case_images: PMC3708428_01
case_images: A chest, abdominal, and pelvic contrast-enhanced computed tomography (CT) scan at the portal venous phase with rectal contrast showed a huge, intraperitoneal, complex, cystic, and multilocular lesion, extending from pelvis up to midabdomen just above umbilicus, collectively measuring 13.5 x 23.3 x 21.5 cm. The source of lesion was more likely to be left ovary which was probably ruptured and leaked into the above-mentioned cystic lesion. In addition, large ascites was identified. No significant lymphadenopathies in abdomen and pelvis were noticed.
case_images: CRIM.OBGYN2013-858501.001.jpg
case_images: PMC3708428_01_CRIM.OBGYN2013-858501.001.jpg
case_images: fig1
case_images: No significant lymphadenopathies in abdomen and pelvis were noticed (Figure 1).
case_images: Macroscopic examination of the left ovarian mass. The mass weighed 1945 g and measured 24 x 21 x 7 cm. The mass was well circumscribed and had whitish nodular outer surface. A break of ovarian capsule was noted for a distance measuring 5.5 cm. Cut-surface showed multiple nodules separated by fibrous septa. Some of nodules were necrotic and others had tan-yellow nodular appearance.
case_images: CRIM.OBGYN2013-858501.002.jpg
case_images: PMC3708428_01_CRIM.OBGYN2013-858501.002.jpg
case_images: fig2
case_images: Some of the nodules were necrotic and others had tan-yellow nodular appearance (Figure 2).
case_images: Microscopic examination of the left ovarian mass. (a) The ovarian mass was composed of immature, poorly differentiated, and spindle-shaped Sertoli cells forming cords and ill-defined tubules (H&E stain, magnification power: 20x). (b) The neoplastic Sertoli cells exhibited nuclear atypia and high mitotic indices (H&E stain, magnification power: 40x). (c) Focal myxoid area containing spindle-shaped cells was identified (H&E stain, magnification power: 20x). (d) Infrequent Leydig cells with eosinophilic cytoplasm were identified focally (H&E stain, magnification power: 20x).
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case_images: PMC3708428_01_CRIM.OBGYN2013-858501.003.jpg
case_images: fig3
case_images: Microscopically, the ovarian tumor mass was composed of immature, poorly differentiated, spindle-shaped Sertoli cells forming cords, and ill-defined tubules (Figure 3(a)). The neoplastic Sertoli cells exhibited nuclear atypia and high mitotic index (Figure 3(b)). Focal myxoid area containing spindle-shaped cells was identified (Figure 3(c)). Infrequent Leydig cells with eosinophilic cytoplasm were identified focally (Figure 3(d)). 
case_images: Immunohistochemical examination of the left ovarian mass. (a) The neoplastic cells stained positive for calretinin (magnification power: 40x). (b) The neoplastic cells stained positive for inhibin (magnification power: 40x). (c) The neoplastic cells stained positive for CD56 (magnification power: 40x). (d) The neoplastic cells stained positive for WT-1 (magnification power: 40x). (e) The neoplastic cells stained positive for CK 8/18 (magnification power: 40x).
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case_images: PMC3708428_01_CRIM.OBGYN2013-858501.004.jpg
case_images: fig4
case_images: CD56, WT-1, and CK 8/18 (Figures 4(a)-4(e). Conversely, the neoplastic cells stained negative for EMA, PLAP, chromogranin A, and synaptophysin.