PMC6385544_01
Contrast-enhanced computed tomographic scan of abdomen in axial (a and b) and coronal images (c and d) showing a well-defined complex mass (large arrow) in right adnexa with enhancing solid component and nonenhancing necrotic part (*). Prominent adjacent adnexal vessels (small arrow) with right ovary not separately identified
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F1
Right salpingo-oophorectomy was done, in which the right ovary was seen to be replaced by a solid cystic tumor with intact capsule [Figure 1].
Macroscopic examination reveals an enlarged ovary replaced by a solid cystic tumor. The solid areas appear gray-yellow in color and show multiple foci of hemorrhage. The cystic spaces were filled with thin yellow fluid
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F2
The solid areas are gray-yellow, showing multiple foci of hemorrhage, and the cysts were filled with thin clear yellow fluid [Figure 2].
Microscopic examination of tumor showing intermediate differentiation with presence of tubules of immature Sertoli cells and clusters of Leydig cells (H and E, x10)
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F3
Delicate fibrous stroma was seen at places in which Leydig cells were found in small clusters, cords, and lying singly [Figure 3].
Sertoli-Leydig cell tumor showing heterologous elements lined by mucinous epithelium (H and E, x10)
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F4
Heterologous elements in the form of glands lined by mucinous epithelium were seen [Figure 4].
Sertoli-Leydig cell tumor showing marked anaplasia (H and E, x10)
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F5
Focal area showed marked anaplasia in the form of many large, bizarre, and multinucleated cells [Figure 5].
Immunohistochemical examination. (a) The neoplastic cells stained positive for calretinin. (b) The neoplasic cells stained negative for epithelial membrane antigen. (c) MIB1 labeling index is approximately 30%, (Anaplastic focus shows a very high MIB1 labeling index of 80%-90%)
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F6
However, areas with anaplasia show a MIB1 labeling index of 80%-90% [Figure 6].