Metastatic Female Adnexal Tumor of Probable Wolffian Origin

Abstract

Female adnexal tumor of probable wolffian origin is a rare neoplasm that can present diagnostic difficulties. We report herein a case of a 60-year-old woman with female adnexal tumor of probable wolffian origin arising within the leaves of a broad ligament and, 5 years later, presenting with metastasis to the liver. The morphologic, immunohistochemical, ultrastructural, and DNA ploidy findings of the original and metastatic tumor, differential diagnoses, and the results of the English-language literature review are presented.

Wolffian Tumor of the Ovary With a Prominent Spindle Cell Component: Report of a Case With Brief Discussion of Unusual Problems in Differential Diagnosis, and Literature Review

“…1,3,16,17 Most female Wolffian tumors behave in a benign manner, but recurrences and distant metastasis, sometimes after many years, have also been reported in a few (a total of 6) cases. [5][6][7][8] In 1 patient, FATWO had recurred several times over a span of 16 years despite repeated surgical excisions and chemotherapy. 18 High mitotic activity, marked cellular atypia, and necrosis have been suggested to be predictive of an aggressive behavior.…”

“…Most cases appear to behave in a benign fashion, but recurrence and metastasis, sometimes after several years, have also been reported. [4][5][6][7][8] Some Wolffian tumors of the ovary appear to be hormonally active, causing endometrial hyperplasia, 9 but most are inert and are discovered only when they are large enough to be palpable or to cause pelvic pain and/or abdominal distension. Wolffian tumors can be misinterpreted as adenocarcinoma or sex cord-stromal tumors, especially on An 87-year-old woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy for endometrioid adenocarcinoma.…”

The complex and often confusing history, histology and histogenesis of mesonephric, STK11 adnexal tumour and mesonephric‐like neoplasms of the upper female genital tract (including broad ligament)

“…Literature review of tumours classified as malignant FATWO 17,18,37,51,[54][55][56][57][58][59][60][61][62][66][67][68][69][70][71][72][73][74][75][76][77][78][79][80][81][82][83] led us to conclude that many represent STK11 adnexal tumour or endometrioid carcinoma (EC) with unusual features. However, we favoured three tumours to be true malignant FATWOs based on photomicrographs and microscopic descriptions noting the presence of typical areas.…”

“…Determining features predictive of malignancy in FATWOs is challenging, as the literature includes tumours that, in our opinion, are not bona fide FATWOs as no definitive typical areas are shown. Literature review of tumours classified as malignant FATWO 17,18,37,51,54–62,66–83 led us to conclude that many represent STK11 adnexal tumour or endometrioid carcinoma (EC) with unusual features. However, we favoured three tumours to be true malignant FATWOs based on photomicrographs and microscopic descriptions noting the presence of typical areas.…”