Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report

Figure 1 Imaging findings of the patient before the fourth operation. A: Transvaginal ultrasonography: The endometrium was thickened (approximately 2.0 cm in total). Several hypoechoic masses were observed in the uterine area. There was no obvious space-occupying lesion in bilateral adnexa; B: Hysteroscopy: the endometrium was extensively thickened, the texture was fragile; C, D: Pelvic MR: The endometrium was thickened (approximately 1.6 cm in total), and the signal in the right corner of the uterine cavity was not uniform.

Figure 2 Imaging findings of the patient before and during the fifth operation. A, B: Transvaginal ultrasonography: A 1.6 cm × 1.2 cm × 1.2 cm mass with hypoechoic was seen in the right ovary, the boundary was clear. Blood-flow signals were detected with color Doppler flow imaging; C: Abdominal computed tomography: There was a low-density nodule with a size of approximately 1.5 cm × 1.0 cm in the right ovary, with clear borders; D: Laparoscopy: The uterus was obviously large and irregular, with multiple fibroids nodules. A yellow protruding lesion of approximately 1 cm was observed on the surface of the right ovary.

Figure 3 Histopathological and immunohistochemical staining findings. A: The tumor cells of the right ovarian lesion were spindle-shaped and bundle-like with sheet-like arrangement, and the cells were densely arranged without obvious atypia. Eosinophilic cell nests with rich cytoplasm were visible in the focal area; B: The densely arranged endometrial glands were hyperplastic, and some glandular lumens were irregular; C: Cytokeratin (focal+); D: Inhibin (part+); E: Wilm’s tumor protein (WT1, part+); F: Calretinin (+); G: Ki-67 (approximately 10% +); H: Net staining showed mostly surrounding single cells.