case_images: PMC6385544_01
case_images: Contrast-enhanced computed tomographic scan of abdomen in axial (a and b) and coronal images (c and d) showing a well-defined complex mass (large arrow) in right adnexa with enhancing solid component and nonenhancing necrotic part (*). Prominent adjacent adnexal vessels (small arrow) with right ovary not separately identified
case_images: IJABMR-9-62-g001.jpg
case_images: PMC6385544_01_IJABMR-9-62-g001.jpg
case_images: F1
case_images: Right salpingo-oophorectomy was done, in which the right ovary was seen to be replaced by a solid cystic tumor with intact capsule [Figure 1].
case_images: Macroscopic examination reveals an enlarged ovary replaced by a solid cystic tumor. The solid areas appear gray-yellow in color and show multiple foci of hemorrhage. The cystic spaces were filled with thin yellow fluid
case_images: IJABMR-9-62-g002.jpg
case_images: PMC6385544_01_IJABMR-9-62-g002.jpg
case_images: F2
case_images: The solid areas are gray-yellow, showing multiple foci of hemorrhage, and the cysts were filled with thin clear yellow fluid [Figure 2].
case_images: Microscopic examination of tumor showing intermediate differentiation with presence of tubules of immature Sertoli cells and clusters of Leydig cells (H and E, x10)
case_images: IJABMR-9-62-g003.jpg
case_images: PMC6385544_01_IJABMR-9-62-g003.jpg
case_images: F3
case_images: Delicate fibrous stroma was seen at places in which Leydig cells were found in small clusters, cords, and lying singly [Figure 3].
case_images: Sertoli-Leydig cell tumor showing heterologous elements lined by mucinous epithelium (H and E, x10)
case_images: IJABMR-9-62-g004.jpg
case_images: PMC6385544_01_IJABMR-9-62-g004.jpg
case_images: F4
case_images: Heterologous elements in the form of glands lined by mucinous epithelium were seen [Figure 4].
case_images: Sertoli-Leydig cell tumor showing marked anaplasia (H and E, x10)
case_images: IJABMR-9-62-g005.jpg
case_images: PMC6385544_01_IJABMR-9-62-g005.jpg
case_images: F5
case_images: Focal area showed marked anaplasia in the form of many large, bizarre, and multinucleated cells [Figure 5].
case_images: Immunohistochemical examination. (a) The neoplastic cells stained positive for calretinin. (b) The neoplasic cells stained negative for epithelial membrane antigen. (c) MIB1 labeling index is approximately 30%, (Anaplastic focus shows a very high MIB1 labeling index of 80%-90%)
case_images: IJABMR-9-62-g006.jpg
case_images: PMC6385544_01_IJABMR-9-62-g006.jpg
case_images: F6
case_images: However, areas with anaplasia show a MIB1 labeling index of 80%-90% [Figure 6].