What happened, in summary

A 70-year-old woman developed increasing abdominal swelling and right-sided pain over about 2 months. Imaging showed a very large ovarian mass measuring about 21 cm. Surgery removed the right ovary and tumor, followed by hysterectomy, removal of the remaining ovary and fallopian tube, omentectomy, biopsies, and lymph node surgery. No visible tumor remained after the operation.

Pathology identified a rare Sertoli-Leydig cell ovarian tumor containing an aggressive rhabdomyosarcomatous component. The tumor was classified as Stage I. The care team decided not to give postoperative chemotherapy or radiation, and her first check 8 weeks later showed no signs of recurrence.

Seven months after surgery, however, she returned with abdominal pain, weight loss, leg swelling, ascites, and large recurrent abdominal masses. She also had a major pulmonary embolism with lung injury and right-sided heart failure. Her condition was too poor for another operation. She received treatment for the immediate complications and was transitioned to palliative care. She died 15 days after that admission. The case illustrates the unusually aggressive course that can occur in this rare ovarian tumor despite an initially early stage.