Sclerosingstromaltumor of the ovary (report case) N Youssouf, F Watik, S Sabir, H Boufettal, S Mahdaoui, N Samouh Gynecology Department C CHU Ibn Rochd Casablanca

YOUSSOUF NABILA: Corresponding author writing the paper WATIK FEDOUA: writing the paper SABIR SOUKAINA: writing the paper BOUFETTALHoussin: correction of the paper MAHDAOUI Sakher: correction of the paper SAMOUH NAIMA:correction of the paper

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

I declare on my honor that the ethical approval has been exempted by my establishment.

None.

Dr. WATIK FEDOUA.

Sclerosing stromal tumor is an extremely rare tumor of the sex cord and stroma, occurring primarily in the second and third decades of life. The possibility of a sclerosing stromal tumor should always be considered in young patients with an ovarian mass, as the clinical presentation and imaging are not specific, and no marker is pathognomonic. The microscopic appearance is characteristic and allows the diagnosis to be made.

Sclerosing stromal tumors represent 6 % of sex cord tumors and tend to occur in young women with a mean age of 30 years [5] . Our patient was 19 years old. The clinical picture is nonspecific with variable symptoms such as menstrual cycle disturbances, pelvic pain and pelvic masses of varying size depending on the duration of the disease, as was the case in our patient [4] . Rare cases of secretory tumors have been reported, mainly of estrogens and androgens responsible for metrorrhagia, amenorrhea and infertility [6] , [7] . The origin of sclerosing stromal tumors is unknown; some authors suggest that they may develop from pre-existing ovarian fibroids [8] . Macroscopically, they are most often multicystic masses. Microscopically, the tumor has a characteristic pseudolobular appearance with alternating cellular and hypocellular areas rich in collagen. Vascular, sclerotic, and edematous changes are consistent features of the tumors, secondary to the local elaboration of certain factors such as vascular permeability factor and vascular-endothelial growth factor [9] . On immunohistochemistry, the cells of sclerotic stromal tumors express vimentin, inhibin, smooth muscle actin, inhibin α, and CD199 and are negative for S-100 and epithelial markers [3] . The treatment of these rare ovarian tumors currently relies primarily on surgery. The surgical management depends on the age of the patient and the stage of extension of the disease. The objective, when possible, is to preserve ovarian and uterine function [10] . These cases can be successfully treated by denucleation or unilateral ovariotomy [11] .

Not commissioned, externally peer-reviewed.

This is a 19-year-old female patient who had no specific pathological history. She presented with a 7-month-old pelvic mass associated with metrorrhagia without any signs of virilization. Pelvic ultrasound showed the presence of a heterogeneous and solid mass at the expense of the right ovary, without ascites. Pelvic magnetic resonance imaging (MRI) showed a solid cystic process in the right uterus measuring 107x85x133 mm with an irregular wall and showing multiple focal parietal thickenings with fibrous components attached to the wall, associated with a small peritoneal effusion ( Figs. 1 and 2 ). Tumor markers were negative: CA 125, LDH, AFP and HCG. Fig. 1 and 2 Appearance on pelvic MRI of the mass. Fig. 1 and 2 Appearance on pelvic MRI of the mass. A surgical exploration was revitalized by our team, which showed the presence of a solid cystic mass at the expense of the right ovary with exophytic vegetations ( Fig. 3 ), contralateral ovary of normal aspect, without effusion with a uterus of normal size and aspect, hence the realization of a right adnexectomy. With omental biopsy and cytology of the peritoneal lavage fluid. The postoperative evolution was simple. The antopathological study confirmed the presence of a sclerosing stromal tumor. Fig. 3 Macroscopic appearance. Fig. 3 Macroscopic appearance.

Sclerosing stromal tumor of the ovary first described by Chalvardjian and Scully in 1973 [1] , is a rare entity in the category of sex cord and stroma representing about 8% of all primary ovarian cancers [2] , less than 100 cases have been described in the literature [3] . It is a pathology that mainly affects young patients in the second and third decades of life [4] . Through our observation and a review of the literature, we will study the paraclinical and clinical presentation and the therapeutic approach of a sclerosing tumor of the ovarian stroma. All our work has been reported according to the SCARE criteria and guidelines (14).

None.

The authors declare having no conflicts of interest for this article.