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Case 11

View the images and select the correct diagnosis from the list below.

Inguinal enigma

FNA of a nodule, right inguinal region of a 78-year-old woman. Recent ovarian tumour resection:

 

 

 

 

 

Select the correct diagnosis:

You answered: Adenoid cystic carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Granulosa cell tumour

CYTOPATHOLOGY:

  • The aspirates are extremely cellular containing a monomorphic population of small to intermediate sized cells with oval nuclei, fine chromatin and distinct nucleoli
  • Nuclear grooves and notched nuclear outlines are easily identified
  • Cells are arranged in loose sheets and numerous variably sized microcystic aggregates containing a myxoid-like material
  • The findings are consistent with those of adult granulosa cell tumour

DISCUSSION:

  • The histological section confirms the diagnosis of a malignant granulosa cell tumour of the adult type
  • The tumour is composed of sheets of relatively uniform tumour cells with pale, oval nuclei, inconspicuous nucleoli and prominent nuclear grooving. There is little pale cytoplasm with indistinct cytoplasmic outlines. There are numerous mitotic figures. The nuclei are arranged in variable sized lobules including foci of small cyst formations, a focal trabecular pattern and microfollicular structures which contain eosinophilic fluid (Call-Exner bodies)
  • Granulosa cell tumour of the adult type is a low-grade malignant neoplasm of the ovary, accounting for 1-2% of all ovarian neoplasms and approximately 5-8% of primary ovarian malignancies. It is derived from the granulosa cell, a hormonally active component of the ovarian stroma that is responsible for estradiol production. It is also categorized as an ovarian sex cord-stromal tumour, and accounts for 70% of the tumours in this category. Although a juvenile variety is encountered, this tumour most commonly occurs in post menopausal women and is usually estrogenic
  • Stage of the tumour is the most significant prognostic factor. Patients require long-term follow-up because of the unpredictable recurrence or metastasizing behaviour many years after a disease-free interval, even with tumours that are Stage I or II at diagnosis
  • A characteristic feature of an adult-type granulosa cell tumour is the presence of nuclear grooves or folds, a characteristic that is not usually seen in the nuclei of adenoid cystic carcinoma
  • Carcinoid tumours may arise as a monodermal derivative of a teratoma or represent a metastasis, generally from the gastrointestinal tract. However, the cells of a carcinoid have typically more granular chromatin, more abundant cytoplasm and lack nuclear grooves and the matrix material of Call-Exner bodies
  • Endometrial stromal sarcomas present in smears as small homogenous cells with round, pale to dark nuclei and high N:C ratios. Often they present with metachromatic fibrillar matrix material (DQ stain) within cohesive tissue fragments
  • Immunohistochemical stains can be useful in the differential diagnosis. Granulosa cell tumours typically stain positive for calretinin, inhibin, vimentin, CD99 and negative for EMA

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Ylagan LR, Middleton WD, Dehner LP. Fine-needle aspiration cytology of recurrent granulosa cell tumor: case report with differential diagnosis and immunocytochemsitry. Diagnostic Cytopathology. 2002 Jul;27(1):38-41.



Schumer ST, Cannistra SA. Granulosa Cell Tumor of the Ovary. Journal of Clinical Oncology, Vol21, Issue 6 (March), 2003: 1180-1189.



Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. The pelvis and scrotal contents. In: Modern Cytopathology. Philadelphia: Churchill Livingstone; 2004. pp 689-728.

You answered: Endometrial stromal sarcoma
Sorry, that is INCORRECT

The correct diagnosis is: Granulosa cell tumour

CYTOPATHOLOGY:

  • The aspirates are extremely cellular containing a monomorphic population of small to intermediate sized cells with oval nuclei, fine chromatin and distinct nucleoli
  • Nuclear grooves and notched nuclear outlines are easily identified
  • Cells are arranged in loose sheets and numerous variably sized microcystic aggregates containing a myxoid-like material
  • The findings are consistent with those of adult granulosa cell tumour

DISCUSSION:

  • The histological section confirms the diagnosis of a malignant granulosa cell tumour of the adult type
  • The tumour is composed of sheets of relatively uniform tumour cells with pale, oval nuclei, inconspicuous nucleoli and prominent nuclear grooving. There is little pale cytoplasm with indistinct cytoplasmic outlines. There are numerous mitotic figures. The nuclei are arranged in variable sized lobules including foci of small cyst formations, a focal trabecular pattern and microfollicular structures which contain eosinophilic fluid (Call-Exner bodies)
  • Granulosa cell tumour of the adult type is a low-grade malignant neoplasm of the ovary, accounting for 1-2% of all ovarian neoplasms and approximately 5-8% of primary ovarian malignancies. It is derived from the granulosa cell, a hormonally active component of the ovarian stroma that is responsible for estradiol production. It is also categorized as an ovarian sex cord-stromal tumour, and accounts for 70% of the tumours in this category. Although a juvenile variety is encountered, this tumour most commonly occurs in post menopausal women and is usually estrogenic
  • Stage of the tumour is the most significant prognostic factor. Patients require long-term follow-up because of the unpredictable recurrence or metastasizing behaviour many years after a disease-free interval, even with tumours that are Stage I or II at diagnosis
  • A characteristic feature of an adult-type granulosa cell tumour is the presence of nuclear grooves or folds, a characteristic that is not usually seen in the nuclei of adenoid cystic carcinoma
  • Carcinoid tumours may arise as a monodermal derivative of a teratoma or represent a metastasis, generally from the gastrointestinal tract. However, the cells of a carcinoid have typically more granular chromatin, more abundant cytoplasm and lack nuclear grooves and the matrix material of Call-Exner bodies
  • Endometrial stromal sarcomas present in smears as small homogenous cells with round, pale to dark nuclei and high N:C ratios. Often they present with metachromatic fibrillar matrix material (DQ stain) within cohesive tissue fragments
  • Immunohistochemical stains can be useful in the differential diagnosis. Granulosa cell tumours typically stain positive for calretinin, inhibin, vimentin, CD99 and negative for EMA

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Ylagan LR, Middleton WD, Dehner LP. Fine-needle aspiration cytology of recurrent granulosa cell tumor: case report with differential diagnosis and immunocytochemsitry. Diagnostic Cytopathology. 2002 Jul;27(1):38-41.



Schumer ST, Cannistra SA. Granulosa Cell Tumor of the Ovary. Journal of Clinical Oncology, Vol21, Issue 6 (March), 2003: 1180-1189.



Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. The pelvis and scrotal contents. In: Modern Cytopathology. Philadelphia: Churchill Livingstone; 2004. pp 689-728.

You answered: Carcinoid
Sorry, that is INCORRECT

The correct diagnosis is: Granulosa cell tumour

CYTOPATHOLOGY:

  • The aspirates are extremely cellular containing a monomorphic population of small to intermediate sized cells with oval nuclei, fine chromatin and distinct nucleoli
  • Nuclear grooves and notched nuclear outlines are easily identified
  • Cells are arranged in loose sheets and numerous variably sized microcystic aggregates containing a myxoid-like material
  • The findings are consistent with those of adult granulosa cell tumour

DISCUSSION:

  • The histological section confirms the diagnosis of a malignant granulosa cell tumour of the adult type
  • The tumour is composed of sheets of relatively uniform tumour cells with pale, oval nuclei, inconspicuous nucleoli and prominent nuclear grooving. There is little pale cytoplasm with indistinct cytoplasmic outlines. There are numerous mitotic figures. The nuclei are arranged in variable sized lobules including foci of small cyst formations, a focal trabecular pattern and microfollicular structures which contain eosinophilic fluid (Call-Exner bodies)
  • Granulosa cell tumour of the adult type is a low-grade malignant neoplasm of the ovary, accounting for 1-2% of all ovarian neoplasms and approximately 5-8% of primary ovarian malignancies. It is derived from the granulosa cell, a hormonally active component of the ovarian stroma that is responsible for estradiol production. It is also categorized as an ovarian sex cord-stromal tumour, and accounts for 70% of the tumours in this category. Although a juvenile variety is encountered, this tumour most commonly occurs in post menopausal women and is usually estrogenic
  • Stage of the tumour is the most significant prognostic factor. Patients require long-term follow-up because of the unpredictable recurrence or metastasizing behaviour many years after a disease-free interval, even with tumours that are Stage I or II at diagnosis
  • A characteristic feature of an adult-type granulosa cell tumour is the presence of nuclear grooves or folds, a characteristic that is not usually seen in the nuclei of adenoid cystic carcinoma
  • Carcinoid tumours may arise as a monodermal derivative of a teratoma or represent a metastasis, generally from the gastrointestinal tract. However, the cells of a carcinoid have typically more granular chromatin, more abundant cytoplasm and lack nuclear grooves and the matrix material of Call-Exner bodies
  • Endometrial stromal sarcomas present in smears as small homogenous cells with round, pale to dark nuclei and high N:C ratios. Often they present with metachromatic fibrillar matrix material (DQ stain) within cohesive tissue fragments
  • Immunohistochemical stains can be useful in the differential diagnosis. Granulosa cell tumours typically stain positive for calretinin, inhibin, vimentin, CD99 and negative for EMA

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Ylagan LR, Middleton WD, Dehner LP. Fine-needle aspiration cytology of recurrent granulosa cell tumor: case report with differential diagnosis and immunocytochemsitry. Diagnostic Cytopathology. 2002 Jul;27(1):38-41.



Schumer ST, Cannistra SA. Granulosa Cell Tumor of the Ovary. Journal of Clinical Oncology, Vol21, Issue 6 (March), 2003: 1180-1189.



Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. The pelvis and scrotal contents. In: Modern Cytopathology. Philadelphia: Churchill Livingstone; 2004. pp 689-728.

You answered: Granulosa cell tumour
That is CORRECT!

CYTOPATHOLOGY:

  • The aspirates are extremely cellular containing a monomorphic population of small to intermediate sized cells with oval nuclei, fine chromatin and distinct nucleoli
  • Nuclear grooves and notched nuclear outlines are easily identified
  • Cells are arranged in loose sheets and numerous variably sized microcystic aggregates containing a myxoid-like material
  • The findings are consistent with those of adult granulosa cell tumour

DISCUSSION:

  • The histological section confirms the diagnosis of a malignant granulosa cell tumour of the adult type
  • The tumour is composed of sheets of relatively uniform tumour cells with pale, oval nuclei, inconspicuous nucleoli and prominent nuclear grooving. There is little pale cytoplasm with indistinct cytoplasmic outlines. There are numerous mitotic figures. The nuclei are arranged in variable sized lobules including foci of small cyst formations, a focal trabecular pattern and microfollicular structures which contain eosinophilic fluid (Call-Exner bodies)
  • Granulosa cell tumour of the adult type is a low-grade malignant neoplasm of the ovary, accounting for 1-2% of all ovarian neoplasms and approximately 5-8% of primary ovarian malignancies. It is derived from the granulosa cell, a hormonally active component of the ovarian stroma that is responsible for estradiol production. It is also categorized as an ovarian sex cord-stromal tumour, and accounts for 70% of the tumours in this category. Although a juvenile variety is encountered, this tumour most commonly occurs in post menopausal women and is usually estrogenic
  • Stage of the tumour is the most significant prognostic factor. Patients require long-term follow-up because of the unpredictable recurrence or metastasizing behaviour many years after a disease-free interval, even with tumours that are Stage I or II at diagnosis
  • A characteristic feature of an adult-type granulosa cell tumour is the presence of nuclear grooves or folds, a characteristic that is not usually seen in the nuclei of adenoid cystic carcinoma
  • Carcinoid tumours may arise as a monodermal derivative of a teratoma or represent a metastasis, generally from the gastrointestinal tract. However, the cells of a carcinoid have typically more granular chromatin, more abundant cytoplasm and lack nuclear grooves and the matrix material of Call-Exner bodies
  • Endometrial stromal sarcomas present in smears as small homogenous cells with round, pale to dark nuclei and high N:C ratios. Often they present with metachromatic fibrillar matrix material (DQ stain) within cohesive tissue fragments
  • Immunohistochemical stains can be useful in the differential diagnosis. Granulosa cell tumours typically stain positive for calretinin, inhibin, vimentin, CD99 and negative for EMA

BACK TO IMAGES



HISTOLOGY



REFERENCES:

Ylagan LR, Middleton WD, Dehner LP. Fine-needle aspiration cytology of recurrent granulosa cell tumor: case report with differential diagnosis and immunocytochemsitry. Diagnostic Cytopathology. 2002 Jul;27(1):38-41.



Schumer ST, Cannistra SA. Granulosa Cell Tumor of the Ovary. Journal of Clinical Oncology, Vol21, Issue 6 (March), 2003: 1180-1189.



Geisinger KR, Stanley MW, Raab SS, Silverman JF, Abati A. The pelvis and scrotal contents. In: Modern Cytopathology. Philadelphia: Churchill Livingstone; 2004. pp 689-728.

From the Cytopathology files of the BC Cancer Agency
Submitted by: Brenda Smith, BSc and Tom Thomson, MD
SOURCE: Case 11 ( )
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