Ovarian Sertoliform Endometrioid Adenocarcinoma: A Rare Variant Which Causes Diagnostic Pitfalls

Abstract

Sertoliform endometrioid carcinoma (SEC) is a rare variant of endometrioid adenocarcinoma, which causes diagnostic pitfalls due to its morphologic resemblance of sex cord stromal tumors. Herein, we report a case of SEC in the ovary almost all of which consisted of sex-cord like areas and was presumed to be a sertoli cell tumour initially. Immunohistochemical features incompatible with sertoli cell tumour were alerting and extensive sampling revealed a focal component of classical endometrioid carcinoma with anastomosing cribriform areas of more columnar cells. The final diagnosis was sertoliform endometrioid adenocarcinoma. This entity should be kept in mind for all the pathologists and gynaecologic oncologists. Sampling such tumours extensively and confirming the diagnosis by immunohistochemistry using a large antibody panel is requisite for the correct diagnosis and preventing the patient from inappropriate therapies.

Keywords

• Endometrioid Adenocarcinoma
• Ovary
• Sertoli Cell Tumour
• Differential Diagnosis

Over Sertoliform Endometrioid Adenokarsinomu: Tanisal Tuzak Olușturan Nadir Bir Varyant

Abstract

Sertoliform endometrioid karsinoma (SEK), endometrioid adenokarsinomanın nadir görülen bir varyantı olup, seks kord stromal tümöre morfolojik benzerlikleri nedeniyle tanısal tuzak olușturur. Burada, neredeyse tamamı seks kord benzeri alanlardan olușan ve bașlangıçta sertoli hücreli tümör olarak düșünülen over SEK’sına ait bir olgu sunulmuștur. Sertoli hücreli tümör ile uyumlu olmayan immunohistokimyasal özellikler uyarıcı olmuș ve makroskopik olarak çok geniș örnekleme yapılmıștır, Fokal bir komponent olarak anastomozlașan kribriform alanlar meydana getiren daha kolumnar özellikte hücrelerle karakterli klasik endometrioid karsinoma alanlarının saptanması üzerine olgu sertoliform endometrioid adenokarsinoma olarak raporlanmıștır. Bu antitenin tüm patologlar ve jinekolojik onkologlar tarafından akılda tutulması gerekir. Bu tümörlerde doğru tanıya ulașılabilmesi ve dolayısıyla hastaların yanlıș tedavilerden korunabilmesi açısından, geniș makroskopik örneklemeyle inceleme yapılması ve geniș bir antikor paneliyle immunohistokimyasal doğrulama çok önemlidir

Keywords

• Endometrioid Adenokarsinoma
• Over
• Sertoli Hücreli Tümör
• Ayırıcı Tanı

References

1. 1. Young RH, Prat J, Scully RE. Ovarian endometrioid carcinomas resembling sex cord-stromal tumors. A clinicopathological analysis of 13 cases. Am J Surg Pathol. 1982; 6: 513-522
2. 2. Roth LM, Liban E, Czernobilsky B. Ovarian endometrioid tumors mimicking Sertoli and Sertoli-Leydig cell tumors: Sertoliform variant of endometrioid carcinoma. Cancer. 1982; 50: 1322-1331
3. 3. Fox H, Brander WL. A sertoliform endometrioid adenocarcinoma of the endometrium. Histopathology. 1988;13:584-586
4. 4. Ordi J, Schammel DP, Rasekh L, et al.. Sertoliform endometrioid carcinomas of the ovary: a clinicopathologic and immunohistochemical study of 13 cases. Mod Pathol. 1999;12:933-940
5. 5. Guerrieri C, Frånlund B, Malmström H, et al. Ovarian endometrioid carcinomas simulating sex cord-stromal tumors: a study using inhibin and cytokeratin 7. Int J Gynecol Pathol. 1998;17:266-271
6. 6. Pelkey TJ, Frierson HF Jr, Mills SE, et al. The diagnostic utility of inhibin staining in ovarian neoplasms. Int J Gynecol Pathol. 1998;17:97-105
7. 7. Matadial L, Escoffery CT, BowenChatoor JS. Sertoliform variant of endometrioid carcinoma of the ovary. West Indian Med J. 1995;44:72-73
8. 8. Remadi S, Ismail A, Tawil A, et al. Ovarian sertoliform endometrioid carcinoma. Virchows Arch. 1995;426:533-536

9. 9. Aguirre P, Thor AD, Scully RE. Ovarian endometrioid carcinomas resembling sex cord-stromal tumors. An immunohistochemical study. Int J Gynecol Pathol. 1989;8:364-373
10. 10. Irving JA, Carinelli S, Prat J. Uterine tumors resembling ovarian sex cord tumors are polyphenotypic neoplasms with true sex cord differentiation. Mod Pathol. 2006;19:17-24
11. 11. Murray SK, Clement PB, Young RH. Endometrioid carcinomas of the uterine corpus with sex cord-like formations, hyalinization, and other unusual morphologic features: a report of 31 cases of a neoplasm that may be confused with carcinosarcoma and other uterine neoplasms Am J Surg Pathol. 2005;29:157-166
12. 12. Eichhorn JH, Young RH, Clement PB. Sertoliform endometrial adenocarcinoma: a study of four cases. Int J Gynecol Pathol. 1996;15:119-126
13. 13. Usadi RS, Bentley RC. Endometrioid carcinoma of the endometrium with sertoliform differentiation. Int J Gynecol Pathol. 1995; 14: 360-364
14. 14. Clement PB, Scully RE. Uterine tumors resembling ovarian sex-cord tumors. A clinicopathologic analysis of fourteen cases. Am J Clin Pathol. 1976;66:512-525
15. 15. Zhao C, Bratthauer GL, Barner R, et al. Comparative analysis of alternative and traditional immunohistochemical markers for the distinction of ovarian sertoli cell tumor from endometrioid tumors and carcinoid tumor: A study of 160 cases. Am J Surg Pathol. 2007;31:255-266
16. 16. Liang SX, Patel K, Pearl M, et al. Sertoliform endometrioid carcinoma of the endometrium with dual immunophenotypes for epithelial membrane antigen and inhibin alpha: case report and literature review. Int J Gynecol Pathol. 2007;26:291-297
17. 17. Berezowski K, Stastny JF, Kornstein MJ. Cytokeratins 7 and 20 and carcinoembryonic antigen in ovarian and colonic carcinoma. Mod Pathol. 1996;9:426–429
18. 18. Chu P, Wu E, Weiss LM. Cytokeratin 7 and cytokeratin 20 expression in epithelial neoplasms: a survey of 435 cases. Mod Pathol. 2000;13:962–972
19. 19. Vang R, Herrmann ME, Tavassoli FA. Comparative immunohistochemical analysis of granulosa and sertoli components in ovarian sex cord-stromal tumors with mixed differentiation: potential implications for derivation of sertoli differentiation in ovarian tumors. Int J Gynecol Pathol. 2004;23:151–161
20. 20. Oliva E, Alvarez T, Young RH. Sertoli cell tumors of the ovary: a clinicopathologic and immunohistochemical study of 54 cases. Am J Surg Pathol. 2005;29:143–156