47. Minimally Invasive Ovarian-Preserving Approach for the Management of a Sclerosing Stromal Tumor in an Adolescent

Abstract

<h3>Background</h3> Sclerosing stromal tumor (SST) is a rare benign ovarian tumor that primarily occurs in the 2nd and 3rd decades of life with the most common presentation being abdominal pain due to a pelvic mass. Due to its rarity, ambiguous laboratory results, and imaging findings concerning for malignancy, unilateral salpingo-oophorectomy is often performed. There are scant case reports describing a laparoscopic approach of tumor enucleation allowing ovarian preservation. Herein, we present a case of SST in an adolescent treated via a minimally invasive ovarian-sparing technique. <h3>Case</h3> A 13 year-old post-pubertal female initially presented with acutely worsening right lower quadrant (RLQ) pain. She denied fevers, nausea/vomiting, hirsutism and reported normal bowel movements. There was no family history of ovarian or breast cancer. Physical exam revealed tenderness in the RLQ with mild rebound tenderness and a palpable RLQ mass. Breast and genitalia examination demonstrated Tanner stage IV as well as normal labia majora, minora, external urethral meatus and clitoris. Laboratory studies showed normal CEA, LDH, HCG, and AFP, but mildly elevated CA-125 (49 U/ml), free testosterone (2.6 pg/ml), and inhibin-A (9 pg/ml). US showed a 9.7 cm solid, heterogenous ovarian mass. CT abdomen and pelvis revealed a 9 cm predominantly cystic mass lesion arising from the left adnexa with nodular lesions and multiple enhancing septa. The decision was made to remove the tumor with potential unilateral salpingo-oopherectomy and possible staging. Using a laparoscopic approach, the mass was visualized, and pelvic washings were obtained. The tumor occupied nearly the entire ovary and grossly appeared smooth and distinct from the ovarian parenchyma (Fig 1). It was enucleated from the ovarian cortex via blunt and sharp dissection and entirely resected with preservation of uninvolved ovarian parenchyma. Frozen section results were inconclusive. Final pathology revealed a sclerosing tumor with a dense, fibrous capsule, sharply demarcated from ovarian tissue. It contained both hyper- and hypocellular areas in a pseudolobular pattern with prominent, branching vasculature (Fig 2: A, B). On higher power, both luteinized cells and spindle cells were noted (Fig 2: C,D). <h3>Comments</h3> SSTs are rare benign ovarian tumors often treated with oophorectomy. To our knowledge, this is the first case of a minimally invasive approach using an ovarian-sparing technique for an adolescent female reported in the United States. It is important for clinicians providing care for adolescent girls to entertain this rare diagnosis for a solid ovarian tumor and consider a minimally invasive approach with preservation of the normal ovarian parenchyma.