Ovarian Fibroma With Minor Sex Cord Elements and Luteinized Cells in an 81‐Year‐Old Woman: A Case Report With Molecular Findings and Review of the Literature
Akbar Ali, Shivam Gandhi, Christopher Potts, Nathanial Branscome, Sheharyar Raashid, Mariam GhafoorBackground
Ovarian fibroma with minor sex cord elements (MSCE) is a fibroma or fibrothecoma containing scattered sex cord‐type elements that occupy less than 10% of the tumor area. First described by Young and Scully in 1983, it is not recognized as a separate entity in the current World Health Organization classification, and its behavior follows that of the underlying stromal tumor. About two dozen ovarian cases have been published, a number that probably reflects under‐reporting rather than true rarity. Reported patients range from 13 to 81 years of age.
Case
An 81‐year‐old woman with a remote total hysterectomy with ovarian preservation presented with abdominal discomfort, constipation, and a pelvic mass that computed tomography initially described as uterine. Pelvic ultrasonography showed a 10.6 cm complex cystic mass adjacent to the vaginal cuff. Robotic‐assisted bilateral salpingo‐oophorectomy removed a 9 cm right ovarian mass. Histology showed a fibroma with scattered tubules, trabeculae, and nests of sex cord‐type cells and a few clusters of luteinized cells, together less than 10% of the tumor; the sex cord elements expressed SF‐1, WT1, calretinin, and inhibin. A targeted next‐generation sequencing panel performed by the consulting reference laboratory showed no reportable variants, including no FOXL2 c.402C>G mutation, and microsatellite stability. Pelvic washings were negative. She had no clinical signs of hormone excess before surgery; hot flashes reported at follow‐up were not investigated biochemically and have several possible explanations. There was no recurrence at 8 months.
Conclusion
This case adds an octogenarian patient and targeted sequencing data to the limited published experience with ovarian fibroma with MSCE. Recognition of the minor sex cord component did not change management; its practical importance lies in excluding adult granulosa cell tumor, for which adequate sampling and, when needed, FOXL2 mutation analysis are useful.