Female Adnexal Tumour of Wolffian Origin Masquerading as a Broad Ligament Fibroid: A Rare Case Report
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CASE REPORT
Female Adnexal Tumour of Wolffian Origin Masquerading as a Broad Ligament Fibroid: A Rare Case Report Athira Sasidharan1
•
Manna Valiathan2
•
Geetha Vasudevan2
Received: 17 September 2020 / Accepted: 9 November 2020 / Published online: 22 November 2020 Ó Association of Gynecologic Oncologists of India 2020
Abstract Background Female adnexal tumour of Wolffian origin (FATWO), a rare neoplasm arising from the female adnexa, is typically benign in nature, although recurrences and metastasis have been reported infrequently. First identified and reported in the early 1970s, less than 100 cases have been reported thus far. Case Presentation We present a case of a 16-year-old girl with a left adnexal tumour of Wolffian origin who presented with excessive bleeding during mensuration. With no overt clinical signs, ultrasound revealed a left ovarian neoplasm which was confirmed by CT scan as a solid enhancing lesion in the left adnexa measuring 6.2 x 5 x 4.5 cm. A broad ligament mass was excised, and cytology of peritoneal fluid wash revealed no malignancy. Histomorphological examination and immunohistochemistry confirmed the diagnosis of FATWO. The postoperative course was uneventful; however, the patient was lost to follow-up. Conclusion Due to the rarity of occurrence, asymptomatic presentation, its variable location, and its morphological diversity, the diagnosis of FATWO may present a challenge especially when the tumour arises in an ovarian location. Keywords Neoplasm Wolffian adnexal tumor FATWO Ovary Benign
Introduction Female Adnexal Tumours of Wolffian Origin (FATWO) were first reported by Karimnejad and Scully [1] in the year 1973. These were primarily described as tumours arising from the remnants of the mesonephric duct [Wolffian Duct], which may be retained within the leaves of the broad ligament between the uterus, fallopian tube, and ovaries [1]. There are less than 100 cases of FATWO reported in English Literature so far with most of them considered to have a benign course with an indolent behaviour; however, there have been reports of recurrences and metastasis. These are typically well-differentiated epithelial tumours growing in a tubular, sieve-like, diffuse architecture containing eosinophilic secretions when observed microscopically [2]. Immunohistochemical (IHC) & Athira Sasidharan [email protected] 1
KMCT Medical College, Calicut, India
2
Kasturba Medical College, Manipal University, Manipal, India
panels play a critical role in differentiating the Wolffian origin tumours from other similar tumours; however, there has been no single specific IHC stain identified for these so far [3]. The majority of these tumours have been incidental findings during exploratory surgeries as the patients typically present with vague abdominal symptoms [3, 4]. A 16-year-old girl presented with symptoms of heavy menstrual bleeding and the conclusive diagnostic procedures revealed a left adnexal tumour of Wolffian origin.
Clinical Presentation A 16-year-old girl who attained menarche at
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