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Ahuja C, Tymon-Rosario J, Rottmann D, Raad RA, Silasi DA, Vash-Margita A. Minimally Invasive Ovarian-Preserving Approach for the Management of a Sclerosing Stromal Tumor in an Adolescent: A Case Report. J Pediatr Adolesc Gynecol 2022; 35:505-508. [PMID: 35123057 DOI: 10.1016/j.jpag.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/25/2021] [Accepted: 01/23/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Sclerosing stromal tumors (SSTs) are rare benign ovarian tumors that occur in adolescents and young adults. They are often treated with unilateral salpingo-oopherectomy due to concern for malignancy. CASE A 13-year-old postpubertal female presented with sharp, constant abdominal pain with physical exam concerning for a lower abdominal mass. An ultrasound revealed a 9.7-cm solid, heterogenous left ovarian mass. The abdomen and pelvis CT confirmed the findings and showed a predominantly cystic mass arising from the left adnexa. During surgery, a smooth and distinct mass arising from the left ovary was encountered without abnormal findings in surrounding structures. A cystectomy was performed, and intraoperative findings showed no evidence of malignancy. Based on the lab, imaging, and surgical findings, staging and salpingo-oopherectomy were not pursued. SUMMARY AND CONCLUSION Given the benign nature of SSTs, it is important to entertain the diagnosis in adolescents presenting with clinically congruent ovarian masses. The minimally invasive approach allows for sparing of the ovary in the adolescent population.
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Affiliation(s)
- Chaarushi Ahuja
- Department of Gynecology, Obstetrics and Reproductive Sciences, Yale New Haven Hospital, New Haven, Connecticut 06510.
| | - Joan Tymon-Rosario
- Department of Gynecology, Obstetrics and Reproductive Sciences, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, Connecticut 06510
| | - Douglas Rottmann
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520
| | - Rita Abi Raad
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut 06520
| | - Dan-Arin Silasi
- Gynecologic Oncology, Obstetrics and Gynecology, Mercy Hospital, St. Louis, Missouri 63141
| | - Alla Vash-Margita
- Department of Gynecology, Obstetrics and Reproductive Sciences, Division of Pediatric and Adolescent Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510
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Chen Q, Chen YH, Tang HY, Shen YM, Tan X. Sclerosing stromal tumor of the ovary with masculinization, Meig’s syndrome and CA125 elevation in an adolescent girl: A case report. World J Clin Cases 2020; 8:6364-6372. [PMID: 33392319 PMCID: PMC7760423 DOI: 10.12998/wjcc.v8.i24.6364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/24/2020] [Accepted: 10/20/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Sclerosing stromal tumor (SST) is an extremely rare sex cord stromal tumor of the ovary. It was first reported and named in 1973. These tumors typically present with pelvic/abdominal pain and tenderness, a mass, and/or abnormal menses, but rarely present with masculinity in children and adolescents. Only 2 cases of these tumors have been reported in premenarchal girls, who demonstrated hormonal activity, with a history of the development of a virilizing female due to hyperandrogenism. Here, we report a case of a giant SST with obvious masculinity combined with Meig’s syndrome and CA125 elevation.
CASE SUMMARY A 17-year-old female presented with a 7-year history of the development of masculinity and a 2-year history of amenorrhea. She had hirsutism, acne, obvious laryngeal prominence, and voice deepening. Physical examination showed a male suprapubic hair pattern and a 4.0 cm × 1.5 cm enlarged clitoris. Laboratory tests showed that the testosterone level was > 15.00 ng/mL (normal range: 0.14-0.76 ng/mL), and androstenedione level was > 10.00 ng/mL (normal range: 0.3-3.3 ng/mL). A computed tomography scan of the abdomen and pelvis was carried out and showed a large, solid and cystic, partly calcified pelvic mass in the right ovary measuring 27.1 cm × 20.0 cm × 11.0 cm, 15 cm above the umbilicus (to the level of the upper part of L1). Intraoperative findings at laparotomy revealed a large tumor arising from the right ovary. Approximately, 500 mL of pale-yellow clear liquid was found in the pelvic cavity. A right salpingo-oophorectomy was performed. Microscopic examination and immunohistochemical staining of the surgical specimen showed an SST of the ovary.
CONCLUSION This report is remarkable as our patient was not only diagnosed with an SST of the ovary, which is extremely rare in this age group, but was the largest and most obvious reported patient with this tumor who presented with virilization. Therefore, gynecologists should be aware of this potential complication in adolescent girls with a mass in the ovary.
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Affiliation(s)
- Qian Chen
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yi-Hong Chen
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Hui-Yun Tang
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
| | - Yang-Mei Shen
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Xin Tan
- Obstetrics and Gynecology Department, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University, Ministry of Education, Chengdu 610041, Sichuan Province, China
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Momtahan M, Akbarzadeh-Jahromi M, Najib FS, Namazi N. Different Presentations of Five Rare Cases of Sclerosing Stromal Tumor of the Ovary. Indian J Surg Oncol 2018; 9:581-584. [PMID: 30538393 DOI: 10.1007/s13193-018-0776-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 05/08/2018] [Indexed: 11/28/2022] Open
Abstract
A rare subtype of preceding neoplasm of ovary is sclerosing stromal cell tumor with few presented cases in the literature. In these case series, we describe five cases of ovarian sclerosing stromal cell tumor with different presentations in our department. Interestingly, one of our cases had elevated alfa-fetoprotein.
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Affiliation(s)
- Mozhdeh Momtahan
- 1Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Fateme Sadat Najib
- 3Infertility Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Niloofar Namazi
- 1Obstetrics and Gynecology Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Bairwa S, Satarkar RN, Kalhan S, Garg S, Sangwaiya A, Singh P. Sclerosing Stromal Tumor: A Rare Ovarian Neoplasm. Iran J Pathol 2017; 12:402-405. [PMID: 29563938 PMCID: PMC5844687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 06/02/2017] [Indexed: 11/27/2022]
Abstract
Ovarian sex cord-stromal tumors are relatively infrequent neoplasms that account for approximately 8% of all primary ovarian neoplasm. Sex cord-stromal tumors of the ovary include granulosa cell tumors, fibrothecomas, Sertoli-Leydigcell tumors, steroid cell tumors, and sclerosing stromal tumors (SST). Sclerosing stromal tumors account for 2% to 6% of ovarian stromal tumors. Despite the rarity of this particular neoplasm, it is not always possible to predict the presence of this tumor preoperatively on the basis of clinical and sonographic findings. Histopathological and immunohistochemical (IHC) examinations confirm the diagnosis. Herein, the clinical findings and histopathological features of SST are described in a 24-year-old female.
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Affiliation(s)
- Shilpa Bairwa
- Corresponding Information: Dr. Shilpa Bairwa, Department of pathology, SHKM, GMC, Nalhar, Mewat, Haryana, India,
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Yesil S, Tanyildiz HG, Akyurek N, Bozkurt C, Sahin G. A Rare Presentation of Paraovarian Sclerosing Stromal Tumor with High Mitotic Activity. J Pediatr Adolesc Gynecol 2016; 29:e13-5. [PMID: 26327562 DOI: 10.1016/j.jpag.2015.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2015] [Revised: 07/08/2015] [Accepted: 08/22/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Sclerosing stromal tumor is an extremely rare type of benign ovarian sex cord stromal tumor. CASE The benign characteristic of this tumor is well known but we present an uncommon case of paraovarian sclerosing stromal tumor with high mitotic activity. RESULTS AND CONCLUSION Despite this potential malignancy, our patient was treated successfully with enucleation only.
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Affiliation(s)
- Sule Yesil
- Department of Pediatric Oncology, Dr Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital, Ankara, Turkey.
| | - Hikmet Gulsah Tanyildiz
- Department of Pediatric Oncology, Dr Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Nalan Akyurek
- Department of Pathology, Gazi University, Faculty of Medicine, Ankara, Turkey
| | - Ceyhun Bozkurt
- Department of Pediatric Oncology, Dr Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
| | - Gurses Sahin
- Department of Pediatric Oncology, Dr Sami Ulus Maternity, Children's Health and Disease Training and Research Hospital, Ankara, Turkey
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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. J Minim Invasive Gynecol 2015; 22:892-5. [PMID: 25764974 DOI: 10.1016/j.jmig.2015.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/04/2015] [Accepted: 03/04/2015] [Indexed: 12/17/2022]
Abstract
Gorlin-Goltz syndrome is a rare hereditary multisystemic disease. Multiple basal cell carcinomas, odontogenic keratocysts, and skeletal abnormalities are the main clinical manifestations of the syndrome, but several organs can be involved. Moreover, this condition is associated with the development of various benign and malignant tumors, even in the genital tract. This report describes a rare association between Gorlin-Goltz syndrome and the sclerosing stromal tumor of the ovary. Because the ultrasound and magnetic resonance imaging patterns of this tumor can be similar to those of a malignant neoplasm, prompt surgical intervention and histological confirmation of diagnosis is mandatory; however, this is a benign lesion and thus can be approached with a laparoscopic fertility-sparing surgery. Gynecologists should be aware of this possible association to provide appropriate counseling for these women, and to take a fertility-sparing laparoscopic approach whenever possible.
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Affiliation(s)
- Gianluca Grechi
- Gynecologic Section, Woman's Health Sciences Department, Polytechnic University of Marche, Hospital G. Salesi, Ancona, Italy
| | - Nicolò Clemente
- Gynecologic Section, Woman's Health Sciences Department, Polytechnic University of Marche, Hospital G. Salesi, Ancona, Italy
| | - Alessandra Tozzi
- Gynecologic Section, Woman's Health Sciences Department, Polytechnic University of Marche, Hospital G. Salesi, Ancona, Italy
| | - Andrea Ciavattini
- Gynecologic Section, Woman's Health Sciences Department, Polytechnic University of Marche, Hospital G. Salesi, Ancona, Italy.
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Furukawa S, Kanno K, Kojima M, Ohara M, Soeda S, Suzuki S, Watanabe T, Nishiyama H, Honda T, Fujimori K. Sclerosing stromal tumor of the ovary treated with 2-incision total laparoscopic cystectomy. Int J Surg Case Rep 2015; 9:72-4. [PMID: 25732615 PMCID: PMC4392182 DOI: 10.1016/j.ijscr.2015.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/23/2022] Open
Abstract
Sclerosing stromal tumor (SST) is an extremely rare benign tumor of the ovary and preoperative diagnosis of SST is difficult as it often mimics a malignant tumor. SST occurs in young women. Many cases of SST were treated by abdominal oophorectomy and laparoscopic surgery is seldom performed in SST cases. We report a case of SST of the ovary in an 18-year-old girl who was diagnosed by preoperative imaging and underwent laparoscopic cystectomy.
Sclerosing stromal tumor (SST) is an extremely rare benign tumor of the ovary that is derived from the sex cord stroma [1,2] and occurs in young women [3–11]. Preoperative diagnosis of the tumor is difficult as it often mimics a malignant tumor. Oophorectomy is usually performed in many cases of young women [3], and diagnosis of SST is made based on post-operative pathological examination. Laparoscopic surgery is seldom performed in SST cases. Here, we report a case of SST of the ovary in an 18-year-old girl who was diagnosed by preoperative imaging and underwent laparoscopic cystectomy. Accurate preoperative imaging helped to perform minimally invasive surgery for SST.
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Affiliation(s)
- Shigenori Furukawa
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan.
| | - Kiyoshi Kanno
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Manabu Kojima
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Miki Ohara
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Satoshi Suzuki
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Hiroshi Nishiyama
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Tsuyoshi Honda
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima 960-1295, Japan
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Yen E, Deen M, Marshall I. Youngest reported patient presenting with an androgen producing sclerosing stromal ovarian tumor. J Pediatr Adolesc Gynecol 2014; 27:e121-4. [PMID: 24656709 DOI: 10.1016/j.jpag.2013.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Revised: 09/12/2013] [Accepted: 09/13/2013] [Indexed: 01/05/2023]
Abstract
BACKGROUND Sclerosing stromal tumors are extremely rare sex cord stromal tumors of the ovary, with approximately 100 cases reported since first described in 1973. These tumors present predominantly in the 2nd and 3rd decades of life, typically present with pelvic/abdominal pain and tenderness, mass, and/or abnormal menses, and with hormonal activity reported predominantly in postmenarchal females. Only 5 cases of these tumors have been reported in premenarchal girls, with age ranging from 7 months to 12 years. Only 2 demonstrated hormonal manifestations, with vaginal bleeding due to hyperestrogenism in the 7 month old, and virilization in an 11-year-old female. CASE We report a 9-year-old female who was diagnosed with this ovarian tumor, and who presented with virilization. SUMMARY AND CONCLUSION This report is remarkable as our patient not only was diagnosed with an ovarian tumor that is extremely rare in this age group but is the youngest reported patient with this tumor who presented with virilization.
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Affiliation(s)
- Elizabeth Yen
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Malik Deen
- Department of Pathology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Ian Marshall
- Department of Pediatrics, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
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Atram M, Anshu, Sharma S, Gangane N. Sclerosing stromal tumor of the ovary. Obstet Gynecol Sci 2014; 57:405-8. [PMID: 25264533 DOI: 10.5468/ogs.2014.57.5.405] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 04/22/2014] [Accepted: 05/15/2014] [Indexed: 11/13/2022] Open
Abstract
Sclerosing stromal tumor is a rare ovarian tumor, occurring in young adults in the second and third decade of life. We report clinical and histopathological features of three cases of sclerosing stromal tumor of the ovary with a review of literature. The tumor has distinct histological features and is easily recognizable when a high index of suspicion is maintained in young patients presenting with an ovarian mass. These tumors are benign and can be treated successfully by enucleation or unilateral ovariotomy.
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Onur MR, Simsek BC, Kazez A. Sclerosing stromal tumor of the ovary: ultrasound elastography and MRI findings on preoperative diagnosis. J Med Ultrason (2001) 2011; 38:217-20. [PMID: 27278587 DOI: 10.1007/s10396-011-0311-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Accepted: 05/04/2011] [Indexed: 11/27/2022]
Abstract
Sclerosing stromal tumor (SST) is a benign stromal tumor of the ovary. Preoperative diagnosis of this benign tumor mainly depends on imaging findings. Dynamic computed tomography (CT) and magnetic resonance imaging (MRI) show typical contrast enhancement of SST with peripheral enhancement in the early phase and centripetal progression in the delayed phases. We present the imaging findings of ultrasonography, ultrasound elastography, and dynamic MRI in the diagnosis of SST. Abdominal ultrasound elastography is a novel technique that depicts the stromal structure of SSTs by comparing the elasticity of the tumor and the myometrium using quantitative strain values.
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Affiliation(s)
- Mehmet Ruhi Onur
- Department of Radiology, University of Firat Faculty of Medicine, Firat Universitesi Hastanesi Rektorluk Kampusu, 23119, Elazig, Turkey.
| | | | - Ahmet Kazez
- Department of Pediatric Surgery, University of Firat Faculty of Medicine, Elazig, Turkey
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Youm HS, Cha DS, Han KH, Park EY, Hyon NN, Chong Y. A case of huge sclerosing stromal tumor of the ovary weighing 10 kg in a 71-year-old postmenopausal woman. J Gynecol Oncol 2008; 19:270-4. [PMID: 19471655 DOI: 10.3802/jgo.2008.19.4.270] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2008] [Revised: 12/01/2008] [Accepted: 12/02/2008] [Indexed: 11/30/2022] Open
Abstract
Sclerosing stromal tumor (SST) is a rare benign neoplasm of ovarian stromal origin and predominantly affects young women in the second and third decades. This tumor characteristically differentiates itself histologically and clinically from both thecomas and fibromas. We present a case of huge SST of the ovary weighing 10 kg in a 71-year-old postmenopausal woman with a brief review of the literature.
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Affiliation(s)
- Hyun Sik Youm
- Department of Obstetrics and Gynecology, Wonju College of Medicine, Yonsei University, Wonju, Korea
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