Contributed by Suzanne Bakdash, MD, MPH and Gloria Carter, MD
Published on line in July, 2004
CLINICAL HISTORY AND GROSS DESCRIPTION:
This 60-year-old post-menopausal female underwent an exploratory laparotomy and bilateral salpingo-oophorectomy for a 30.0 cm mass of the right adnexa, which was found to be a fibrothecoma of the right ovary with cystic degeneration. On gross examination, the left ovary was somewhat obscured by adhesions and measured approximately 4.5 x 3.0 x 1.2 cm by palpation. The left fallopian tube and two simple paratubal cysts, up to 0.5 cm in diameter, were also identified. The cut surface of the ovary was tan with a few white and light yellow nodules. Representative cross sections, to include ovary and adhered fallopian tube, were submitted for microscopic evaluation.
The hematoxylin and eosin stained sections demonstrate a portion of ovary with adherent fallopian tube and fibrovascular meso-ovarian soft tissue. The fallopian tube is attached to the ovary by fibrovascular adhesions. The dense ovarian stroma consists mainly of wavy spindle-shaped stromal cells with scanty cytoplasm arranged in whorls and storiform patterns. A few well-circumscribed nodules of dense collagen with convoluted borders (corpora albicans) remain in the ovarian medulla near the hilus (Figure 1). In addition to the above structures, a 0.9 cm nodule, composed of large polygonal cells, with abundant granular eosinophilic cytoplasm and large vesicular nuclei, is noted in the mesovarium (Figures 2 - 5). Similar cells surround and lie within nerves (Figures 6- 8). One focus showed a number of these cells entrapped in a sclerotic background, singly and in clusters (Figure 9).
The cells in the meso-ovarian nodule, nerve and sclerotic focus are all positive for inhibin on paraffin section immunohistochemistry (figures 2a-3a, 6a-7a and 9a, respectively). An extensive search in sections stained with Masson's Trichrome revealed rare cells with homogenous, non-refractile, blunt-ended rod-shaped cytoplasmic crystals (Reinke crystals) (Figures 10 and 11).