Microscopic Sertoliform Sex Cord Proliferations: A Rare Incidental Finding Associated With Endometriosis and Ovarian Epithelial Neoplasia

Abstract

Microscopic sex cord proliferations are a rare incidental finding seen in association with ovarian and uterine stromal or epithelial neoplasms and more uncommonly non-neoplastic conditions such as endometriosis and adenomyosis. They may also occur in the absence of other pathology, as an incidental finding in the ovaries of pregnant women and in heterotopic locations such as the fallopian tube. Most reports of this phenomenon describe adult granulosa cell tumor-like morphology. Herein, we describe 4 cases of microscopic sex cord proliferations with Sertoliform features, occurring in the stromal component of endometriosis or in the wall of an epithelial ovarian neoplasm; 2 of the patients with endometriosis had concurrent endometrioid adenocarcinoma (1 uterine corpus, 1 ovary). The proliferations were positive with sex cord markers inhibin and calretinin. As far as we are aware, such Sertoliform proliferations have not been reported previously in endometriosis and have only rarely been described in association with ovarian epithelial neoplasia. It is likely that such proliferations represent a benign non-neoplastic phenomenon. Awareness of this phenomenon is important in order to avoid misdiagnosis as a sex cord or other neoplasm. In reporting this unusual phenomenon, we review incidental sex cord and sex cord-like proliferations in the female genital tract.

Microscopic Sertoliform Sex Cord Proliferation Involving Pelvic Peritoneum: Report of a Case Associated With Endosalpingiosis

“…and W.G.M.) reported 4 cases of sex cord proliferations resembling Sertoli cell tubules (Sertoliform proliferations), involving the stromal component of endometriosis or an epithelial ovarian neoplasm 6 . We now report a further case of Sertoliform sex cord elements involving the pelvic peritoneum in association with endosalpingiosis, a phenomenon that has not been reported previously in the literature.…”

“…First described by Young and Scully (1) in the context of ovarian fibromas and thecomas, these proliferations resemble granulosa cells, Sertoli cells or have indifferent sex cord appearance. Ovarian examples include fibroma with minor sex cord elements and incidental proliferations in the stroma of epithelial neoplasms, adenosarcoma or endometriosis (1)(2)(3)5,6). In the uterus, such proliferations uncommonly occur in a variety of neoplasms, including adenosarcoma and low-grade endometrial stromal tumors (7).…”

“…Recently, we (K.L.T. and W.G.M) reported a series of 4 cases with Sertoliform features, 3 associated with ovarian or parametrial endometriosis and 1 in the stroma of a seromucinous borderline tumor with a small focus of clear cell carcinoma 6 . All 4 examples were incidental and microscopic, lacked cytologic atypia, showed positive staining with sex cord markers, including inhibin, calretinin, CD56 and SF1 and were favoured to be non-neoplastic.…”

Two Rare Cases of Paratubal Leydig Cell Nodules: Clinical Relevance and Debated Terminology of a Noteworthy Incidentaloma

“…The use of the term heterotopia for nests or nodules found at extraovarian sites led to academic debate and study as to whether the term eutopia is more appropriate to use than heterotopia (1,6,7,(11)(12)(13). Case series of microscopic sex cord proliferations with sertoliform histology (14) and histologic features other than sertoliform or Leydig cell patterns (15) have also been described.…”