Stall Jennifer N, Young Robert H
Hospital Pathology Associates, Minneapolis, Minnesota (J.N.S.) The James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (R.H.Y.).
Int J Gynecol Pathol. 2019 Mar;38(2):143-150. doi: 10.1097/PGP.0000000000000508.
Sixteen adult granulosa cell tumors which had conspicuous zones of cells with pale cytoplasm imparting a resemblance to thecoma are reported. The neoplasms occurred in patients from 38 to 86 yr of age, the majority being over 55 yr of age. Ten tumors were incidental findings, the remainder being associated with symptoms or signs related to an adnexal mass. All the tumors were unilateral, typically small, usually under 5 cm, with only 3 being larger. With 1 exception they were uniformly solid and were typically entirely or focally yellow on sectioning. Microscopic examination typically showed a nodular pattern of growth constituted by cells with moderate to abundant pale cytoplasm; the cells resembled those seen in most thecomas. The nodules occasionally became confluent and focally a diffuse pattern was seen. Typical foci of adult granulosa cell neoplasia in the form of foci of conspicuous epithelial differentiation were absent or rare in most cases but were seen in subtle form in 6 cases and overtly in 3. A few tumors had other features seen in some thecomas, hyaline plaques, sclerosis, and calcification. Reticulin stains were examined in 13 cases and showed that the thecoma-like foci exhibited a dearth of reticulum indicating that those areas were predominantly of granulosa cell nature. Most adult granulosa cell tumors have cells with scant cytoplasm; occasional tumors have abundant eosinophilic cytoplasm, so-called luteinized adult granulosa cell tumors. That some granulosa cell tumors have the cytoplasmic features described herein has occasionally been noted but the resemblance to thecoma has not been emphasized to the best of our knowledge and in the past such tumors may have been misdiagnosed as thecoma, the referral diagnosis in 6 of our cases. A reticulin stain is of crucial aid in indicating the epithelial nature of the thecoma-like foci in these cases. Given the small size of the majority of the tumors the distinction between a small adult granulosa cell tumor and thecoma does not have significant prognostic or therapeutic implications in most cases but awareness of this feature of a small subset of adult granulosa cell tumors is warranted. Our findings have import to the diagnosis of thecoma which is uncommon if strict criteria, including exclusion of granulosa tumors of the type described, are used.
报告了16例成人颗粒细胞瘤，这些肿瘤有明显的细胞区，其细胞质淡染，类似卵泡膜瘤。肿瘤发生于38至86岁的患者，大多数患者年龄超过55岁。10例肿瘤为偶然发现，其余与附件肿块相关的症状或体征有关。所有肿瘤均为单侧，通常较小，通常小于5cm，只有3例较大。除1例例外，肿瘤均为实性，切片时通常全部或局部呈黄色。显微镜检查通常显示由细胞质中度至丰富且淡染的细胞构成的结节状生长模式；这些细胞类似于大多数卵泡膜瘤中的细胞。结节偶尔融合，局部可见弥漫性模式。大多数病例中不存在或罕见典型的成人颗粒细胞瘤灶，即明显上皮分化的灶，但在6例中呈细微形式可见，3例中明显可见。少数肿瘤具有一些卵泡膜瘤中可见的其他特征，如透明斑块、硬化和钙化。对13例进行了网状纤维染色，结果显示类似卵泡膜瘤的灶网状纤维缺乏，表明这些区域主要为颗粒细胞性质。大多数成人颗粒细胞瘤的细胞细胞质稀少；偶尔有肿瘤细胞有丰富的嗜酸性细胞质，即所谓的黄素化成人颗粒细胞瘤。据我们所知，偶尔有人注意到一些颗粒细胞瘤具有本文所述的细胞质特征，但与卵泡膜瘤的相似性未得到强调，过去此类肿瘤可能被误诊为卵泡膜瘤，我们的6例病例转诊诊断为此。在这些病例中，网状纤维染色对于表明类似卵泡膜瘤的灶的上皮性质至关重要。鉴于大多数肿瘤体积较小，在大多数情况下，小的成人颗粒细胞瘤与卵泡膜瘤的区分对预后或治疗没有显著影响，但有必要认识到一小部分成人颗粒细胞瘤的这一特征。我们的发现对卵泡膜瘤的诊断具有重要意义，如果使用严格标准，包括排除所述类型的颗粒细胞瘤，则卵泡膜瘤并不常见。
