Gynandroblastoma of the ovary: a case report with an immunohistochemical and ultrastructural study.

An ovarian gynandroblastoma in a 60-year-old woman is described. The cut-surface of the right ovary showed multiple macrofollicles separated by white fibrous tissues and multiple ill-defined yellowish nodules. The tumour consisted of substantial amount of a granulosa cell element and a Sertoli cell element with intermingled Leydig cells. Immunohistochemically, the tumour cells in both the granulosa cell and Sertoli cell elements were positive for cytokeratin CAM5.2. The granulosa cell element showed strong membrane staining of Ewing's sarcoma antigen 013 and the Sertoli cell element was locally positive. Vimentin was observed in both the Sertoli cell element and the granulosa cells. Both elements and the Leydig cells were uniformly negative for epithelial membrane antigen, muscle specific actin, CD31 and CD34. The tumour was aneuploid by flow cytometry. The patient was well with no evidence of tumour five months after surgery.

Gynandroblastoma with elements resembling juvenile granulosa cell tumor.

Gynandroblastoma is an extremely rare sex cord-stromal tumor that exhibits significant ovarian and testicular differentiation. In most previously reported tumors, adult granulosa cell tumor has formed the ovarian-type component and Sertoli or Sertoli-Leydig cell tumor (SLCT) has formed the testicular-type component. In contrast, the ovarian-type element in the case reported here resembled juvenile granulosa cell tumor (JGCT). The testicular-type elements accounted for 20% of the tumor and resembled intermediate-grade SLCT. The Sertoli cells had strong cytoplasmic staining for cytokeratin CAM 5.2 and positive nuclear staining with estrogen and progesterone receptor, whereas the JGCT-like areas were negative for these antibodies. Ultrastructurally, the JGCT-like areas consisted of groups of cells that were invested by a basal lamina and had low nuclear-cytoplasmic ratios, cytoplasmic lipid droplets, and simple junctional complexes. The Sertoli cells in the SLCT-like areas had long, tight junctions and well-formed desmosomes. Gynandroblastoma usually presents clinically as an abdominal mass, often associated with either virilizing or feminizing manifestations. The prognosis is favorable and similar to that of the individual tumor components, but clinical follow-up in the small number of cases has been limited.

Origin of unreactive hyaline bodies from erythrocytes in genital tumors.

Two genital tumors, one a lipid virilizing cell tumor of the ovary, the other an ovarian Sertoli-Leydig cell tumor with retiform pattern, were studied focusing attention on the numerous eosinophilic hyaline bodies that were present both in the extracellular spaces and within the cytoplasm of the proliferating cells. Histochemistry and immunohistochemistry revealed that they were PAS positive and alpha-1-fetoprotein negative. Under electronmicroscopy these hyaline bodies appeared to correspond to variably altered red blood cells: red blood cell ghosts, erythrocytes with Heinz bodies, phagocytosed erythrocytes. Our findings could explain the origin of at least a part of the hyaline bodies found in similar or in other unrelated pathologies.

Gynandroblastoma of the ovary.

Gynandroblastoma is an extremely rare primary tumour of the ovary showing morphological evidence of both male and female differentiation. We describe the light and ultrastructural features of this tumour and review the present knowledge about its nature, function and behaviour.

Granulosa cell tumor of the ovary with Sertoli-Leydig cell tumor components (gynandroblastoma).

A rare granulosa cell tumor with Sertoli-Leydig cell tumor components (gynandroblastoma) arising in the left ovary was reported in a 63-year-old female. Microscopically, the tumor was composed predominantly of granulosa cells arranged mainly in a diffuse solid pattern, but in some areas there were a trabecular pattern and thecofibromatous stromal components. Also, well-differentiated Sertoli-Leydig cell tumor elements were present as a minor component. The tumor produced, endocrinologically, a large amount of estradiol, some androstenedione and a small amount of testosterone. The possibility that estradiol in the present tumor was produced predominantly from androstenedione via estrone was suggested by the results of an in vitro biosynthetic study.

Gynandroblastoma: its ultrastructure.

Gynandroblastoma is a rare, sex-cord stromal tumor of the ovary that shows morphologic evidence of female and male differentiation. Such a tumor produced masculinization in a 24-year-old woman, whose symptoms disappeared following removal of the tumor. By electron microscopy, the granulosa cell nests displayed Call-Exner (CE) bodies of the hyaline type composed of multiple layers of basal lamina resembling CE bodies of the normal graafian follicle. In contrast, CE bodies of a classic granulosa theca cell tumor were of the spongiform type, consisting of a space limited by a single basal lamina containing altered granulosa cells and cell processes. Both types of CE bodies are believed to arise following secretion by and/or degeneration of granulosa cells, the variation in morphology between the two resulting from differences in amounts of basal lamina deposited. The tubular components of the tumor resembled more closely the rete ovarii than did Sertoli cells, and its proposed that such structures be called by the alternate and less specific term "androblastoma." The identity of Leydig cells was established by demonstrated of intracytoplasmic Reinke crystals. Despite a difference in architectural pattern, there was a close ultrastructural resemblance between the different sex-cord components of the gynandroblastoma.