Diagnostic value of inhibin immunoreactivity in ovarian gonadal stromal tumours and their histological mimics

Stewart, Colin J.R.; Jeffers, Michael; Kennedy, Alex. Mills

doi:10.1046/j.1365-2559.1997.5780819.x

Cited by 84 publications

(40 citation statements)

References 26 publications

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“…Relatively soon thereafter inhibin positivity in sex cord cells but not in the cells of surface epithelial tumors (with rare exceptions) added to the aid provided by immunohistochemistry in this area. [56][57][58][59][60][61][62] The next development of note was the recognition by two groups independently 18,63 that calretinin, previously considered to mark selectively mesothelial cells, also stained sex cord cells and other papers have borne this out. [63][64][65] The above combined findings have established the triad of EMA positive, inhibin negative, and calretinin negative as a strong argu-ment against a sex cord tumor, the converse results favoring it.…”

Section: Sex Cord-stromal Tumors Unclassifiedmentioning

confidence: 99%

Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems

2005

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Gonadal sex cord-stromal tumors contain some of the most morphologically interesting neoplasms of the gonads and these lead to many important issues in differential diagnosis. The pathology of these tumors is reviewed with emphasis on new information, similarities and differences in the two gonads, and diagnostic problems. Sertoli cell tumors occur in both gonads being more common in the testis where they usually exhibit a lobular pattern of hollow or solid tubules. In the ovary, tubular differentiation is usually the predominant feature but the lobulation typically seen in the testis is generally not as striking. One variant of Sertoli cell tumor, the large cell calcifying form, appears to be restricted to the male gonad and in contrast to other sex cord tumors is much more frequently bilateral and is associated in many cases with unusual clinical manifestations. In both sexes, patients with Peutz-Jeghers syndrome often have distinctive gonadal pathology. In females, it is in the form of the sex cord with annular tubules whereas in males, the lesion has features that are often intermediate between those of a sex cord tumor with annular tubules and a large cell calcifying Sertoli cell tumor. Sertoli-Leydig cell tumors are more morphologically diverse than pure Sertoli cell tumors and for practical purposes are an issue only in ovarian pathology being exceptionally rare in the testis. The classification proposed by Meyer into well, intermediate, and poor differentiation, remains important prognostically. More recently, heterologous and retiform differentiation has been described. Heterologous tumors most often contain mucinous epithelium, sometimes with small foci of carcinoid or less commonly, and generally in poorly differentiated neoplasms, rhabdomyosarcoma or fetal-type cartilage. Such tumors should be distinguished from pure sarcomas and teratomas. The retiform neoplasms, which tend to occur in young females, may mimic serous borderline tumors or even serous carcinomas. Granulosa cell tumors are much more common in females and in both gonads are divided into adult and juvenile forms. In females, granulosa cell tumors and other sex cord tumors may have markedly bizarre nuclei potentially leading to overdiagnosis as more malignant neoplasms. The juvenile granulosa cell tumor of the testis tends to occur in the first 6 months of life and should be carefully distinguished from the yolk sac tumor of the testis, which usually occurs in a slightly older age group. Occasional sex cord-stromal tumors cannot be readily categorized into the Sertoli or granulosa families and are diagnosed as sex cord-stromal tumors unclassified. In females, this is a relatively common placement for a neoplasm in a pregnant patient. Unclassified tumors are overall more common in males and may entrap residual normal germ cells potentially leading to the erroneous placement of the tumor in the category of a mixed germ cell sex cord-stromal tumor. From the practical viewpoint, the most helpful immunohistochemical findings are the negative s...

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Section: Sex Cord-stromal Tumors Unclassifiedmentioning

confidence: 99%

Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems

2005

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“…The opposite, in fact, appears to be the case. Several reports indicate inhibin o-and S-subunit expression in gonadal sex-cord tumors (Gurusinghe et al, 1995;Flemming et al, 1995Flemming et al, ,1996Costa et al, 1997;Stewart et al, 1997;Yamashita et al, 1997;Zheng et al, 1997). In some cases, these tumors are associated with elevated circulating inhibin levels that are decreased following surgical resection (Lappohn et al, 1989;Silverman et al, 1994;Cooke et al, 1995;Yamashita et al, 1997).…”

Section: Molecular Regulation Of Inhibin Subunitsmentioning

confidence: 99%

Mechanisms of Inhibin Signal Transduction

Bernard

Chapman²,

Woodruff³

2001

Recent Progress in Hormone Research

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Inhibin was first identified as a gonadal hormone that potently inhibits pituitary follicle-stimulating hormone (FSH) synthesis and secretion. Although the notion of a nonsteroidal, gonadally derived inhibitory substance was realized in the early 1930s (McCullagh, 1932) identification of the hormone was not accomplished until more than 50 years later. At that time, inhibin was purified from bovine and porcine follicular fluid and was shown to be produced in two forms through dimeric assembly of an Q subunit (I 8 kDa) and one of two closely related i3 subunits (PA and PB, approximately I4 kDa) Miyamoto et al., 1985;Rivier et al., 1985;Robertson et al., 1985).

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“…Although various markers have been reported to stain SCSTs, inhibin has proven to be the most helpful to date (3)(4)(5)(6)(7). Despite its general utility, however, inhibin is not expressed by all SCSTs (7), and some laboratories do not offer this marker because it is relatively infrequently needed.…”

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confidence: 99%

Ovarian Sex Cord-Stromal Tumors: An Immunohistochemical Study Including a Comparison of Calretinin and Inhibin

et al. 2003

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Because ovarian sex cord-stromal tumors (SCST) are morphologically heterogeneous neoplasms that are relatively infrequently encountered, their diagnosis can be difficult. Immunohistochemical staining may be useful for establishing the diagnosis in problematic cases. We studied 53 ovarian SCSTs to characterize their immunohistochemical staining pattern: 17 adult granulosa cell tumors (AGCTs), 4 juvenile granulosa cell tumors (JGCTs), 3 sex cord tumors with annular tubules (SCTATs), 9 SertoliLeydig cell tumors (SLCTs), 10 fibromas, 5 fibrothecomas (FTs), and 5 thecomas. In 8 of the 53 cases, the tissue studied was from a metastatic site. The immunopanel included calretinin, inhibin, WT1, cytokeratin cocktail, epithelial membrane antigen (EMA), and cytokeratin 5/6 (CK5/6). The fibromas and FTs were also tested with CD10. The extent of staining was assessed in a semiquantitative fashion and ranked on a scale of 0 through 4؉. All of the tumors, except for 1 metastatic SLCT, were positive for calretinin. Forty-five of the cases (85%) stained for inhibin; 1 metastatic AGCT, 3 fibromas, and 4 FTs were negative. WT1 was present in 39 tumors (74%), with expression most prominent in the SLCTs. The cytokeratin cocktail stained 23 of the 53 tumors (43%), whereas just 1 tumor was positive for EMA (1؉ in a JGCT). All tumors were negative for CK5/6, and the 15 fibromas and FTs were negative for CD10. We conclude that because cytokeratin is frequently expressed by SCSTs, in particular by granulosa cell tumors, SLCTs, and SCTATs, the inclusion of EMA in a panel may help to exclude epithelial neoplasms. In addition, WT1, present in normal granulosa cells, is expressed by a majority of SCSTs. Finally, these results demonstrate that calretinin is at least as sensitive as inhibin for ovarian SCSTs overall and that it is more sensitive than inhibin for fibromas and FTs.

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Diagnostic value of inhibin immunoreactivity in ovarian gonadal stromal tumours and their histological mimics

Abstract: Inhibin is a sensitive immunohistochemical marker of a wide range of gonadal stromal tumours and is of value in the differential diagnosis of ovarian neoplasia.

Cited by 84 publications

References 26 publications

Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems

Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems

Mechanisms of Inhibin Signal Transduction

Ovarian Sex Cord-Stromal Tumors: An Immunohistochemical Study Including a Comparison of Calretinin and Inhibin

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