Abstract Sclerosing stromal tumor (SST) is an extremely rare and benign ovarian neoplasm of the sex cord stromal category which occurs predominantly in the second and third decades of life. Herein, we report a case of sclerosing stromal tumor of ovary in a 22 year old woman who was clinically suspected to have malignancy, but proven to be SST of ovary on histopathological examination. Hence, in such circumstances it is essential to keep in mind the possibility of sclerosing stromal tumor in a young woman

Gurpreet Singh

Manoj Sankala

Megha Kathuria

Nisha Marwah

Pradeep Sansanwal

Rajeev Sen

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          International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 91-94 
 
91 
www.ijhbr.com     ISSN: 2319-7072 
 
Case report  
Sclerosing stromal  tumor  of  the ovary: A case report 
Nisha Marwah, Manoj Sankala, Pradeep Sansanwal, Gurpreet Singh, Megha Kathuria, Rajeev 
Sen 
Department of Pathology, Pt. B.D. Sharma PGIMS Rohtak, Haryana, India   
Corresponding author : Dr Manoj Sankala 
 
Abstract 
Sclerosing stromal tumor (SST) is an extremely rare and benign ovarian neoplasm of the sex cord stromal category which occurs 
predominantly in the second and third decades of life. Herein, we report a case of sclerosing stromal tumor of ovary in a 22 year 
old woman who was clinically suspected to have malignancy, but proven to be SST of ovary on histopathological examination. 
Hence, in such circumstances it is essential to keep in mind the possibility of sclerosing stromal tumor in a young woman. 
Key words: ovary, sclerosing stromal tumor, fibroma 
 
Introduction 
Sclerosing stromal tumors (SST) are rare benign 
ovarian neoplasms of the sex cord stromal category. 
Most cases occur predominantly in the second and 
third decades of life. The tumor is characterized by 
cellular pseudolobules, prominent intrerlobular 
fibrosis, frequently marked vascularity and a dual cell 
population.1 Diagnosis of sclerosing stromal tumor is 
often made by postoperative pathologic examination. 
The important differential diagnosis are other sex 
cord stromal tumors including fibroma, thecoma and 
lipoid cell tumors.2,3 
Case Report 
A 22 year old woman presented to the hospital with 
vague abdominal pain, abdominal fullness and 
irregular menstruation since last two years. On 
clinical examination, a large mass was palpable in 
right hypogastric region arising from the pelvis. 
Ultrasonography showed a heterogeneous apparently 
solid mass of 96x88 mm dimension with some cystic 
foci in right ovary. All laboratory tests including 
tumor markers and serum hormonal assays were 
normal.Under the impression of solid ovarian tumor, 
the patient underwent exploratory laprotomy. After 
opening the peritoneal cavity, 200 cc of clear fluid in 
the cul-de-sac was found and a smooth well 
circumscribed mass was found attached to the right 
ovary. For this, right sided oopherectomy was done 
and biopsy from omental tissue, peritoneum and left 
ovary was taken. Gross examination of the resected 
specimen showed an encapsulated, globular soft 
tissue mass measuring 8x6x3 cm with smooth surface 
attached to normal appearing ovarian tissue. On cut 
sections, the mass was grey white to grey yellow, 
solid in consistency along with multiple cystic foci. 
Microsections examined revealed ill-defined, cellular 
pseudo-lobules separated by hyalinised and 
edematous stroma. Two cell types were present 
within the lobules: spindle cells producing collagen 
and polygonal cells with round to oval nuclei. Mitotic 
figures were not seen and cytoplasm was vacuolated. 
Prominent thin walled blood vessels were seen within 
some nodules. 
Immunohistochemical analysis on the tissue blocks 
revealed positivity for vimentin, inhibin, smooth 
          International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 91-94 
 
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muscle actin (SMA), and calretinin while negativity 
for desmin. 
Sections examined from omental tissue, peritoneum 
and left ovary were unremarkable. 
The specimen was diagnosed as Sclerosing Stromal 
tumor of the right ovary. 
Discussion 
Sclerosing stromal tumor is a rare and benign ovarian 
tumor which is derived from the sex cord stroma. 
This tumor was first described by Chalvaridjian and 
Scully (1973)4 and occurs most frequently in the 
second and third decades of life. This relatively rare 
tumor characteristically differentiates itself clinically 
and histologically from others. The most common 
presenting clinical symptoms include menstrual 
irregularity, pelvic pain and non-specific symptoms 
related to ovarian mass. Masculinization or 
anovulation may be present in some patients as they 
are occasionally associated with estrogen and rarely 
androgen secretion.5 The patient reported here had no 
clinical virilization and hormone levels were normal. 
Microscopically, the tumor is characterized by 
cellular pseudo-lobules, prominent interlobular 
fibrosis, frequently marked vascularity and a dual cell 
population:collagen producing spindle cells and lipid 
containing round or ovoid cells. The hererogenity due 
to the variation in cellular size and shape are helpful 
features in the differential diagnosis of sclerosing 
stromal tumors and contrasts with the relative 
homogeneity of thecoma and fibroma.1,6 
Vascular tumor due to prominent vascularity and 
massive ovarian oedema may be confused with 
sclerosing stromal tumor. Inhibin positivity suggests 
the diagnosis of sclerosing stromal tumor over 
vascular tumor, whereas oedematous stroma and 
absence of heterogeneity favours the diagnosis of 
massive ovarian oedema.7 
Rarely, the vacuolated cells in SST may evolve into a 
signet ring like structures that mimics the Krukenberg 
tumor. However, they can be differentiated as the 
later are mostly bilateral, occur usually in the sixth 
and seventh decades and lack pseudo-lobular pattern 
of SST. Signet ring cells of Krukenberg tumors 
contain mucin rather than lipid and may exhibit 
mitotic activity and nuclear atypia.1 
Immunohistochemical analysis in SST shows 
positivity for predominantly SMA, inhibin and 
vimentin, suggesting stromal origin of sclerosing 
tumors (as seen in our case).8 Other 
immunohistochemical markers such as calretinin or 
desmin may be positive or negative and SSTs are 
negative for pancytokeratin. 
It is difficult to distinguish SSTs consisting of solid 
and cystic areas from ovarian malignancies on the 
basis of radiological and macroscopic examination as 
these tumors additionally appear very vascular giving 
the impression of malignant tumors. On radiological 
examination, especially by sonogram, the appearance 
of SSTs may be confused to be malignant ovarian 
tumor as they show a mixed pattern of solid and 
cystic component.9 
Conclusion 
The present case suggests that SST cannot be 
predicted preoperatively on the basis of clinical and 
sonographic findings, but this rare tumor should be 
kept in mind while dealing with young female 
patients with ovarian mass which will help to prevent 
untoward morbidity of the patients due to extensive 
surgery and also help in the selection of definite 
treatment. 
Conflicts of Interest 
The authors have no conflicts of interest. 
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1 2 
3 4 
5 
6 
7 
Figure. 1 Prominent and dilated blood vesseles(4X) 
Figure. 2 Cellular pseudolobular pattern seperated by 
edematous fibrous band (4X) 
Figure. 3 Two distinct cell population of spindle shaped 
fibroblast admixed with polygonal vacuolated cells (4X) 
Figure. 4 Calretinin positive cells (10X) 
Figure. 5 Inhibine positive cells( 4X) 
Figure. 6 SMA positive cells (10X) 
Figure. 7 Vimentine positive cells (10X) 
 
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          International J. of Healthcare and Biomedical Research, Volume: 03, Issue: 03, April 2015, Pages 91-94 
 
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References 
1. Chalvardjian A, Scully RE. sclerosing stromal tumors of the ovary.Cancer 2973;31:664-670. 
2. Prat J. pathology of the Ovary. London: Saunders; 2004: 216-218. 
3. Fox J, Wells M. Haines and Taylor Obstetrical and Gynecological Pathology. 5th ed. New York: Churchill 
Livingstone; 2003: 842-843. 
4. Russell P, Farnsworth A. surgical Pathology of the Ovaries. 2nd ed. New York: Churchill Livingstone; 1997: 422. 
5. S. M. Ismail and S. M. Walker, “Bilateral virilizingsclerosing stromal tumors of the ovary in a pregnant woman 
with Gorlin’s syndrome: implications for pathogenesis of ovarian stromal neoplasm,” Histopathology, vol. 17, 
no. 2, pp. 159-163, 1990. 
6. Pwng H, Chang T, Hsueh S. Sclerosing stromal tumor of the ovary. Chang Gung Med J.2003; 26: 444-447. 
7. Ihara N, Togashi K, Toso G, Nakai A, Kojima N, Ishigaki T, Sufinami N, Kinoshita M, Shintaku M. sclerosing 
stromal tumor of the ovary: MRI. J comput Assist Tomogr 1999; 23: 555-557. 
8. A. J. Tiltman and Z. Jaffajee, ‘Sclerosing stromal tumors, thecomas, and fibromas of the ovary: an 
immunohistochemical profile,” International Journal of Gyecological Pathology, Bol. 18, no.3, pp. 254-258, 
1999. 
9. Lee MS, Cho JC, Lee YH, Hong SR. ovarian sclerosing stromal tumors: gray scale and color Doppler 
sonographic findings. J Ultrasound Med 2001; 20(4): 413-7. 
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Sclerosing stromal tumor of the ovary: A case report

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Sclerosing stromal tumor of the ovary: A case report

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