PMC3708428_01
A chest, abdominal, and pelvic contrast-enhanced computed tomography (CT) scan at the portal venous phase with rectal contrast showed a huge, intraperitoneal, complex, cystic, and multilocular lesion, extending from pelvis up to midabdomen just above umbilicus, collectively measuring 13.5 x 23.3 x 21.5 cm. The source of lesion was more likely to be left ovary which was probably ruptured and leaked into the above-mentioned cystic lesion. In addition, large ascites was identified. No significant lymphadenopathies in abdomen and pelvis were noticed.
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No significant lymphadenopathies in abdomen and pelvis were noticed (Figure 1).
Macroscopic examination of the left ovarian mass. The mass weighed 1945 g and measured 24 x 21 x 7 cm. The mass was well circumscribed and had whitish nodular outer surface. A break of ovarian capsule was noted for a distance measuring 5.5 cm. Cut-surface showed multiple nodules separated by fibrous septa. Some of nodules were necrotic and others had tan-yellow nodular appearance.
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Some of the nodules were necrotic and others had tan-yellow nodular appearance (Figure 2).
Microscopic examination of the left ovarian mass. (a) The ovarian mass was composed of immature, poorly differentiated, and spindle-shaped Sertoli cells forming cords and ill-defined tubules (H&E stain, magnification power: 20x). (b) The neoplastic Sertoli cells exhibited nuclear atypia and high mitotic indices (H&E stain, magnification power: 40x). (c) Focal myxoid area containing spindle-shaped cells was identified (H&E stain, magnification power: 20x). (d) Infrequent Leydig cells with eosinophilic cytoplasm were identified focally (H&E stain, magnification power: 20x).
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Microscopically, the ovarian tumor mass was composed of immature, poorly differentiated, spindle-shaped Sertoli cells forming cords, and ill-defined tubules (Figure 3(a)). The neoplastic Sertoli cells exhibited nuclear atypia and high mitotic index (Figure 3(b)). Focal myxoid area containing spindle-shaped cells was identified (Figure 3(c)). Infrequent Leydig cells with eosinophilic cytoplasm were identified focally (Figure 3(d)). 
Immunohistochemical examination of the left ovarian mass. (a) The neoplastic cells stained positive for calretinin (magnification power: 40x). (b) The neoplastic cells stained positive for inhibin (magnification power: 40x). (c) The neoplastic cells stained positive for CD56 (magnification power: 40x). (d) The neoplastic cells stained positive for WT-1 (magnification power: 40x). (e) The neoplastic cells stained positive for CK 8/18 (magnification power: 40x).
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CD56, WT-1, and CK 8/18 (Figures 4(a)-4(e). Conversely, the neoplastic cells stained negative for EMA, PLAP, chromogranin A, and synaptophysin.