Quiz Case: A 19-Year-Old Woman with Hypercalcemia and Abdominal Pain

necroses. Microscopic examination disclosed 2 patterns, the one with diffuse arrangement of small cells with scanty cytoplasm and the other with follicles varying from small to large with eosinophilic fluid in the lumen. In the 2nd pattern, the tumor cells had abundant eosinophilic cytoplasm. Mitotic figures were numerous (> 30 mitoses/high power field (HPF)). Immunohistochemically, the tumor’s profile was as follows: positive for p53, vimentine, Wilms’ tumor protein 1 (WT-1), CD99, and negative for thyroid transcription factor 1 (TTF1), calretinin, a-inhibin, epithelial membrane antigen (EMA), placental alkaline phosphatase (PLAP) and CD10. Morphology and immunohistochemistry differentiated the tumor from juvenile granulosa cell tumor, dysgerminoma and small-cell carcinoma pulmonary type (fig. 1).