Sex cord stromal tumours and germ cell tumour

What immunos are positive in sex cord stromal tumours? (Eg fibroma, thecone, granular cell tumour, sertoli/leydig cell tumour)

calretinin, inhibit, SF1, FOXL2, Melan-A, WT1, CD99

Ovarian tumour - yellow cut suface - what’s this tumour?

Thecoma - yellow cos it’s full of steroids

Thecome - histology is spindle cells with vacuolated cytoplasm that will stain with what?

Oil red O stain

What stain can differentiate thecoma from Adult granulosa cell tumour, since many of their IHC overlap?

Reticulum will stain around each cell in thecoma but not in AGCT

Sertoli letting cell tumour is divided into five subtypes - well diff, intermediate diff, poorly diff, retiform , with heterologous elements

Less diff tumours lack well formed sertoli cell tubules and fewer leydig cells.

Well diff - well formed tubules formed by Sertoli cells advised with clusters of leydig cells

Intermediate - cords (ie tubules compressed and so without lumen) of sertoli , fewer leydig cells

Poor diff - sheets of Sertoli cells ( just looks like spindle cells) and fewer leydig cells

Retiform pattern - form slit like spaces looks like rete of testis (pic)

With heterologous element eg mucinous epithelium

What is the mutation common in sertoli leydig cell tumour?

DICER1 - also cause multinodular goitre

You see crystals of Reinke- what rumour is it, and where in the ovary does it arise from ?

Leydig cell tumour , originated in the ovary hilum

Steroid cell tumour makes what hormones

50% androgen, 10% oestrogen

Teratoma - learn what tissue is from which ectoderm/ mesoderm/ endoderm etc

• Mixture of mature, benign tissues

  • Ectodermal (most common): squamous epithelium, sebaceous glands, hair follicles, brain tissue

  • Mesodermal (second most common): bone, cartilage, smooth muscle, fibroadipose tissue

  • Endodermal: intestinal or respiratory epithelium, thyroid, salivary gland

What is the characteristic look of sex cord tumour with annular tubule - tips: antipodal nuclei

Composed of aggregates of simple or complex annular tubules Cells are columnar with clear cytoplasm with an “antipodal” arrangement of the nuclei (at opposite ends) Hyaline basement membrane-like material within nests

What does choriocarcinoma cause in serum

What does it look like?

Very high hcg

Formed by Malignant cytotrophoblasts (mononuclear) and syncytiotrophoblasts (multinucleated)

Abundant Hemorrhage and necrosis.

It can develop from polar pregnancy, ectopic pregnancy or even normal pregnancy

Think about embryonal carcinoma - what does it look like?

High grade, large cells with vesicular nuclei and prominent nucleoli forming sheets/ glands, nests (and others - many architecture type)

Basically Purple high grade looking cell with lots of mitosis

Aggressive

Germ cell tumour IHc

What is steroid cell tumour ?

Steroid cell tumor, not otherwise specified (NOS), of the ovary is composed of uniform polygonal cells with an appearance suggestive of steroid hormone synthesis ie it looks like it makes androgen (ie looks like leydig cells) - It has abundant eosinophilic or microvacuolated lipid-rich cytoplasm.

It is morphologically similar to Leydig cell tumor but lacks Reinke crystals.

50% makes androgen, 10a% makes oestrogen

stromal luteoma, referring to a steroid cell tumor < 2cm in size in a background of stromal hyperthecosis

Schiller - duval bodies - which tumour?

Ovarian yolk sac tumour

This is pseudopapillary structure with a central vessel surrounded by a double layer of cuboidal cells which contains intracytoplasmic and extracytoplasmic globules (PAS positive)

What’s the most common mixed germ cell tumour consists of?

Dysgerminoma plus yolk sac tumour

Ovarian dysgerminoma - what’s histology like?

Like Seminoma in testis: large cells with clear cytoplasm, prominent nucleoli, lymphocytic infiltration. Those clear cells are PLAP positive

What does ovarian dysgerminoma raise in blood?

Serum LDH,

HCG ±/-

What’s the most common mature teratoma?

Dermoid cyst

What’s the rumour that present with gonadal dysgenesis?

Gonadoblastoma

It consists of a combination of germ cells and sex cord stromal component

Germ cell component often - GCNIS ; sec cord component - SCTAT

What hormone does thecoma make

Oestrogen