Ovarian stromal tumor with minor sex cord elements with coexistent endometrial carcinoma
A 79-year-old woman presented with post-menopausal bleeding and pain in lower abdomen for 2 months. The obstetric history of the patient was P2L2 and the patient had attained menopause 30 years back. The age of menarche was 14 years. On examination, a firm mass was palpable in lower abdomen extending upto umbilicus. On vaginal examination, uterus size could not be made out and a large abdomino pelvic mass was palpable. Abdominal ultrasonography revealed a normal-sized uterus with endometrial thickness of 7 mm and a 20 × 10 cm solid mass in pelvis and lower abdomen. Left ovary was not seen separately and there was minimal ascites. Patient underwent endometrial aspiration and it was reported as endometrioid adenocarcinoma (Grade 1). Patient underwent staging laparotomy which revealed a 20 × 10 cm solid left ovarian tumor. The right ovary was normal and there was minimal ascites which was sent for cytology. On exploration, intestines, liver and biliary tract, pancreas, omentum, and fallopian tubes were without lesions and the uterus was of normal size. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, infra-colic omentectomy, and pelvic lymphadenectomy and the specimen was submitted for histopathological examination.\nLeft ovary measured 21 × 14 × 10 cm and the cut section was homogenously fleshy with areas showing yellowish discoloration. Cut section of the uterus revealed a 4 × 3 cm exophytic fundal growth in the endometrial cavity infiltrating less than one-third of the myometrium. The right ovary, omentum, and bilateral fallopian tubes were grossly normal. On microscopic examination, left ovary showed features of a stromal tumor with minor sex cord elements []. The tumor comprised mainly of fibroma-thecoma component (more than 90%) with few aggregates of granulosa cells []. These granulosa cell aggregates were immunoreactive for inhibin [] and calretinin [].\nMultiple sections from the endometrial growth showed features of a well-differentiated endometrioid adenocarcinoma (Grade I). The omentum and lymph nodes were free of tumor.\nThe patient did not receive radiotherapy post-operatively and she is on regular follow-up.