Sclerosing Stromal Tumor (SST) with Massive Blood Loss at Operation: A Case Report

One of the rare ovarian neoplasms is sclerosing stromal tumor (SST). The most common age at presentation of sclerosing stromal tumor is the second and third decades of life. Usually this tumor presents with menstrual irregularity and pelvic pain as reported previously. Surgery is mandatory for diagnosis because there is not any distinctive feature to diagnose by imaging techniques.

Our case in this report is a 26-year-old woman presented with pelvic pain. We conducted routine laboratory tests and checked ovarian mass tumor markers preoperatively. Due to her normal hormonal status in physical examination, we did not request more hormonal laboratory tests. However on imaging, we did not suspect benign tumor. Doppler sonography showed low resistance flow in peripheral and center of the mass. Right ovarian mass was resected and diagnosed as ovarian stromal tumor compatible with sclerosing stromal tumor. Unexpectedly at operation, we encountered severe hemorrhage from peritoneal surface so that conservativemanagement such as packing and suturing or cauterization was not helpful. Finally, argon coagulation stopped bleeding. All coagulation laboratory tests requested by a hematologist were normal.

In conclusion, we believe that vascular endothelial growth factor (VEGF) production of tumor is responsible for massive bleeding.