ABSTRACT
We herein report a rare tumor combination of mucinous cystadenoma and an adult granulosa cell tumor in the same ovary of a 50-year-old woman. Ultrasound examination showed a multicystic mass in the left ovary. Histologically it showed 2 components that were intimately admixed. One was composed of cysts lined by mucinous epithelium of the intestinal type that was strongly positive for cytokeratin-20 and cytokeratin-7. The other was a granulosa cell tumor of the adult type in which the tumor cells showed microfollicular, sheets, and trabecular patterns. They were positive for calretinin, α-inhibin, and CD99. There are many theories for the histogenesis of such a combination. After discussing all the possibilities we conclude that the mucinous component is probably a heterologous mucinous differentiation within an adult granulosa cell tumor because of the intimate admixture of the 2 components and the mucinous epithelium being of the intestinal type.
Subject(s)
Cystadenoma, Mucinous/pathology , Granulosa Cell Tumor/pathology , Ovarian Neoplasms/pathology , 12E7 Antigen , Antigens, CD/analysis , Calbindin 2 , Cell Adhesion Molecules/analysis , Cystadenoma, Mucinous/diagnosis , Diagnosis, Differential , Female , Granulosa Cell Tumor/diagnosis , Humans , Inhibins/analysis , Keratin-17/analysis , Keratin-20/analysis , Middle Aged , Neoplasms, Multiple Primary/pathology , Ovarian Neoplasms/diagnosis , S100 Calcium Binding Protein G/analysisABSTRACT
OBJECTIVE: To report a case of primary yolk sac (endodermal sinus) tumour (YST) of the vulva which is very rare and to highlight some unusual features of this tumour in the vulva. CLINICAL PRESENTATION AND INTERVENTION: A 23-year-old woman presented with a 1-month swelling in the right labium majus that was non-tender and rapidly increasing in size. The mass was excised; it grossly measured 6 × 5 × 3 cm and was firm with a grey white cut surface. Microscopically it showed features of YST. The patient returned to the clinic only after 2 months with a recurrent mass of almost the same size with ipsilateral lymphadenopathy. At that time serum α-fetoprotein showed only a mild increase (13.4 µg/l, normal: 0-10 µg/l). Further management was not possible as she decided to return to her native country for treatment. A literature review shows that local excision with lymphadenectomy followed by cisplatin-based chemotherapy is the best mode of treatment for primary YST of the vulva. CONCLUSION: This case is presented for its rarity and to highlight the fact that serum α-fetoprotein estimation may not aid in the primary diagnosis or detection of recurrence in patients on follow-up for YST arising in the vulva unlike those seen in the gonads.
