Sex cord stromal tumors

Signet ring stromal tumor

Editor-in-Chief: Debra L. Zynger, M.D.
Aarti Sharma, M.D.
Jennifer A. Bennett, M.D.

Last author update: 12 September 2019
Last staff update: 2 May 2023 (update in progress)

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PubMed search: Ovarian signet ring stromal tumor

Aarti Sharma, M.D.
Jennifer A. Bennett, M.D.
Page views in 2022: 7,144
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Cite this page: Sharma A, Bennett J. Signet ring stromal tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/ovarytumorsignetringstromal.html. Accessed June 5th, 2023.
Definition / general
  • Rare, benign ovarian stromal tumor with signet ring cells
Essential features
  • Primary ovarian stromal neoplasm comprised of various proportions of signet ring and spindle cells
  • Cytoplasmic vacuoles in signet ring cells are negative for lipid, mucin and glycogen
  • Diffusely positive for vimentin, variably express inhibin A, calretinin and actin - alpha smooth muscle but typically are negative for cytokeratin and EMA
  • Signet ring stromal cell tumor (SRSCT)
  • Signet ring stromal tumor (SRST)
ICD coding
  • ICD-10: D27.9 - benign neoplasm of unspecified ovary
  • ICD-O: 8590 / 1, C56 - sex cord gonadal stromal tumor, NOS
  • < 20 cases reported to date
  • No age predilection (range: 21 - 83 years; mean: 54 years; median: 53 years)
  • Ovary
  • Unknown
Clinical features
  • Nonspecific including abdominopelvic pain, abnormal uterine bleeding or incidental finding on imaging
Radiology description
  • No defining features to distinguish from other ovarian neoplasms on imaging
  • Solid or cystic, may appear complex
Prognostic factors
  • No reports of metastasis or recurrence
Case reports
  • Surgical excision (oophorectomy)
Gross description
  • Most are unilateral
  • Typically well circumscribed and unencapsulated
  • Yellow to tan and soft to firm cut surface
    • May show white fibromatous areas
    • Variable hemorrhage, necrosis and cystic spaces
  • Range from 1.1 to 13 cm (mean: 6.8 cm; median: 5.5 cm)
Gross images

Case #184

Yellowish with areas of hemorrhage

Images hosted on other servers:

White-gray ovarian mass

Microscopic (histologic) description
Microscopic (histologic) images

Case #184

Diffuse growth

Signet ring cells


AFIP images

Diffuse growth of cells with eccentric nuclei

Positive stains
Negative stains
Electron microscopy description
Molecular / cytogenetics description
Sample pathology report
  • Right ovary, oophorectomy:
    • Signet ring stromal tumor (5.0 cm)
Differential diagnosis
Board review style question #1
Which of the following is true regarding the ovarian lesion pictured below?

  1. It arises from ovarian stromal cells
  2. It has a poor prognosis
  3. It is typically bilateral
  4. Treatment involves local excision with adjuvant chemotherapy
  5. Tumor cells are strongly positive for cytokeratin
Board review style answer #1
A. It arises from ovarian stromal cells (this is a signet ring stromal tumor)

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Reference: Signet ring stromal tumor
Board review style question #2
A 32 year old woman without significant past medical history presents with abdominal pain. Workup reveals a 2 cm right adnexal mass on ultrasound and she undergoes salpingo-oophorectomy. Histologic examination of the ovarian tumor reveals sheets of cells with crescent shaped nuclei and intracytoplasmic vacuoles. The vacuoles are negative for mucicarmine and PAS, while the cells are negative for CAM5.2 and inhibin A. What is the likely diagnosis?

  1. Adult granulosa cell tumor with signet ring cell change
  2. Krukenberg tumor
  3. Microcystic stromal tumor
  4. Signet ring stromal tumor
  5. Thecoma with signet ring cell transformation
Board review style answer #2
D. Signet ring stromal tumor

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Reference: Signet ring stromal tumor
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