Imaging characteristics of a female adnexal tumor of probable Wolffian origin (FATWO): Case report

Introduction: Female adnexal tumor of probable Wolffian origin (FATWO) is a rare tumor arising from the mesonephric duct remnants and is often asymptomatic. Information on this clinical entity, including imaging features is scarce. Case Report: We report the case of a 58-year-old female with a Wolffian tumor in the broad ligament highlighting its imaging characteristics, particularly the sonographic features. A solid, slightly lobulated mass with a mixed echogenic pattern with scattered hyperechoic foci, multiple acoustic shadowing and moderate peripheral vascular flow was described. Immunohistochemical analysis supported the diagnosis of a Wolffian tumor. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Conclusion: The diagnosis of FATWO is challenging due to its rarity, nonspecific presentation, and poorly documented imaging features with variable descriptions. Further case reports and series are needed to refine diagnostic criteria, improve preoperative recognition and guide standardized management and follow-up.