PMC7184839_01
Clinical and imaging findings for our ovarian tumor patient. Photographs show hairiness of the neck, back (A), and knee (B). Moon face and facial flushing appeared as signs of Cushing's syndrome (C). Abdominal ultrasonography revealed an 8.0-cm-sized well-defined uniform solid tumor (D). Dual absorption areas in the tumor were observed by CT (E). The tumor was uniformly visualized on T2-weighted magnetic resonance imaging (F).
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F1
A 4-year-old female patient was admitted to our hospital with abdominal distention, hoarseness associated with virilization, hirsutism (Fig. 1A and B), cliteromegaly, and the characteristic moon face and facial flushing signs of Cushing's syndrome (Fig. 1C). Abdominal ultrasonography detected an 80 x 50 x 50 mm tumor of the right ovary (Fig. 1D). CT pelvic scan and MRI revealed a fat-containing bimodal pelvic mass (Fig. 1E).
Gross appearance and pathological findings of the steroid cell tumor. Tumor surface was smooth and white without adhesion to surrounding area (A). Cut surface showed a monotonous yellow fat-rich appearance (B). The tumor was composed of both eosinophilic and vacuolated cytoplasm. Tumor cell infiltration into the capsule (arrow) was observed (C). Tumor cells showed spontaneous severe nuclear atypia (D). Tumor hemorrhage (E) and necrosis (F) were observed. Venous infiltration of tumor cells was observed (G, H). Inhibin-positive cells were demonstrated by brown color on immunostaining (I). Original magnification, x10 in C, G; x40 in E, F, H, and I; x100 in D.
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F2
The surface of the tumor was smooth and white without adhesion to the surrounding area (Fig. 2A and B) and was found to originate from the right ovary. On pathological examination, clear-type cells with rich transparent cytoplasm, visible large vacuole formation, and small nuclei were diffusely proliferated in the adrenal cortex (Fig. 2C). Three nuclear divisions were observed in 10 high-power fields (HPF), and nuclear dysplasia was occasionally detected (Fig. 2D). The fibrous capsule was maintained, but tumor cells were infiltrating into the capsule (Fig. 2C). Other malignant features such as hemorrhage, necrosis, and vascular infiltration were also observed (fig. 2E-H). The immunohistochemistry was positive for inhibin (Fig. 2I), calretinin, and melan-A.