A Giant Ovarian Sex Cord Stromal Tumor Presenting as a Massive Abdomino-pelvic Mass: A Rare Case Report

Abstract

Objective: To present a case report of ovarian spindle cell neoplastic lesions with sex cord stromal differentiation, highlighting diagnostic challenges in the absence of immunohistochemistry (IHC). Methods: Clinical, radiological, surgical, and histopathological data were reviewed for patients presenting with large abdomino-pelvic masses suspicious for ovarian spindle cell neoplasms. Diagnostic criteria and limitations due to lack of IHC were discussed. Results: We report a rare case of a giant ovarian spindle cell neoplasm with sex cord-like differentiation in a 52-year-old hypertensive female presenting with a massive abdomino-pelvic mass. Imaging suggested a large complex adnexal tumor (O-RADS V) with elevated CA-125 levels. Staging laparotomy revealed a 32×24×21 cm right ovarian mass weighing over 15 kg with no evidence of metastasis. Histopathology revealed a spindle cell neoplasm with features suggestive of a sex cord–stromal origin. Conclusion: Ovarian spindle cell neoplasms with sex cord stromal differentiation pose significant diagnostic challenges, especially when IHC is not feasible. Awareness of clinical, radiological, and histomorphological features along with literature guidance supports appropriate surgical management. Further research and improved access to IHC are essential for precise diagnosis and tailored therapy.