Subscribe to Newsletter
Diagnostics Histology, Training and education, Microscopy and imaging

Case of the Month

Pancreatic tumors of this type occur most often in which syndrome?

a. Multiple endocrine neoplasia type I
b. Multiple endocrine neoplasia type II
c. von Hippel-Lindau syndrome
d. Neurofibromatosis type I

Click here to register your guess.

We will reveal the answer next month.

Do you have an interesting case that you would like us to feature? Email it to [email protected].

Question 1:
A. Calretinin

Question 2:
B. Estrogenic changes

This case corresponds to ovarian thecoma. Thecomas are one-third as common as granulosa cell tumors and typically occur in postmenopausal women. They are associated with estrogenic changes, such as uterine bleeding in 60 percent of cases, and as many as 20 percent of cases can be associated with endometrial carcinoma (usually endometrioid) (1). They tend to occur at a slightly older age than granulosa cell tumors (2).

Thecomas typically range from 5–10 cm, and only 3 percent are bilateral. Macroscopically, they are solid and present yellow cut surfaces. Cysts, hemorrhage, necrosis, and focal calcification may occur (1). Microscopically, these tumors are composed of sheets and nodules of round cells with ill-defined borders, including moderate to abundant eosinophilic to pale cytoplasm. Nuclei are round to slightly spindled with little or no atypia. A fibromatous component often forms septa that separate nodules, and hyaline plaques with calcification may be seen (2).

The neoplastic cells are positive for calretinin, inhibin, CD56, and WT1. They are often also positive for estrogen and progesterone receptor (1).

The differential diagnosis comprises several tumors of the sex cord-stromal tumors group, including fibroma, granulosa cell tumor, steroid cell tumor, and others (3).


  1. PB Clement, RH Young, Atlas of gynecologic surgical pathology, 3rd edition. Elsevier: 2014.
  2. RH Young, “Ovarian sex cord-stromal tumors: reflections on a 40-year experience with a fascinating group of tumors, including comments on the seminal observations of Robert E. Scully, MD”, Arch Pathol Lab Med, 142, 1459–1484 (2018). PMID: 30500284.
  3. RH Young, “Ovarian sex cord-stromal tumours and their mimics”, Pathology, 50, 5–15 (2018). PMID: 29132723.

Submitted by Luis Humberto Cruz Contreras, Hospital Materno-Infantil, Irapuato, Mexico.

Receive content, products, events as well as relevant industry updates from The Pathologist and its sponsors.
Stay up to date with our other newsletters and sponsors information, tailored specifically to the fields you are interested in

When you click “Subscribe” we will email you a link, which you must click to verify the email address above and activate your subscription. If you do not receive this email, please contact us at [email protected].
If you wish to unsubscribe, you can update your preferences at any point.

Most Popular
Register to The Pathologist

Register to access our FREE online portfolio, request the magazine in print and manage your preferences.

You will benefit from:
  • Unlimited access to ALL articles
  • News, interviews & opinions from leading industry experts
  • Receive print (and PDF) copies of The Pathologist magazine