Juvenile granulosa cell tumor of the ovary: A comprehensive clinicopathologic analysis of 15 cases.

OBJECTIVE: Juvenile granulosa cell tumor(JGCT) is an uncommon ovarian sex-cord stromal tumor, with diverse clinical, radiological and histopathologic features. The present study describes the clinicopathological and histomorphological spectrum of JGCTs, and highlights the key differentiating features from its mimics. METHODS: A retrospective analysis of all cases reported as JGCTs during 2011-19 (8 years) was performed with detailed evaluation of clinical, histopathologic data and follow-up details. RESULTS: Of a total 115 GCTs reported during the study period, 15(13%) were reported as JGCTs. The mean age at presentation was 17 years. Abdominal pain and distension were the most common clinical presentations. Five patients were pre-menarchal with 3 exhibiting precocious puberty. Majority of tumors were unilateral(left>right), solid-cystic, ranging in size from 4 to 20 cm. Microscopically, macrofollicular architecture was most frequent (n = 12;80%). The tumor cells depicted variable nuclear pleomorphism, small distinct nucleoli and moderate-abundant pale eosinophilic-clear/vacuolated cytoplasm. Mitotic activity ranged from 1 to 10/10HPFs. Uncommon histopathologic features included microcystic and tubulo-cystic architecture, myxoid degeneration, bizarre tumor giant cells, hob-nailing of the tumor cells, intracytoplasmic hyaline globules, multifocal calcification and thick hyalinized blood vessels. Majority(n = 12;80%) presented in stage I. Surgical treatment included unilateral salpingo-oophorectomy without any adjuvant chemotherapy, bilateral salpingo-oophorectomy (BSO) and total abdominal hysterectomy with BSO with adjuvant BEP chemotherapy (Bleomycin, etoposide, cisplatin). CONCLUSIONS: JGCT is a rare ovarian tumor affecting young women and children with diverse histopathologic features. Despite an aggressive histopathology, these tumors have a good outcome, when diagnosed at an early stage.

'Size does matter': Prophylactic gonadectomy in a case of Swyer syndrome.

Swyer syndrome also known as pure or complete gonadal dysgenesis is a very rare disorder of sex development wherein the individuals are phenotypically females with 46, XY genotype and preserved mullerian structures. These individuals characteristically have dysgenetic streak gonads which carry an increased risk of malignant transformation. Prophylactic gonadectomy is highly recommended as soon as a clinical diagnosis is established to diminish the chances of tumor development. We present a case of complete gonadal dysgenesis with bilateral small gonads with a dysgerminoma arising in a background of gonadoblastoma in one gonad and immature teratoma in the other. The present case, besides adding a rare case to the literature, highlights the importance of detailed pre-operative assessment of gonadal size and prompt prophylactic gonadectomy in cases with gonadal dysgenesis.

Role of polymerase chain reaction in breast tuberculosis.

BACKGROUND: Breast tuberculosis (TB) is an uncommon condition even in endemic countries. Breast abscess is usually seen in young females. PCR helps in such challenging cases to clinch the correct diagnosis. OBJECTIVE: The present study was performed to compare FNAC and TB PCR in inflammatory lesions of breast. METHODS: FNAC cases reported as breast abscess, necrosis, non-specific and granulomatous inflammation on cytology was taken. The material for PCR was obtained from archived MGG smears and PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed. RESULTS: A total of 54 cases were studied. The age ranged from 19-55 years. On FNAC, acute suppurative inflammation without granulomas and negative AFB staining was noted in 18 cases; granulomatous inflammation/mastitis in 26 cases and granulomatous inflammation with necrosis with AFB positivity confirming tuberculosis in 10 cases. PCR for Mycobacterium tuberculosis for insertion sequence IS6110 was performed. None of the 18 cases of acute suppurative inflammation had positivity for PCR. 13/26 [53.3%] cases of granulomatous inflammation/ mastitis with AFB negativity were positive for PCR. 10/10 cases of granulomatous inflammation with necrosis with AFB positivity showed PCR positivity. Therefore, proven cases of TB after FNAC were only 10/54 [17.24%] and the sensitivity increased to 23/54 [42.6%] after performing PCR on FNA aspirate. CONCLUSION: PCR helped in identifying 13/26 [50%] cases reported as granulomatous inflammation on cytology as tuberculosis. FNAC acted as an efficient modality for collection of material for PCR. This study shows how PCR aids in diagnosis of breast TB.