Bladder-Washing Cytology of

Metastatic Ovarian Granulosa

Cell Tumor
Aleksandar Vodovnik, M.D.*

An 86-year-old Caucasian female presented with two weeks his-

tory of discomfort discharging urine, occasional hematuria, and
suprapubic pain. The patient had a history of left salpingo-oopho-
rectomy for an ovarian tumor, performed four years earlier. Ul-
trasound showed a solid mass surrounding the orifice of the left
ureter. Bladder washing cytology yielded single, loosely cohesive
syncytial aggregates of rather uniform cells. A few discretely
grooved nuclei (“coffee bean nuclei”) were seen. Histologic ex-
amination revealed muscular tissue infiltrated by oval to round
cells, arranged in solid and follicular structures. The tumor cells
were immunoreactive for estrogen receptor, inhibin, vimentin, and
calretinin. The use of antibodies to pancytokeratin, inhibin, estro-
gen receptor, S-100, calretinin, and chromagranin could help
confirm granulosa cell tumor. To my knowledge, there was no
previous report on bladder washing cytology of metastatic gran-
ulosa cell tumor. Diagn. Cytopathol. 2002;26:387–388.
© 2002 Wiley-Liss, Inc.

Key Words: granulosa cell tumor; metastasis; bladder; washing

cytology
Bladder washing cytology of metastatic ovarian granulosa
cell tumor (GCT) is reported. An 86-yr-old Caucasian fe-
male presented with 2 weeks history of discomfort discharg-
ing urine, occasional hematuria, and suprapubic pain. Ul-
trasound showed a solid mass, 15 mm in diameter,
surrounding the orifice of the left ureter. The patient had a
history of left salpingo-oophorectomy for an ovarian tumor,
performed 4 yr earlier. Cytology revealed single, loosely
cohesive syncytial aggregates of rather uniform cells. The
amount of mostly pale, focally finely granular cytoplasm
was variable with indistinct cell borders. Tumor nuclei were
uniformly rounded and did not vary much in size. A few
discretely grooved nuclei (“coffee bean nuclei”) were seen;
County Hospital Gävle-Sandviken, Laboratory for Clinical Pathology
and Cytology, Gävle, Sweden
*Correspondence to: Aleksandar Vodovnik, MD, County Hospital
Gävle-Sandviken, Laboratory for Clinical Pathology and Cytology, SE –
801 87 Gävle, Sweden. E-mail: aleksandar.vodovnik@lg.se
Received 12 October 2001; Accepted 21 December 2001
DOI 10.1002/dc.10095
Published online in Wiley InterScience (www.interscience.wiley.com).
Fig. 1. Loose, syncytial aggregate of uniform cells. Single, discretely
grooved nuclei are present (⫻400, Papanicolaou).
the individual tumor nuclei appeared lobated (Fig. 1). The
chromatin was granular and evenly distributed, with small
and indistinct nucleoli. Average size of the tumor cells and
nuclei was 20 and 16 ␮m, respectively. No Call-Exner
bodies were found. Single benign urothelial cells were seen
in the background of erythrocytes, neutrophils, and lympho-
cytes. Cytologic findings were summarized as “probably
malignant tumor cells of non-urothelial origin.” Primary
transitional cell and small cell carcinoma of the urinary
bladder were considered as less possible due to cellular
architecture as well as nuclear size and chromatin structure,
respectively. At this point, clinical data about past tumor
history were not available. Cystoscopy showed a solid oval
protrusion of the bladder mucosa with no visible ulcer-
ations. Histologic examination revealed muscular tissue in-
filtrated by the tumor (Fig. 2) and only single detached
fragments of an ordinary urothelium. The tumor was com-
posed of oval to round cells arranged in solid and follicular
structures (Fig. 3). The tumor cells possessed scant and
granular cytoplasm. The nuclei showed indentations, lobu-

© 2002 WILEY-LISS, INC. Diagnostic Cytopathology, Vol 26, No 6 387

VODOVNIK
Fig. 2. Tumor tissue infiltrates muscular layer of bladder wall (⫻100,
hematoxylin and eosin).
lations, and small nucleoli. Mitoses were rare and were not
atypical. Hypocellular, edematous stroma was moderate and
focally vascularized. Delicate reticulum surrounded aggre-
gates of granulosa cells. Review of the original slides of the
left ovary disclosed a tumor with the same histology as that
of the bladder tumor and consistent with GCT. The tumor
cells were immunoreactive for estrogen receptor (predi-
luted; Ventana, Tucson, AZ, USA), inhibin (1:200; Serotec,
UK), vimentin (1:2000), and calretinin (1:25, DAKO-
PATTS, Denmark). No immunoreactivity was found in the
tumor cells for muscle-specific actin (1:500), epithelial
membrane antigen (1:200), chromogranin (1:400), S-100
(1:2000), and pancytokeratin (1:400, all DAKOPATTS).
Primary extraovarian and metastatic GCT are rare, with
few reports published in the English literature.1– 4 To my
knowledge, there are no previous reports on bladder-wash-
ing cytology of metastatic GCT. Cytologic and histologic
diagnosis of GCT is mainly based on cellular arrangement,
nuclear size, chromatin structure, and characteristic reticu-
lum distribution. Tumor architecture, muscular involve-
ment, and detached but intact urothelial fragments provided
the diagnosis of metastasis in this case. The use of antibod-
ies to pancytokeratin, inhibin, estrogen receptor, S-100, and
chromogranin can help confirm GCT and exclude other
388 Diagnostic Cytopathology, Vol 26, No 6
Fig. 3. Solid and follicular arrangement of tumor cells (note one mitosis)
(⫻400, hematoxylin and eosin).
histologically similar neoplasms, such as undifferentiated
carcinoma (cytokeratin-positive, inhibin-negative), neu-
roendocrine tumors (chromogranin-positive, inhibin-nega-
tive), malignant melanoma (S-100-positive, inhibin-nega-
tive), and endometrial stromal sarcoma (cytokeratin- and
inhibin-negative).1– 4 As this case has shown, calretinin an-
tibody might be included on the list of immunohistochem-
ical markers when GCT is considered.
Bladder-washing cytology is shown to be a useful tool
when dealing with neoplasms of the urinary bladder. There-
fore, awareness of metastatic ovarian GCT in the urinary
bladder is important for consideration in the differential
diagnosis.
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