PMC4916276_01
(a) Sagittal transvaginal ultrasound image: large heterogeneous adnexal mass. (b) Sagittal pelvic US with Doppler imaging: vascular adnexal mass with low resistant arterial flow (RI = 0.29). (c) Axial CT pelvis with IV contrast: yellow arrow: uterus, red arrowhead: enhancing adnexal mass, and curved blue arrow: cul-de-sac metastasis. (d) Sagittal CT pelvis with IV contrast: yellow arrow: uterus, red arrowhead: adnexal mass, and white asterisk: ascites.
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Pelvic sonogram revealed a solid left adnexal mass measuring 11.8 x 6.5 x 8.8 cm with marked increased vascularity and low resistance arterial waveforms with a resistance index of 0.29 (Figures 1(a) and 1(b)). A CT scan confirmed a 10.4 x 5.9 cm solid left adnexal mass as well as another solid nodule mass measuring 4.9 x 4 cm in the cul-de-sac and mild ascites (Figures 1(c) and 1(d)).
(a) The tumor demonstrated a solid and multinodular gross pattern composed of polygonal to round tumor cells (H&E stain). (b) The cytoplasm was moderate to abundant and varied from eosinophilic and granular (lipid-poor) to spongy which was lipid-rich as demonstrated by positive oil-red stain. (c) Arrow shows a representative cell with high tumor cellularity and a central nucleus containing prominent nucleoli. (d) Immunohistochemistry showed diffuse positive staining for inhibin.
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On microscopic examination, the left ovarian mass demonstrated a solid and multinodular gross pattern composed of polygonal to round tumor cells with distinct cell borders (Figure 2(a)). The cytoplasm was moderate to abundant and varied from eosinophilic and granular (lipid-poor) to spongy which was lipid-rich as demonstrated by positive oil-red stain (Figure 2(b)). There was grade 1 to 2 nuclear atypia (Figure 2(c)). Immunohistochemistry showed diffuse positive staining for inhibin (Figure 2(d)) and negative staining for CD10, PAX-8, and CK7.