18 August 2010 - Case #184
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Samia Abdel Razik, Saudi-German Hospital, Jeddah, Saudi Arabia, for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.
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Case #184
Clinical history:
A 37 year old woman complained of lower abdominal pain. An abdominal ultrasound revealed a right ovarian solid mass, which was excised. The ovoid mass measured 5 x 4 cm and had a glistening smooth outer surface. The cut section was yellowish with areas of hemorrhage.
The tumor cells were immunoreactive only for vimentin (see below) and negative for cytokeratin, EMA, AFP and chromogranin. The vacuoles were negative for PAS, Alcian blue and Sudan III.
Gross images:
Microscopic images:
What is your diagnosis?
Diagnosis: Ovarian signet ring stromal tumor
Discussion:
Ovarian signet ring stromal tumor, first described in 1976, is a very rare tumor, with < 20 cases reported to date (Cancer 1976;38:166).
Histologically, it is composed of spindle and round cells, which contain a large cytoplasmic vacuole which displaces the nucleus, resembling a signet ring. Numerous cells may show intracytoplasmic hyaline globules, which may actually be degenerating erythrocytes phagocytosed by the tumor cells (Ultrastruct Pathol 1995;19:401). The tumor cells are immunoreactive for vimentin, actin, inhibin and calretinin. They are negative for keratins, mucin and lipid stains.
The differential diagnosis includes other signet ring tumors, including Krukenberg tumor, primary or metastatic mucinous carcinoma of the ovary, mucinous carcinoid tumor and clear cell carcinoma. All of these tumors have some epithelial component that is immunoreactive with keratin. Krukenberg tumors are often bilateral or associated with extraovarian tumor. The signet ring cells are immunoreactive for keratin and PAS diastase and negative for vimentin (Int J Gynecol Pathol 2004;23:45).
Ovarian signet ring stromal tumor has benign behavior and excision is curative.
All cases are archived on our website. To view them sorted by case number, diagnosis or category, visit our main Case of the Month page. To subscribe or unsubscribe to Case of the Month or our other email lists, click here.
Thanks to Dr. Samia Abdel Razik, Saudi-German Hospital, Jeddah, Saudi Arabia, for contributing this case. This case was reviewed in May 2020 by Dr. Jennifer Bennett, University of Chicago and Dr. Carlos Parra-Herran, University of Toronto.
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(1) We added a feature to the Conferences page to quickly see the new postings, in reverse date posted. This feature was already present on the Jobs and Fellowship pages.
(2) We are redesigning our textbook pages so they load faster, by pulling the images directly from the server, instead of making them part of our file. Let us know if you notice any problems.
(3) We continue to update our 5000+ topics on a regular basis. If you are interested in reviewing a topic, please email us your CV and let us know what chapter and topics you are interested in reviewing.
Visit and follow our Blog to see recent updates to the website.
Case #184
Clinical history:
A 37 year old woman complained of lower abdominal pain. An abdominal ultrasound revealed a right ovarian solid mass, which was excised. The ovoid mass measured 5 x 4 cm and had a glistening smooth outer surface. The cut section was yellowish with areas of hemorrhage.
The tumor cells were immunoreactive only for vimentin (see below) and negative for cytokeratin, EMA, AFP and chromogranin. The vacuoles were negative for PAS, Alcian blue and Sudan III.
Gross images:
Microscopic images:
What is your diagnosis?
Click here for diagnosis and discussion:
Diagnosis: Ovarian signet ring stromal tumor
Discussion:
Ovarian signet ring stromal tumor, first described in 1976, is a very rare tumor, with < 20 cases reported to date (Cancer 1976;38:166).
Histologically, it is composed of spindle and round cells, which contain a large cytoplasmic vacuole which displaces the nucleus, resembling a signet ring. Numerous cells may show intracytoplasmic hyaline globules, which may actually be degenerating erythrocytes phagocytosed by the tumor cells (Ultrastruct Pathol 1995;19:401). The tumor cells are immunoreactive for vimentin, actin, inhibin and calretinin. They are negative for keratins, mucin and lipid stains.
The differential diagnosis includes other signet ring tumors, including Krukenberg tumor, primary or metastatic mucinous carcinoma of the ovary, mucinous carcinoid tumor and clear cell carcinoma. All of these tumors have some epithelial component that is immunoreactive with keratin. Krukenberg tumors are often bilateral or associated with extraovarian tumor. The signet ring cells are immunoreactive for keratin and PAS diastase and negative for vimentin (Int J Gynecol Pathol 2004;23:45).
Ovarian signet ring stromal tumor has benign behavior and excision is curative.
