestation such as signs of virilization which are absent in SEC. A single case of SEC showing signs of virilization has been reported.[4] Signs of virilization were absent in our patient.

Grossly, SECs are solid, cystic with the presence areas of hemorrhage and necrosis while SLCTs are golden to tan yellow.[3]

On microscopic examination, the presence of areas of well-differentiated endometrioid carcinoma merging with sertoliform areas, squamous metaplasia, presence of adenofibroma component, luminal mucin, and presence of cilia favors SEC.[3] In the present case, all these features were present. Tumor was limited to the ovary with intact capsule, so it was staged 1. Grading of these tumors should be done considering the histological appearance of endometrioid carcinoma excluding SLTs like areas.[1]

IHC examination is mandatory for confirmation of diagnosis. SEC is usually immunoreactive for EMA, PANCK, ER, PR, and CK7. Sertoliform areas are negative for inhibin, calretinin, and WT1. In contrast, SLTs will be positive for inhibin, calretinin, and WT1.[1] In the present study, PANCK, EMA, ER, PR, and CK7 were positive while inhibin, calretinin, and WT1 were negative.

The main line of treatment for SEC is surgical, with bilateral salpingo-oophorectomies as the preferred choice.[3] In our case, as a patient was young, unilateral salpingo-oophorectomy was done with advice of close follow-up.

SEC is an unusual variant of endometrioid carcinoma often causing diagnostic difficulties to pathologists. All histopathologists should be aware of this entity. Thorough sampling and panel of IHC markers are necessary to arrive at the final diagnosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Kankaya D, Kahraman K, Ortaç F, Ensari A. Ovarian sertoliform endometrioid adenocarcinoma: A rare variant which causes diagnostic pitfalls. Ankara Üniv Tıp Fak Mecmuası 2015;68:133-6.
2Lee KR, Tavassoli FA, Prat J, Dietel M, Gersell DJ, Karseladze AI, et al. Surface epithelial-stromal tumours. In: Tavassoli FA, Devilee P, editors. Pathology and Genetics of Tumours of the Breast and Female Genital Organs. 4th ed. Lyon, France: IARC Press; 2003. p. 131-3.
3Misir A, Sur M. Sertoliform endometrioid carcinoma of the ovary: A potential diagnostic pitfall. Arch Pathol Lab Med 2007;131:979-81.
4Ordi 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.
5Bakshi N, Gupta N, Mahajan V. Ovarian sertoliform endometrioid carcinoma: A diagnostic dilemma. Indian J Pathol Microbiol 2013;56:327-8.