a sharp border separating the two tumors ( Figure 1D). Both components lack conspicuous mitotic activity, prominent cellular atypia, hemorrhage, or necrosis. Immunohistochemically, both tumors express vimentin, and both components were negative for broad spectrum cytokeratin (AE1/AE3) (data not shown). Calretinin highlighted the rounded, short spindled, bland-looking cells component while absent in the signet-ring cell component ( Figure 1E). Taken together, the findings indicate that the tumor is a combination of a sclerosing stromal tumor and a signet-ring stromal tumor of the ovary. Both sclerosing stromal tumor and signet-ring stromal tumor are very rare benign sex-cord stromal tumor in ovary. Sclerosing stromal tumor is an uncommon pure stromal tumor of ovary and almost all tumors occur unilaterally, and patients usually do not have hormonal symptoms. 4 The incidence of signet-ring stromal tumor is not clear due to its rarity. 4 It is characterized by aggregates of signet-ring cell with large intracytoplasmic vacuole which lacks of mucin, an important feature to differentiate from Krukenberg tumor. Immunohistochemically, the absence of calretinin or inhibin expression is another feature of the tumor. 4 Interestingly, in one case report, He et al., showed that a sclerosing stromal tumor with characteristics of signet-ring stromal tumor in a 4-year-old girl. They have proposed that sclerosing stromal tumor and signet-ring stromal tumor may represent a spectrum of ovarian stromal tumor evolution. 5 However, in our case, there is a distinct border between two tumors and no area shows admixture of the two components, supporting the scenario of a collision tumor. Albeit rare, pathologists should be aware of the possibility of collision tumor when confronting a neoplasm exhibiting two entirely distinct morphological features.
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