Sertoliform Endometrioid Carcinoma of the Ovary in a Young Woman: Diagnostic Challenges for the Pathologist

Abstract

Sertoliform endometrioid carcinoma (SEC) is a rare variant of ovarian endometrioid carcinoma commonly affecting older women. The morphology of this tumour closely resembles that of Sertoli and Sertoli–Leydig cell tumours. Microscopically, the tumour is composed of anastomosing cords, nests, trabeculae and tubules lined by pseudostratified columnar epithelium with elongated nuclei. We present a case of Sertoliform endometrioid carcinoma in a 24-year-old woman. A 24-year-old woman presented with lower abdominal pain and bleeding per vagina for the past 6 months associated with loss of weight and appetite. Ultrasound abdomen showed a complex pelvic mass. Positron emission tomography–computed tomography scan showed complex abdominopelvic mass with metastatic peritoneal and omental nodules, moderate ascites and right pleural thickening. Complete cytoreduction was performed. On microscopy, both ovaries showed infiltration by a malignant neoplasm composed of cells arranged as sheets, trabeculae, nests and focal tubules lined by moderately pleomorphic cells with elongated ovoid hyperchromatic nuclei, inconspicuous nucleoli and scant cytoplasm. Focally, cribriform pattern was noted with tall columnar lining epithelium showing nuclear stratification. The tumour cells were positive for cytokeratin, epithelial membrane antigen, oestrogen receptor and progesterone receptor and negative for p53, synaptophysin, chromogranin, CD99, inhibin and calretinin. A diagnosis of Sertoliform endometrioid carcinoma of the ovaries was rendered. To our knowledge, only a single case report has been published so far where SEC presented in a woman in her twenties. We would like to emphasise with this case the need to include SEC as a differential diagnosis for tumours with sex cord stromal components seen in younger women and to reiterate the importance of adequate and thorough sampling of the tumour to look for conventional endometrioid carcinoma areas.