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Mentions: The final histological examination revealed a well-capsulated mass that measured 6 × 5 × 2 cm in diameter, which was located in the right broad ligament and attached to the right fallopian tube. The cut section of the mass showed a circumscribed, solid tissue without apparent cystic areas. Pathologic examination revealed a tumor composed of sheets of polygonal cells with fairly monomorphic nuclei, dispersed chromatin and conspicuous nucleoli. The tumor showed different histological patterns, including a reticular, sieve-like appearance, tubule, dilated cystic structures and islands of cells peripheral to glandular spaces with eosinophilic secretions. Immunohistochemically, the tumor was strongly positive for vimentin, calretinin, inhibin and pan-cytokeratin (MNF 116; fig. 2, fig. 3); CK7 and chromogranin were negative. Ovaries, fallopian tubes, uterus, omentum and pelvic peritoneum were macroscopically and histologically unremarkable. A total of 32 pelvic and 24 aortic nodes were collected, all of them were negative for neoplastic infiltration. Based on pathological and immunohistochemical results, the diagnosis of FATWO has been confirmed [7,8,9]. The pathological specimens of the adnexal mass were also reviewed by the National Institute of Tumor in Milan that confirmed the diagnosis.
One-Step Laparoscopic Management of a Female Adnexal Tumor of Wolffian Origin
Bottom Line: Transvaginal ultrasonographic findings suggested a solid right para-ovarian mass suspected to be malignant.After thorough counseling, the patient underwent operative laparoscopy for excision of the para-ovarian mass with frozen section (FS) examination resulting in the diagnosis of a poorly differentiated adenocarcinoma.Final pathological and immunohistochemical results confirmed the diagnosis of FATWO.
Affiliation: Minimally Invasive Gynecological Surgery Center, Gynecology and Reproductive Medicine Unit, University of Bologna, Bologna, Italy.
We report a case of female adnexal tumor of Wolffian origin (FATWO), a rare neoplasm arising from the mesonephric ducts. A 48-year-old woman came first to our center for a recent discovery of a pelvic mass. Transvaginal ultrasonographic findings suggested a solid right para-ovarian mass suspected to be malignant. After thorough counseling, the patient underwent operative laparoscopy for excision of the para-ovarian mass with frozen section (FS) examination resulting in the diagnosis of a poorly differentiated adenocarcinoma. In this case, FS results allowed performing a comprehensive oncological staging, through a totally laparoscopic extrafascial hysterectomy, bilateral adnexectomy, total omentectomy, pelvic wall peritonectomy, and pelvic, parasacral and para-aortic lymphadenectomy. Final pathological and immunohistochemical results confirmed the diagnosis of FATWO. To our knowledge, this is the first case of FATWO managed entirely by a minimally invasive laparoscopic approach in a single surgical session.