Incidental intraoperative discovery of a Wolffian tumor in a postmenopausal woman: a case report and literature review

Background Female adnexal tumor of Wolffian origin (FATWO) is an exceedingly rare gynecologic neoplasm characterized by nonspecific clinical manifestations and diagnostic challenges. This article presents a case of an incidentally discovered FATWO in a postmenopausal woman, with a literature review. Case presentation A 54-year-old postmenopausal woman was found to have a 5.2-cm solid mass in the left adnexa during routine examination. Ultrasonography revealed a well-circumscribed lesion with detectable blood flow, while computed tomography (CT) scan suggested an ovarian origin. Tumor markers were within normal limits, and the patient remained asymptomatic. Single-port laparoscopic exploration identified a 5-cm solid ovarian nodule with an intact capsule. Intraoperative frozen section analysis suggested FATWO, prompting subsequent total hysterectomy with bilateral salpingo-oophorectomy. No adjuvant therapy was administered postoperatively, and the patient showed no evidence of disease progression during 1-year follow-up. Conclusion FATWO exhibits a potentially malignant biological behavior. For postmenopausal patients, total hysterectomy with bilateral salpingo-oophorectomy is recommended. Postoperative management should be individualized. Current evidence regarding treatment strategies for reproductive-age patients remains limited, warranting further investigation to optimize clinical decision-making.