Sclerosing stromal tumor (SST) of the ovary: a case report and review of the literature

Sclerosing stromal tumor is a rare benign neoplasm of the ovary. It occurs in women in the second-third decades of life and is generally hormonally inactive. It has nonspecific symptoms like menstrual irregularity, abdominal pain, amenorrhea, infertility and on imaging it is represented by a solid or cystic unilateral ovarian mass. We describe a case of a 17-year-old woman who presented with menstrual irregularity and pelvic pain. She underwent laboratory analysis including serum markers that were within normal ranges and a MRI which showed a solid mass measuring 4 cm of the right ovary. The patient underwent a laparoscopic surgery with the enucleation of the mass and, a ter the result of the frozen section examination, a conservative approach with preservation of the ovary was possible. Histopathological and immunohistochemical examinations confirmed the diagnosis of sclerosing stromal tumor of the ovary and allowed a differential diagnosis with other benig normalignant ovarian masses. SST of the ovary is a difficult diagnosis to make preoperatively. It commonly occurs in young women in whom ovarian conservation should be considered. Normal serum tumor markers and findings on imaging studies could suggest the diagnosis. However, the definitive diagnosis can only be made by histopathological examination of the removed tumor that can be treated successfully with fertility preserving surgery.

Ovarian tumor; Ovarian stromal neoplasm; Sclerosing stromal tumor; Young women

[1] Kaygusuz EI, Cesur S, Cetiner H, Yavuz H, Koc N. Sclerosing stromal tumour in young women: clinicopathologic and immunohistochemical spectrum. Journal of Clinical and Diagnostic Research. 2013; 7: 1932–1935.

[2] Chalvardjian A, Scully RE. Sclerosing stromal tumors of the ovary. Cancer. 1973; 31: 664–670.

[3] Nguyen M, Soumit N, Waheed A, Sees J, Azhar E. A rare case of sclerosing stromal tumor of the ovary presenting in pregnancy: a diagnostic dilemma on presentation. Case Reports in Obstetrics and Gynecology. 2019; 2019: 1–4.

[4] Palmeiro MM, Cunha TM, Loureiro AL, Esteves G. A rare benign ovarian tumour. BMJ Case Reports. 2016; 2016: bcr2015214101.

[5] Atram M, Anshu, Sharma S, Gangane N. Sclerosing stromal tumor of the ovary. Obstetrics & Gynecology Science. 2014; 57: 405.

[6] Fox H, Wells M. Haines and Taylor obstetrical and gynaecological pathology. 5th ed. New York: Churchill Livingstone. 2003.

[7] Bairwa S, Satarkar R, Kalhan S, Garg S, Sangwaiya A, Singh P. Sclerosing stromal tumor: a rare ovarian neoplasm. Iranian Journal of Pathology. 2017; 12: 402–405.

[8] Cashell AW, Cohen ML. Masculinizing sclerosing stromal tumor of the ovary during pregnancy. Gynecologic Oncology. 1991; 43: 281–285.

[9] Özdemir O, Sari M, Sen E, Kurt A, Ileri A, Atalay C. Sclerosing stromal tumour of the ovary: a case report and the review of literature. Nigerian Medical Journal. 2014; 55: 432–437.

[10] Kawauchi S, Tsuji T, Kaku T, Kamura T, Nakano H, Tsuneyoshi M. Sclerosing stromal tumor of the ovary. The American Journal of Surgical Pathology. 1998; 22: 83–92.

[11] Kuscu E, Oktem M, Karahan H, Bilezikci B, Demirhan B. Sclerosing stromal tumor of the ovary: a case report. European Journal of Gynaecological Oncology. 2003; 24: 442–444.

[12] Sambiasi D, Lambo R, Pilato B, Tommasi S, Trojano G, Kardhashi A, et al. BRCA1/2 and clinical outcome in a monoinstitutional cohort of women with hereditary breast cancer. Oncology Reports. 2014; 31: 365–369.

[13] Digennaro M, Sambiasi D, Tommasi S, Pilato B, Diotaiuti S, Kardhashi A, et al. Hereditary and non-hereditary branches of family eligible for BRCA test: cancers in other sites. Hereditary Cancer in Clinical Practice. 2017; 15: 7.

[14] Caponio MA, Addati T, Popescu O, Petroni S, Rubini V, Centrone M, et al. P16INK4a protein expression in endocervical, endometrial and metastatic adenocarcinomas of extra-uterine origin: diagnostic and clinical considerations. Cancer Biomarkers. 2014; 14: 169–175.

[15] Ismail SM, Walker SM. Bilateral virilizing sclerosing stromal tumours of the ovary in a pregnant woman with Gorlin’s syndrome: implications for pathogenesis of ovarian stromal neoplasms. Histopathology. 1990; 17: 159–163.

[16] Damjanov I, Probnjak P, Grizelj V, Longhino N. Sclerosing stromal tumor of the ovary. Obstetrics & Gynecology. 1975; 45: 675–678.

[17] Tiltman AJ, Haffajee Z. Sclerosing stromal tumors, thecomas, and fibromas of the ovary: an immunohistochemical profile. International Journal of Gynecological Pathology. 1999; 18: 254–258

[18] Kim JY, Jung K, Chung DS, Kim OD, Lee JH, Youn SK. Sclerosing stromal tumor of the ovary: MR-pathologic correlation in three cases. Korean Journal of Radiology. 2003; 4: 194–197.

[19] Jena A, Patnayak R, Vijaylaxmi B, Manilal B, Settipalli S, Sundaram R. Sclerosing stromal tumor of ovary in a young female: a case report and brief review of literature. Clinical Cancer Investigation Journal. 2015; 4: 670.

[20] Calabrese M, Zandrino F, Giasotto V, Rissone R, Fulcheri E. Sclerosing stromal tumor of the ovary in pregnancy: clinical, ultrasonography, and magnetic resonance imaging findings. Acta Radiologica. 2004; 45: 189–192.

[21] Joja I, Okuno K, Tsunoda M, Takeda Y, Sugita K, Mizutani Y, et al. Sclerosing stromal tumor of the ovary: US, MR, and dynamic MR findings. Journal of Computer Assisted Tomography. 2001; 25: 201–206.

[22] Pellegrino A, Damiani GR, Loverro M, Pirovano C, Fachechi G, Corso S, et al. Comparison of robotic and laparoscopic radical typeB and C hysterectomy for cervical cancer: long term-outcomes. Acta Biomed. 2017; 88: 289–296.

[23] Filipa S, Daniela M, Fernando C, João PM, Ana LA, Guilherme T, et al. Ovarian sclerosing stromal tumour: a challenging diagnosis during pregnancy. Journal of Universal Surgery. 2017; 25: 739–744.

[24] Lasalandra C, Coviello M, Falco G, Divella R, Trojano G, Laterza AM, et al. Serum vascular endothelial growth factor and adiponectin levels in patients with benign and malignant gynecological diseases. International Journal of Gynecological Cancer. 2010; 20: 507–512.

[25] Grechi G, Clemente N, Tozzi A, Ciavattini A. Laparoscopic treatment of sclerosing stromal tumor of the ovary in a woman with gorlin-goltz syndrome: a case report and review of the literature. Journal of Minimally Invasive Gynecology. 2015; 22: 892–895.

[26] Kardhashi A, Deliso MA, Renna A, Trojano G, Zito FA, Trojano V. Benign granular cell tumor of the vulva: first report of multiple cases in a family. Gynecologic and Obstetric Investigation. 2012; 73: 341–348.