Failure of multiple surgical procedures and adjuvant chemotherapy in early-stage steroid-cell ovarian tumor treatment: a case report and literature review

Abstract

Ovarian steroid-cell tumors (SCTs) are a rare subgroup of sex-cord tumors of the ovary, accounting for less than 0.1% of all ovarian tumors. Not otherwise specified (NOS) tumors are the most common subtype. More than half of patients with SCTs-NOS show hyperandrogenic symptoms. The primary treatment for SCTs is surgery, as most cases are early-staged and benign. Because of the low incidence of metastatic disease, there is insufficient reliable information on the role of adjuvant therapy and the most effective treatment regimen. In this report, a rare case of a recurrent SCT-NOS in a 36-year-old female patient without endocrine symptoms is presented, highlighting the significance of appropriate pathological evaluation and immunohistochemical testing for the accurate diagnosis of this malignancy, particularly in the case of hormonally "silent" tumors. The metastatic tumor described here showed no response to four courses of adjuvant chemotherapy after several debulking surgeries. Based on the clinical findings, the neoplastic etiology should always be considered during the resection of ovarian tumors to prevent possible disease dissemination due to inappropriate surgical techniques.

Keywords: Adjuvant chemotherapy; chemotherapy failure; debulking surgery; neoplastic etiology; not otherwise specified tumor; recurrent ovarian steroid-cell tumor.

Figure 1.

Microscopic appearance of the SCT-NOS (H&E) in a 36-year-old Caucasian female patient (a) and positive staining of the tumor cells for inhibin A (b), calretinin (c), and Ki-67 (d) (20×) H&E: hematoxylin and eosin.

Figure 2.

CT scan of the patient reported in this case showing 14.5 × 8.8-cm metastatic masses within the pelvis. CT: computed tomography.

Figure 3.

Treatment course of the patient described in this report. BEP: bleomycin, etoposide, and cisplatin.