Female adnexal tumour of probable Wolffian origin: MR findings

Magnetic resonance imaging findings of a case with Wolffian tumor and related literature review

Background

Wolffian tumors in females are rare gynecological neoplasms, with fewer than 100 cases reported. Existing literature primarily focuses on the pathology, and reports involving imaging are limited.

Objective

This study presents a case of Wolffian tumor, emphasizing its magnetic resonance imaging (MRI) characteristics to enhance preoperative diagnostic accuracy.

Case report

A 56-year-old woman presented with a year-long history of irregular vaginal bleeding. MRI revealed a solid mass in the right adnexal region. On T2-weighted images, the mass exhibited slightly elevated signal intensity with a distinctive low-signal intensity rim. Diffusion-weighted imaging displayed markedly increased signal intensity, and the contrast enhancement was moderate. The patient underwent laparoscopic right adnexectomy and received a Wolffian tumor diagnosis. No recurrence was observed during a 6-month follow-up.

Conclusions

Wolffian tumors exhibit distinctive MRI presentations. Notably, the prominent low-signal intensity rim on MRI may aid in accurate preoperative tumor diagnosis.

Female Adnexal Tumor of Wolffian Origin Presenting as Paratubal / Broad Ligament Masses: A Case Report

Introduction: A female adnexal tumor of probable Wolffian origin (FATWO) is a rare type of gynecological tumor that is difficult to diagnose based on laboratory and radiologic studies. Although FATWO is considered a benign tumor, recurrence and metastasis have been reported. Currently, there is no best surgical and surveillance approach for FATWO. We presented two Wolffian tumors as paratubal / broad ligament masses. Case Presentation: This is a report of a 32-year-old woman with vaginal discharge and incidentally pelvic mass diagnosis who underwent conservative surgery with a frozen section based on the Wolffian duct tumor. Immunohistochemically, the results confirmed FATWO. The patient was free of recurrence 20 months after conservative surgery. Conclusions: Although FATWO has benign behavior, some types of this tumor have malignant features, and there is no clear recommendation regarding optimal treatment and surveillance of FATWO. Therefore, based on the literature, pathologists are recommended to utilize a wide array of immunohistochemical stainings to offer appropriate diagnosis and optimal surgery to patients. Moreover, patients should be followed up for a long-term period until we have enough knowledge in the field.

MRI, CT and FDG-PET/CT findings of Wolffian tumor: four-case series

Purpose

The purpose of this study is to describe the characteristic MRI, CT, and ¹⁸F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) findings of Wolffian tumor.

Methods

We reviewed preoperative images in four surgical cases of Wolffian tumor. MRI was available for review in all cases with additional diffusion-weighted images (DWI) in three, and contrast-enhanced images in two. CT was available in three. FDG-PET/CT was obtained in two.

Results

Two patients were asymptomatic, while the other two presented with acute abdomen. On MRI, all tumors were well-defined masses of increased signals on T2WI. Three tumors were solid, whereas the other was solid and cystic. The normal ipsilateral ovary was identified in two patients of reproductive ages, but not in two postmenopausal patients. Tumors in two patients presented with acute abdomen were complicated by hemorrhage. All three tumors evaluated on DWI showed high intensities. Contrast-enhanced images of MRI and CT showed homogeneous enhancement as the same degree as the myometrium. On CT, one tumor contained punctate calcifications. FDG-PET/CT showed moderate FDG accumulation.

Conclusion

Wolffian tumors may be typically solid extraovarian tumors occasionally associated with cysts and calcifications. Although they are benign, they mimic malignancy due to high intensities on DWI and increased FDG accumulation.

Female adnexal tumor of probable Wolffian Origin - A report of two cases at one institution

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FATWOs are rare gynecologic neoplasms of low malignant potential derived from mesonephric (Wolffian) duct remnants.

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FATWOs have diverse presentations from vague abdominal symptoms to incidental diagnosis.

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In general, FATWOs require no additional management beyond initial surgical intervention.

Female Adnexal Tumor of Probable Wolffian Origin: A Review

CONTEXT.—

Female adnexal tumor of probable Wolffian origin (FATWO) is an extremely rare gynecologic neoplasm of low malignant potential. Fewer than 90 cases of this entity have been described in the English-language literature. It is presumed to be derived from mesonephric (Wolffian) duct remnants in the upper female genital tract. We provide a literature review to increase awareness of this extremely uncommon entity.

OBJECTIVES.—

To review the clinical and pathologic findings of FATWO and to discuss common entities in the differential diagnosis.

DATA SOURCES.—

The study involved PubMed (National Center for Biotechnology Information, Bethesda, Maryland) searches, including multiple review articles, case reports, retrospective studies, selected book chapters, and University of Mississippi Medical Center cases.

CONCLUSIONS.—

FATWO can affect patients from a wide age range and present with a nonspecific clinical presentation. It typically presents as solid tumors with occasional nodular, lobulated, or cystic appearances. FATWO can show a variety of histologic patterns which may result in diagnostic difficulties for pathologists. There is no single specific immunohistochemical stain for FATWO, and the pathogenesis and molecular alterations are not yet well understood. Although it is generally considered a benign entity, recurrent and metastatic cases have been reported. There are no current recommendations regarding the optimal clinical management of FATWO.

Large Wolffian adnexal tumor of the ovary: A case report and literature review

Female Wolffian adnexal tumor (WAT) is a rare neoplasm arising from the remnants of the mesonephric duct and <100 cases have been reported globally. The present case report describes a 73-year-old female patient with WAT in the left ovary which, to the best of our knowledge, is the largest benign WAT tumor to be reported. In addition, the present case report reviewed previous studies on the clinical characteristics and therapy for WAT and the surgery methods for female WAT of ovary were summarized. WATs are typically benign; however, a number factors may increase the risk of malignancy.

Ultrasound Presentation of a Female Adnexal Tumor of Probable Wolffian Origin (FATWO)

Female adnexal tumor of probable Wolffian origin (FATWO) is a rare tumor arising from the remnants of the mesonephric duct and often presents with insidious symptoms. Limited information is available regarding the ultrasonographic characteristics of a FATWO tumor. We present the case of a woman in her mid-40s, G2, P2, with a FATWO tumor while focusing on the ultrasonographic characteristics.

Diagnosis and management of female adnexal tumor of probable Wolffian origin (FATWO) arising from ovary: a case report

Female adnexal tumor of probable Wolffian origin (FATWO) is a rare neoplasm which is usually considered as benign, although in some cases metastasis or recurrences have been reported even after a long interval following the initial diagnosis. Preoperative diagnosis of FATWO is very difficult because of the rarity of the disease and the limited literature available. In this case report, we present a case of FATWO arising from the ovary and review the literature based on the clinical characteristics and management of this rare condition. A 51- year- old postmenopausal woman was referred to our clinic for evaluation of an adnexal mass. After diagnostic evaluation, the patient underwent explorative laparotomy. Intra-operatively, a solid- cystic mass was found in the right ovary, the rest of the abdomen and the pelvis were normal. The ovarian mass was removed and examined with frozen-section (FS). When the frozen section proved negative for malignancy, total abdominal hysterectomy and bilateral adnexectomy were performed. The anatomic study revealed a well-capsulated mass which was 3.5×1.5 cm in diameter. Based on pathological and immunohistochemical results, the final diagnosis was concluded to be FATWO. Adjuvant therapy was not administered. Te patient was followed up after discharge from the hospital. One year after surgery she was asymptomatic. No evidences of recurrence were observed throughout this period. Although FATWOs are rare tumors, they should be kept in mind in women with an abdominal mass. They can present diagnostic difficulties and the diagnosis is based on the exclusion of other neoplasms. FATWO has malignant potential, after the initial surgical treatment patients should be appropriately followed up for possible recurrence and metastasis.

Wolffian duct tumors: case reports and review of the literature

BACKGROUND

Female adnexal tumors of probable wolffian origin are a distinctive epithelial neoplasm arising from the remnants of the mesonephric duct. Although generally considered a tumor of low malignant potential, these tumors can recur. Two cases are reported here.

CASES

(1) A 38-year-old G(6)P(6) Latin American woman presented with lower abdominal pain and a pelvic mass. She had a history of a total abdominal hysterectomy and bilateral salpingo-oophorectomy with a paratubal nodule found incidentally 3 years prior. The pathologic findings were consistent with a female adnexal tumor of probable wolffian origin. Imaging studies revealed significant metastatic disease throughout her abdomen and pelvis. The recurrence was confirmed at laparotomy and tumor debulking was performed. Four months later the patient suffered a second recurrence and is currently undergoing treatment with systemic therapy. (2) A 71-year-old Caucasian woman who had undergone exploratory laparotomy and tumor reductive surgery for a female adnexal tumor of probable wolffian duct origin was seen for routine evaluation 1 year after her surgery. Her computed tomography scan revealed possible evidence of recurrence.

CONCLUSION

Most female adnexal tumors of wolffian origin behave in a benign fashion. However, there is a potential risk of recurrence. Surgical excision by total abdominal hysterectomy and bilateral salpingo-oophorectomy at the time of diagnosis may be the best recommended mode of therapy. The role of adjuvant radiation therapy or chemotherapy remains questionable.