sertoliform endometrioid carcinoma of the ovary ( sec ) is an uncommon variant that bears histologic similarity to sertoli and sertoli - leydig cell tumors ( slts ) .
recognition of this tumor is important as it is a well - differentiated , low - grade malignancy that displays a good prognosis when confined to the ovary .
a 55-year - old postmenopausal female patient presented with mass per abdomen since 2 years and pain for 2 days .
ultrasonography showed multicystic lesion measuring 12 cm  11 cm in the left ovary [ figure 1 ] .
ultrasonography showing multicystic lesion measuring 12 cm  11 cm in the left ovary on gross examination , ovary weighed 550 g , measured 13 cm  11 cm  7 cm , showed solid and cystic areas on cut section [ figure 2 ] .
microscopy showed round to solid tubules lined by pseudostratified columnar epithelium with elongated nuclei resembling sertoli tumor - like pattern along with conventional endometrioid tumor [ figures 35 ] .
inset : outer surface showing blackish areas due to torsion microphotograph showing sertoliform endometrioid carcinoma showing tubules and tightly packed nests of tumor cells separated by fibrous stroma .
individual tumor cells having vesicular nuclei , prominent nucleoli , and moderate cytoplasm ( h and e , 400 ) microphotograph showing foci of conventional endometrioid carcinoma ( h and e , 400 ) microphotograph showing foci of conventional endometrioid carcinoma and sertoli cell tumor - like pattern ( h and e , 200 ) immunohistochemistry ( ihc ) showed tumor cells strongly immunoreactive for epithelial membrane antigen ( ema ) , cytokeratin ( ck ) but negative for inhibin [ figures 68 ] , thus confirming the diagnosis of sec of left ovary .
sertoliform endometrioid carcinoma showing cytokeratin positivity ( immunohistochemistry , 200 ) sertoliform endometrioid carcinoma showing epithelial membrane antigen positivity ( immunohistochemistry , 400 ) sertoliform endometrioid carcinoma showing inhibin negativity ( immunohistochemistry , 400 )
endometrioid carcinoma of ovary resembling sex cord - stromal tumor is a rare variant of endometrioid adenocarcinoma that focally looks like a sex cord - stromal tumor with sertoli , leydig , or granulosa cells .
ordi et al . , in their study , reported that sec typically demonstrates the following characteristics , while slts do not : ( 1 ) presence of areas with usual pattern of endometrioid carcinoma , ( 2 ) presence of mucin at the apical borders of the tumor cells .
other factors that may favor sec would include squamous or squamoid areas , well - developed cilia , the presence of endometriosis , or a concomitant adenocarcinoma of the endometrium .
immunostains for alpha - inhibin is positive in most neoplastic sertoli cells but negative in the cells of endometrioid carcinoma , while positive ema and ck immunostains favor sec . despite histologic similarity
misir and sur in their study report that in slts , the patient age tends to be younger , with an average age of 25 years and clinically , up to 50% of slt patients may exhibit endocrine manifestations .
in contrast , sec occurs almost exclusively in postmenopausal women with an average age of 68 years .
virilizing symptoms , though uncommon in endometrioid carcinoma , may be encountered in the sertoliform variant , thus compounding the diagnostic difficulty . in our case ,
usually , solid portion of endometrioid adenocarcinoma is considered as grade 3 according to the international federation of obstetrics and gynecologists grading system .
sec should be considered as grade 1 ( well - differentiated ) , despite the presence of solid , sex cord - like proliferation as it carries good prognosis when confined to ovary . according to these suggestions ,
our case is graded as well - differentiated ( grade 1 ) based on the histological features of foci of conventional endometrioid carcinoma .
the case is presented for its rarity . in view of relatively good prognosis of sec as compared to endometrioid tumor , identifying this variant by an extensive sampling of the specimen is mandatory .
 sertoliform endometrioid carcinoma of the ovary ( sec ) is an uncommon variant that bears histologic similarity to sertoli and sertoli - leydig cell tumors . 
 we report an interesting case of sec in a 55-year - old female with a left ovarian mass with torsion . 
 histology revealed an sec , featuring foci of typical endometrioid carcinoma , and areas composed of uniform , small , hollow tubules lined by columnar cells with apical cytoplasm . 
 tumor cells were strongly immunoreactive for ema and cytokeratin but negative for inhibin ; thus , confirming the diagnosis of sec ovary . 
 recognition of this tumor is important as it is a well - differentiated , low - grade malignancy that displays good prognosis when confined to the ovary . 