Steroid Cell Tumor of the Ovary Presenting with Ascites: A Rare Neoplasm in a Postmenopausal Woman.

Steroid cell tumors of the ovary are rare sex-cord stromal tumors, accounting for approximately 0.1% of all ovarian neoplasms. Majority of these tumors are benign, occur in pre-menopausal women and are associated with hyperandrogenism. However, around one-third of cases are malignant and do not present with hormonal manifestations. A 48-year-old post-menopausal woman presented with complaints of gradually increasing progressive abdominal distension over the past 3 months. She had a history of weight gain but denied any symptoms of virilization. On examination, abdominal distension associated with ascites was noted. Serum CA125 level was raised. Contrast-enhanced computed tomography revealed a solid right adnexal mass. Based on the clinical impression of epithelial ovarian malignancy, the patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy. Histopathological examination revealed steroid cell tumor of the not otherwise specified type in the right ovary with the capsular breach. However, all other organs, including the omentum were free of tumor. The index case is unique for its presentation in a post-menopausal woman, association with ascites, elevated CA125 levels and lack of any virilization manifestations. Establishing an early and accurate tissue diagnosis is essential so that appropriate surgical management can be done to prevent the development of metastases in potentially malignant cases.

Ultrasound-guided fine needle aspiration of ovarian masses: Assessment of diagnostic accuracy and risk stratification using a categorical reporting system.

INTRODUCTION: The present study was undertaken to assess the accuracy of fine needle aspiration cytology (FNAC) and cell-block immunocytochemistry, and to estimate the risk of malignancy, using a categorical reporting system, in the diagnosis of ovarian masses. METHODS: This was a 5-year retrospective study of FNAs of ovarian masses. The cytological diagnoses were categorised as inadequate, non-neoplastic, benign neoplasms, indeterminate for malignancy, suspicious for malignancy and malignant neoplasms. The cytology was correlated with the corresponding histopathology to assess the diagnostic accuracy and risk of malignancy associated with each diagnostic category. RESULTS: Of a total of 66 703 FNAs performed during the study period, 580 (0.9%) were performed on ovarian masses. Of these, 40 (6.9%) were reported as non-neoplastic; 76 (13.1%) as benign neoplasms; 14 (2.4%) as indeterminate for malignancy, 48 (8.3%) as suspicious for malignancy, 337 (58.1%) as malignant neoplasms and 65 (11.2%) as inadequate for interpretation. Immunocytochemistry (ICC) was performed on 99 (17%) aspirates. Subsequent histopathology was available in 208 (35.8%) cases. On cyto-histopathological correlation, 183 (88%) were concordant and 25 (12%) were discordant. The overall sensitivity, specificity, positive and negative predictive values and diagnostic accuracy for diagnosing ovarian malignancy were 88.4%, 85.7%, 96.8%, 60.0% and 88% respectively. Risk of malignancy for each category was 80%, 0%, 4.5%, 66.7%, 88.5% and 98.5% respectively. CONCLUSIONS: Ultrasound-guided FNAC has high specificity and diagnostic accuracy for preoperative diagnosis of ovarian malignancies and hence is a valid diagnostic procedure in certain clinical situations. Reporting using a categorical system imparts uniformity and also provides the clinicians with an associated risk of malignancy to guide further management.

Cytologic features of angiolymphoid hyperplasia with eosinophilia: Highlighting the diagnostic clues.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is an uncommon, benign, inflammatory disorder involving the skin and microvasculature with an undetermined etiopathogenesis. Although the histopathology is well-characterized, the cytologic features of this entity have been rarely described in literature. This study was conducted to describe in detail the cytomorphologic features of ALHE and to identify the characteristic features that can help in establishing a correct diagnosis of this entity. This was a retrospective study conducted over a period of 3 years, wherein the corresponding cytologic smears of histopathologically diagnosed cases of ALHE were retrieved and reviewed. All the cytologic features were recorded to identify characteristic features that can be used to differentiate ALHE from other cytologic mimics. On histopathologic examination, 15 cases were reported as ALHE. Corresponding cytologic samples were available for three cases. All the three cases were males who were 21, 22 and 52 years old, respectively. The sites of the swellings were scalp, orbital and preauricular. The most consistent cytologic findings were the presence of eosinophilia, scattered plump endothelial cells and a reactive lymphoid background. We believe that a thorough cytologic examination for the presence of plump to spindle-shaped cells in smears with eosinophilia and reactive lymphoid tissue, can help in reaching to a cytologic diagnosis of ALHE in suspected cases.