Solid ovarian tumor: A diagnostic and management dilemma

Abstract

Abstract Pure Sertoli cell tumors (SCTs) are an uncommon type of ovarian sex cord–stromal tumor. The variety of symptoms, solid in nature and different histopathological presentation make it difficult the proper diagnosis and optimal treatment regimens in such tumor. Due to nonspecific clinical appearance, diagnosis is mistaken by ultrasound as fibroid or uterine mass. Intraoperative surprises and suspicious for malignancy due to the solid nature of the tumor lead to surgical management dilemma. The diagnosis is confirmed by histopathological examination only. The prognosis is excellent as most are detected in the early stages and surgical management is often curative in most cases. In this case, a 22 year old unmarried female presented to us with irregular periods for 5 years. Her trans-abdominal ultrasound revealed a solid hypoechoic mass of 5 x 6 centimeter size, in close approximate to the uterus on the right side, with probable diagnosis of broad ligament fibroid. On operative laparoscopy, uterus and left ovary was normal, the mass was originated from the right ovary, which was removed and its histopathological and immunohistochemistry report shows elevated alpha inhibin and steroidogenic factor 1 (SF 1) (Sex cord stromal marker) which is suggestive pure Sertoli cell tumor. There was no family/personal history of malignancy. She was treated with surgical resection and remains clear of disease. Prognostic indicators for SCTs include degree and type of heterologous element differentiation. Thorough characterization of such elements is crucial for adequate diagnosis and treatment.