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Robert H Young - One of the best experts on this subject based on the ideXlab platform.
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uterine Tumor resembling ovarian Sex Cord stromal Tumor utrosct a series of 3 cases with extensive rhabdoid differentiation malignant behavior and esr1 ncoa2 fusions
The American Journal of Surgical Pathology, 2020Co-Authors: Jennifer A Bennett, Robert H Young, Ricardo R Lastra, Julieta E Barroeta, Megan Parilla, Filippo Galbo, Pankhuri Wanjari, Thomas Krausz, Esther OlivaAbstract:ESR1 and GREB1 fusions have recently been described in uterine Tumor resembling ovarian Sex Cord Tumor (UTROSCT). Thus far, recurrences have been documented in a subset of those harboring GREB1 fusions, but not in those with ESR1 rearrangements. Here we describe the clinicopathologic features of 3 recurrent UTROSCTs with striking rhabdoid morphology (an unusual feature of these Tumors overall) and ESR1-NCOA2 fusions. The patients were 32, 37, and 54 years at initial diagnosis and first recurrence occurred at 7, 9, and 32 years. The primary Tumors (available in two cases) were centered in the myometrium and showed infiltrative borders. They predominantly grew in sheets and Cords, but also had a pseudopapillary appearance. Cells were uniformly epithelioid with eccentric nuclei, prominent nucleoli, abundant eosinophilic globular/glassy (rhabdoid) cytoplasm, and infrequent mitoses (≤4/10 high-power fields [HPFs]). Recurrences were morphologically identical to the primary Tumors, but demonstrated brisk mitotic activity (≥16/10 HPFs). The third Tumor (with only recurrences available) had multiple patterns, including diffuse, Corded, trabecular, and a focal retiform growth. Rhabdoid cells were conspicuous, but only comprised ~50% of the Tumor, and mitoses numbered up to 2/10 HPFs. All Tumors were strongly and diffusely positive for WT1, CAM5.2, ER, and PR, but negative for inhibin. Diffuse calretinin and desmin expression, as well as focal melan-A positivity, was noted in one Tumor, but was negative in the others. In all 3 Tumors, INI-1 and BRG-1 were retained, and ESR1-NCOA2 fusions were detected by targeted RNA sequencing. This study is the first to highlight an association between UTROSCTs with extensive rhabdoid differentiation, ESR1-NCOA2 fusions, and aggressive behavior. UTROSCTs are considered neoplasms of uncertain malignant potential, but have a benign course in most cases. Thus, it is important to be aware of these specific features and recommend long-term follow-up due to their propensity for late recurrences.
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unusual sertoli cell Tumor associated with Sex Cord Tumor with annular tubules in peutz jeghers syndrome report of a case and review of the literature on ovarian Tumors in peutz jeghers syndrome
International Journal of Surgical Pathology, 2016Co-Authors: Sanjita Ravishankar, Shamlal Mangray, Arlet G Kurkchubasche, Evgeny Yakirevich, Robert H YoungAbstract:We report the case of an 11-year-old girl with Peutz-Jeghers syndrome and a unilateral ovarian Tumor most consistent with Sertoli cell Tumor associated with Sex Cord Tumor with annular tubules. The ovary was replaced by a lobular, solid, yellow Tumor. Microscopic examination showed 2 components that focally merged. The first was composed of uniform, cytologically bland cells arranged mostly in diffuse sheets and focally in tubules. The second showed typical Sex Cord Tumor with annular tubules with extensive calcification. The predominant component of the Tumor clearly fell in the Sex Cord category and most closely resembled Sertoli cell Tumor. This case adds to the limited information on ovarian Sex Cord Tumors, other than typical Sex Cord Tumor with annular tubules, arising in association with Peutz-Jeghers syndrome, a topic reviewed herein.
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Sex Cord-stromal Tumors of the ovary and testis: their similarities and differences with consideration of selected problems
Modern Pathology, 2005Co-Authors: Robert H YoungAbstract:Gonadal Sex Cord-stromal Tumors contain some of the most morphologically interesting neoplasms of the gonads and these lead to many important issues in differential diagnosis. The pathology of these Tumors is reviewed with emphasis on new information, similarities and differences in the two gonads, and diagnostic problems. Sertoli cell Tumors occur in both gonads being more common in the testis where they usually exhibit a lobular pattern of hollow or solid tubules. In the ovary, tubular differentiation is usually the predominant feature but the lobulation typically seen in the testis is generally not as striking. One variant of Sertoli cell Tumor, the large cell calcifying form, appears to be restricted to the male gonad and in contrast to other Sex Cord Tumors is much more frequently bilateral and is associated in many cases with unusual clinical manifestations. In both Sexes, patients with Peutz–Jeghers syndrome often have distinctive gonadal pathology. In females, it is in the form of the Sex Cord with annular tubules whereas in males, the lesion has features that are often intermediate between those of a Sex Cord Tumor with annular tubules and a large cell calcifying Sertoli cell Tumor. Sertoli–Leydig cell Tumors are more morphologically diverse than pure Sertoli cell Tumors and for practical purposes are an issue only in ovarian pathology being exceptionally rare in the testis. The classification proposed by Meyer into well, intermediate, and poor differentiation, remains important prognostically. More recently, heterologous and retiform differentiation has been described. Heterologous Tumors most often contain mucinous epithelium, sometimes with small foci of carcinoid or less commonly, and generally in poorly differentiated neoplasms, rhabdomyosarcoma or fetal-type cartilage. Such Tumors should be distinguished from pure sarcomas and teratomas. The retiform neoplasms, which tend to occur in young females, may mimic serous borderline Tumors or even serous carcinomas. Granulosa cell Tumors are much more common in females and in both gonads are divided into adult and juvenile forms. In females, granulosa cell Tumors and other Sex Cord Tumors may have markedly bizarre nuclei potentially leading to overdiagnosis as more malignant neoplasms. The juvenile granulosa cell Tumor of the testis tends to occur in the first 6 months of life and should be carefully distinguished from the yolk sac Tumor of the testis, which usually occurs in a slightly older age group. Occasional Sex Cord-stromal Tumors cannot be readily categorized into the Sertoli or granulosa families and are diagnosed as Sex Cord-stromal Tumors unclassified. In females, this is a relatively common placement for a neoplasm in a pregnant patient. Unclassified Tumors are overall more common in males and may entrap residual normal germ cells potentially leading to the erroneous placement of the Tumor in the category of a mixed germ cell Sex Cord-stromal Tumor. From the practical viewpoint, the most helpful immunohistochemical findings are the negative staining of Sex Cord Tumors for epithelial membrane antigen, and positive staining for inhibin and calretinin, findings that are converse to those seen in endometrioid carcinomas of the ovary, which commonly have formations that simulate Sex Cord Tumors.
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A brief history of the pathology of the gonads
Modern Pathology, 2005Co-Authors: Robert H YoungAbstract:Our understanding of gonadal pathology has reached its current state as a result of the contributions of numerous outstanding investigators. Knowledge of testicular Tumor pathology dates back to the great British workers Percival Pott and Sir Astley Cooper but the single greatest early stride was made with the description in 1906 by the French urologist Maurice Chevassu of the seminoma. The seminal 1946 paper of Nathan B Friedman and Robert A Moore, which segregated out as a distinct entity embryonal carcinoma, is, however, the foundation for the current classification of testicular Tumors. In that year Pierre Masson described the distinctive neoplasm, the spermatocytic seminoma. The 1950s saw the publication of an important paper by Frank J Dixon and Dr Moore and they also wrote the first series fascicle on testicular Tumors. In this same timeframe, and thereafter, Robert E Scully made significant contributions to testicular pathology, writing the first English language paper on spermatocytic seminoma, describing several subtypes of Sex Cord Tumor, and also the distinctive lesion of interSex, the gonadoblastoma, as well as playing a major role in 1980 in formulating the current classification of premalignant lesions of the testis. The current classification of testicular Tumors was arrived at in the early 1970s when the World Health Organization, under the leadership of Dr FK Mostofi, who himself made notable contributions to testicular pathology, devised what is fundamentally the current classification of neoplasms of the male gonad. Although comments on ovarian pathology were made by such legendary figures of earlier times as Giovanni Battista Morgagni and Matthew Baillie, it is only in the mid to later years of the 19th century that contributions, mostly in Europe, began to move knowledge of ovarian pathology to its current state. Thomas Hodgkin, Richard Bright, and Sir James Paget all wrote extensively on ovarian neoplasms. In 1870, Heinrich Waldeyer, and later in that century, another German, Hermann Johannes Pfannenstiel wrote important papers on the surface epithelial Tumors. The latter was likely the first to refer to neoplasms now known as of ‘borderline malignancy’ and also wrote on pseudomyxoma peritonei and other topics. Their work was followed by that of Robert Meyer who made monumental contributions to gynecological pathology, including recognizing the Brenner Tumor as a distinctive neoplasm and proposing the first classification of Sertoli–Leydig cell Tumors (arrhenoblastomas). He also coined the term ‘disgerminoma’ (soon changed to dysgerminoma) for the ovarian Tumor that had been described in detail by the French investigator Marcel Chenot 5 years after Chevassu had mentioned the Tumor in his paper describing the seminoma. During the Meyer era other significant contributions were made by, among others, Howard C Taylor writing on the borderline Tumors and John A Sampson writing on endometriosis and Tumors, associated with it. In the second-half of the 20th century major contributions were made by Gunnar Teilum of Denmark and Lars Santesson of Sweden. Dr Teilum delineated the morphologic features of the yolk sac Tumor and noted the resemblance of papillary formations within it to the endodermal sinuses of the rat placenta. He also wrote extensively on Sex Cord Tumors in both gonads. At a FIGO meeting in 1961 Dr Santesson played a major role in formulating the first organized classification of the surface epithelial–stromal Tumors of the ovary and also promoted the endometrioid carcinoma as a special variant of ovarian cancer. In a career spanning over 50 years, Dr Scully was the architect of the modern classification of ovarian Tumors being the driving force behind the influential 1973 World Health Organization classification of them. His many original observations have touched upon virtually all categories of ovarian Tumor pathology. His second series fascicle ‘Tumors of the Ovaries and Maldeveloped Gonads’ utilized the WHO classification and presented a lucid elaboration of his by then vast experience with ovarian Tumors. All the above have left a rich legacy which those who follow in their path will be challenged to equal.
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inhibin expression in ovarian Tumors and Tumor like lesions an immunohistochemical study
Modern Pathology, 1998Co-Authors: Friedrich Kommoss, Robert H Young, Esther Oliva, Atul K Bhan, Robert E ScullyAbstract:We investigated 203 ovarian Tumors and Tumor-like lesions for inhibin expression using a monoclonal anti-inhibin alpha antibody. Inhibin was present in the Tumor cells in all 14 primary adult granulosa cell Tumors (4 luteinized) plus 3 metastatic, all 10 primary juvenile granulosa cell Tumors plus 1 metastatic, 10 of 11 thecomas, 3 of 11 fibromas, 4 of 11 sclerosing stromal Tumors, 6 of 11 Sertoli cell Tumors (1 oxyphilic), 7 of 11 Sertoli-Leydig cell Tumors, 1 gynandroblastoma, 10 primary ovarian Sex Cord Tumors with annular tubules plus 2 metastatic, 8 of 9 steroid cell Tumors, both pregnancy luteomas, 1 of 2 unclassified Sex Cord Tumors, 2 of 5 gonadoblastomas, 9 of 10 female adnexal Tumors of probable wolffian origin, and in the non-neoplastic stroma of many carcinomas and germ cell Tumors. The Tumor cells were inhibin-negative in 10 fibrosarcomas, 12 small cell carcinomas of hypercalcemic type, 24 germ cell Tumors (except for a focus of inhibin-positive syncytiotrophoblast in one case), and 17 ovarian carcinomas. Two of the three inhibin-positive fibromas showed diffuse immunostaining and were associated with evidence of estrogenic activity. Among nine Sertoli-Leydig cell Tumors with available clinical data, four that were more than minimally inhibin-positive were accompanied by androgenic manifestations; five inhibin-negative or only minimally positive Tumors lacked such evidence. Inhibin immunostaining may be useful in the differential diagnosis of inhibin-positive Sex Cord Tumors versus histologically similar inhibin-negative neoplasms, but inhibin negativity does not preclude a diagnosis of Sex Cord Tumor. The unexpected, common inhibin positivity of female adnexal Tumors of probable wolffian origin indicates that inhibin staining cannot be used to differentiate these Tumors from Sertoli cell Tumors. Inhibin immunostaining is also helpful in identifying potential steroid hormone-secreting cells in the non-neoplastic stromal component of epithelial, germ cell, and other ovarian Tumors.
Vladimir Nosov - One of the best experts on this subject based on the ideXlab platform.
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non peutz jeghers syndrome associated ovarian Sex Cord Tumor with annular tubules a case report
Fertility and Sterility, 2009Co-Authors: Vladimir Nosov, Susan Park, Jianyu Rao, Sanaz MemarzadehAbstract:Objective Sex Cord Tumors with annular tubules (SCTAT) are a rare subtype of Sex Cord stromal Tumor of the ovary. An evidence-based management plan with follow-up evaluations is difficult to outline because of the rarity of these Tumors. We describe the case of a premenarchal patient with a SCTAT. Design Case report. Setting The patient was encountered during routine patient care process. Patient(s) The patient presented with a pelvic mass and precocious puberty. Her condition was diagnosed as SCTAT. Her clinical presentation was consistent with an estrogen-secreting Tumor, resulting in early menarche and premature breast development. Inhibin and estradiol levels were markedly elevated preoperatively and normalized 5 weeks after surgical removal of the Tumor. The preoperative computed tomography scan demonstrated a 12-cm abdominopelvic mass, which appeared to be mostly cystic. Intervention(s) The patient was treated surgically. She underwent laparotomy, right salpingo-oophorectomy, ipsilateral pelvic and paraaortic lymph node sampling, and partial omentectomy. Peritoneal biopsy samples were obtained from the abdomen and pelvis. Main Outcome Measure(s) The patient did well postoperatively. She is being observed with serial examinations and serum inhibin measurements. Result(s) Normalization of serum estradiol and inhibin along with cessation of menstruation were seen 5 weeks postoperatively, with persistence of morphologic signs of precocious puberty and advanced bone age at 11 months after the diagnosis. Conclusion(s) The diagnosis of SCTAT was established on final pathology examination based on morphologic features of the Tumor microscopically and the marker expression profile on immunohistochemistry. Primary management was surgical.
Cherwei Liang - One of the best experts on this subject based on the ideXlab platform.
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clinicopathologic characterization of greb1 rearranged uterine sarcomas with variable Sex Cord differentiation
The American Journal of Surgical Pathology, 2019Co-Authors: Chenghan Lee, Yuchien Kao, Wan Ru Lee, Yi Wen Hsiao, Chia Ying Chu, Yi Jia Lin, Hsuanying Huang, Tsung Han Hsieh, Yun Ru Liu, Cherwei LiangAbstract:Uterine mesenchymal Tumors are genetically heterogenous; those with uniform cytomorphology, best exemplified by endometrial stromal Tumors, often contain various fusion genes. Novel fusions involving ESR1 and GREB1, key factors in Sex hormone pathways, have been implicated in rare uterine mesenchymal Tumors. Particularly, the fusions between 5'-ESR1/GREB1 and 3'-NCOA2/NCOA3 were recently identified in 4 uterine Tumors resembling ovarian Sex-Cord Tumor (UTROSCT). By RNA sequencing, pathology review, and FISH screening, we identified 4 uterine sarcomas harboring rearranged GREB1, including GREB1-NCOA2 and the novel GREB1-NR4A3, GREB1-SS18, and GREB1-NCOA1, validated by RT-PCR and/or FISH. They occurred in the myometrium of postmenopausal women and were pathologically similar despite minor differences. Tumor cells were generally uniform and epithelioid, with vesicular nuclei and distinct to prominent nucleoli. Growth patterns included solid sheets, trabeculae/Cords, nests, and fascicles. Only 1 Tumor showed small foci of definitive Sex-Cord components featuring well-formed tubules, retiform structures, Leydig-like cells, and lipid-laden cells and exhibiting convincing immunoreactivity to Sex-Cord markers (calretinin, α-inhibin, and Melan-A). In contrast, all the 4 classic UTROSCT we collected occurred in premenopausal patients, consisted predominantly of unequivocal Sex-Cord elements, prominently expressed multiple Sex-Cord markers, and harbored ESR1-NCOA3 fusion. Combined with previously reported cases, GREB1-rearranged Tumors involved significantly older women (P=0.001), tended to be larger and more mitotically active, showed more variable and often inconspicuous Sex-Cord differentiation, and appeared to behave more aggressively than ESR1-rearranged UTROSCT. Therefore, these 2 groups of Tumors might deserve separate consideration, despite some overlapping features and the possibility of belonging to the same disease spectrum.
Esther Oliva - One of the best experts on this subject based on the ideXlab platform.
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uterine Tumor resembling ovarian Sex Cord stromal Tumor utrosct a series of 3 cases with extensive rhabdoid differentiation malignant behavior and esr1 ncoa2 fusions
The American Journal of Surgical Pathology, 2020Co-Authors: Jennifer A Bennett, Robert H Young, Ricardo R Lastra, Julieta E Barroeta, Megan Parilla, Filippo Galbo, Pankhuri Wanjari, Thomas Krausz, Esther OlivaAbstract:ESR1 and GREB1 fusions have recently been described in uterine Tumor resembling ovarian Sex Cord Tumor (UTROSCT). Thus far, recurrences have been documented in a subset of those harboring GREB1 fusions, but not in those with ESR1 rearrangements. Here we describe the clinicopathologic features of 3 recurrent UTROSCTs with striking rhabdoid morphology (an unusual feature of these Tumors overall) and ESR1-NCOA2 fusions. The patients were 32, 37, and 54 years at initial diagnosis and first recurrence occurred at 7, 9, and 32 years. The primary Tumors (available in two cases) were centered in the myometrium and showed infiltrative borders. They predominantly grew in sheets and Cords, but also had a pseudopapillary appearance. Cells were uniformly epithelioid with eccentric nuclei, prominent nucleoli, abundant eosinophilic globular/glassy (rhabdoid) cytoplasm, and infrequent mitoses (≤4/10 high-power fields [HPFs]). Recurrences were morphologically identical to the primary Tumors, but demonstrated brisk mitotic activity (≥16/10 HPFs). The third Tumor (with only recurrences available) had multiple patterns, including diffuse, Corded, trabecular, and a focal retiform growth. Rhabdoid cells were conspicuous, but only comprised ~50% of the Tumor, and mitoses numbered up to 2/10 HPFs. All Tumors were strongly and diffusely positive for WT1, CAM5.2, ER, and PR, but negative for inhibin. Diffuse calretinin and desmin expression, as well as focal melan-A positivity, was noted in one Tumor, but was negative in the others. In all 3 Tumors, INI-1 and BRG-1 were retained, and ESR1-NCOA2 fusions were detected by targeted RNA sequencing. This study is the first to highlight an association between UTROSCTs with extensive rhabdoid differentiation, ESR1-NCOA2 fusions, and aggressive behavior. UTROSCTs are considered neoplasms of uncertain malignant potential, but have a benign course in most cases. Thus, it is important to be aware of these specific features and recommend long-term follow-up due to their propensity for late recurrences.
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inhibin expression in ovarian Tumors and Tumor like lesions an immunohistochemical study
Modern Pathology, 1998Co-Authors: Friedrich Kommoss, Robert H Young, Esther Oliva, Atul K Bhan, Robert E ScullyAbstract:We investigated 203 ovarian Tumors and Tumor-like lesions for inhibin expression using a monoclonal anti-inhibin alpha antibody. Inhibin was present in the Tumor cells in all 14 primary adult granulosa cell Tumors (4 luteinized) plus 3 metastatic, all 10 primary juvenile granulosa cell Tumors plus 1 metastatic, 10 of 11 thecomas, 3 of 11 fibromas, 4 of 11 sclerosing stromal Tumors, 6 of 11 Sertoli cell Tumors (1 oxyphilic), 7 of 11 Sertoli-Leydig cell Tumors, 1 gynandroblastoma, 10 primary ovarian Sex Cord Tumors with annular tubules plus 2 metastatic, 8 of 9 steroid cell Tumors, both pregnancy luteomas, 1 of 2 unclassified Sex Cord Tumors, 2 of 5 gonadoblastomas, 9 of 10 female adnexal Tumors of probable wolffian origin, and in the non-neoplastic stroma of many carcinomas and germ cell Tumors. The Tumor cells were inhibin-negative in 10 fibrosarcomas, 12 small cell carcinomas of hypercalcemic type, 24 germ cell Tumors (except for a focus of inhibin-positive syncytiotrophoblast in one case), and 17 ovarian carcinomas. Two of the three inhibin-positive fibromas showed diffuse immunostaining and were associated with evidence of estrogenic activity. Among nine Sertoli-Leydig cell Tumors with available clinical data, four that were more than minimally inhibin-positive were accompanied by androgenic manifestations; five inhibin-negative or only minimally positive Tumors lacked such evidence. Inhibin immunostaining may be useful in the differential diagnosis of inhibin-positive Sex Cord Tumors versus histologically similar inhibin-negative neoplasms, but inhibin negativity does not preclude a diagnosis of Sex Cord Tumor. The unexpected, common inhibin positivity of female adnexal Tumors of probable wolffian origin indicates that inhibin staining cannot be used to differentiate these Tumors from Sertoli cell Tumors. Inhibin immunostaining is also helpful in identifying potential steroid hormone-secreting cells in the non-neoplastic stromal component of epithelial, germ cell, and other ovarian Tumors.
Robert E Scully - One of the best experts on this subject based on the ideXlab platform.
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inhibin expression in ovarian Tumors and Tumor like lesions an immunohistochemical study
Modern Pathology, 1998Co-Authors: Friedrich Kommoss, Robert H Young, Esther Oliva, Atul K Bhan, Robert E ScullyAbstract:We investigated 203 ovarian Tumors and Tumor-like lesions for inhibin expression using a monoclonal anti-inhibin alpha antibody. Inhibin was present in the Tumor cells in all 14 primary adult granulosa cell Tumors (4 luteinized) plus 3 metastatic, all 10 primary juvenile granulosa cell Tumors plus 1 metastatic, 10 of 11 thecomas, 3 of 11 fibromas, 4 of 11 sclerosing stromal Tumors, 6 of 11 Sertoli cell Tumors (1 oxyphilic), 7 of 11 Sertoli-Leydig cell Tumors, 1 gynandroblastoma, 10 primary ovarian Sex Cord Tumors with annular tubules plus 2 metastatic, 8 of 9 steroid cell Tumors, both pregnancy luteomas, 1 of 2 unclassified Sex Cord Tumors, 2 of 5 gonadoblastomas, 9 of 10 female adnexal Tumors of probable wolffian origin, and in the non-neoplastic stroma of many carcinomas and germ cell Tumors. The Tumor cells were inhibin-negative in 10 fibrosarcomas, 12 small cell carcinomas of hypercalcemic type, 24 germ cell Tumors (except for a focus of inhibin-positive syncytiotrophoblast in one case), and 17 ovarian carcinomas. Two of the three inhibin-positive fibromas showed diffuse immunostaining and were associated with evidence of estrogenic activity. Among nine Sertoli-Leydig cell Tumors with available clinical data, four that were more than minimally inhibin-positive were accompanied by androgenic manifestations; five inhibin-negative or only minimally positive Tumors lacked such evidence. Inhibin immunostaining may be useful in the differential diagnosis of inhibin-positive Sex Cord Tumors versus histologically similar inhibin-negative neoplasms, but inhibin negativity does not preclude a diagnosis of Sex Cord Tumor. The unexpected, common inhibin positivity of female adnexal Tumors of probable wolffian origin indicates that inhibin staining cannot be used to differentiate these Tumors from Sertoli cell Tumors. Inhibin immunostaining is also helpful in identifying potential steroid hormone-secreting cells in the non-neoplastic stromal component of epithelial, germ cell, and other ovarian Tumors.
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oxyphilic sertoli cell Tumor of the ovary a report of three cases two in patients with the peutz jeghers syndrome
International Journal of Gynecological Pathology, 1994Co-Authors: Judith A Ferry, Robert H Young, George Engel, Robert E ScullyAbstract:Three women, aged 19, 21, and 30 years, two with the Peutz-Jeghers syndrome (PJS), had unilateral ovarian Tumors composed of Sertoli cells with abundant eosinophilic cytoplasm. Electron microscopical and immunohistochemical examinations in one case supported the diagnosis of a Sex Cord Tumor. Two patients are well 3 and 20 months postoperatively; the third was well for 15 years when recurrent Tumor involving multiple intraabdominal sites was discovered. The occurrence of two of these Tumors in patients with PJS and the known increased frequency of Sex Cord Tumors in patients with this syndrome indicate an association. Sertoli cell Tumor should be included in the differential diagnosis of oxyphilic ovarian Tumors, particularly if there is a tubular pattern.