ovarian stromal tumor with minor sex cord elements was first described by young and scully in 1983 .
only 11 cases of ovarian stromal tumor with minor sex cord elements have been reported till date .
only three cases of ovarian stromal tumors with minor sex cord elements with coexistent endometrial carcinoma have been reported .
we report a case of a 79-year - old female who presented with post - menopausal bleeding and an ovarian tumor which was post - operatively diagnosed as ovarian fibroma  thecoma with minor sex cord elements .
patient was also found to have well - differentiated endometrioid adenocarcinoma of uterus and underwent surgical staging for it .
a 79-year - old woman presented with post - menopausal bleeding and pain in lower abdomen for 2 months .
the obstetric history of the patient was p2l2 and the patient had attained menopause 30 years back .
a firm mass was palpable in lower abdomen extending upto umbilicus . on vaginal examination ,
uterus size could not be made out and a large abdomino pelvic mass was palpable .
abdominal ultrasonography revealed a normal - sized uterus with endometrial thickness of 7 mm and a 20  10 cm solid mass in pelvis and lower abdomen .
patient underwent endometrial aspiration and it was reported as endometrioid adenocarcinoma ( grade 1 ) .
patient underwent staging laparotomy which revealed a 20  10 cm solid left ovarian tumor .
the right ovary was normal and there was minimal ascites which was sent for cytology . on exploration , intestines , liver and biliary tract , pancreas , omentum , and fallopian tubes
the patient underwent total abdominal hysterectomy with bilateral salpingo - oophorectomy , infra - colic omentectomy , and pelvic lymphadenectomy and the specimen was submitted for histopathological examination .
left ovary measured 21  14  10 cm and the cut section was homogenously fleshy with areas showing yellowish discoloration .
cut section of the uterus revealed a 4  3 cm exophytic fundal growth in the endometrial cavity infiltrating less than one - third of the myometrium .
the right ovary , omentum , and bilateral fallopian tubes were grossly normal . on microscopic examination , left ovary showed features of a stromal tumor with minor sex cord elements [ figure 1 ] .
the tumor comprised mainly of fibroma - thecoma component ( more than 90% ) with few aggregates of granulosa cells [ figure 2 ] .
these granulosa cell aggregates were immunoreactive for inhibin [ figure 3a ] and calretinin [ figure 3b ] .
stromal tumor with minor sex cord elements , fibroma with intermingled sex cord structures sex cord structures show scant cytoplasm and a round to ovoid nucleus with a longitudinal groove resembling granulosa cells granulosa cells showing positive immunostaining for ( a ) inhibin and ( b ) calretinin multiple sections from the endometrial growth showed features of a well - differentiated endometrioid adenocarcinoma ( grade i ) .
the patient did not receive radiotherapy post - operatively and she is on regular follow - up .
ovarian bromas with minor sex cord elements are rare tumors and only 11 such cases have been reported .
the predominant component in such tumors is generally broma or thecoma with sex cord elements dispersed randomly and occupy less than 10% of area of the total area of the tumor on any slide .
these patients usually present with bleeding per vaginum , pain abdomen , or abdominal mass .
the tumor size can range from 1 to 10 cm or ovary may be of normal size . in our patient ,
the gross appearance of such tumors resembles broma or a thecoma , which are solid , rm , whitish - to - yellow neoplasm .
on microscopy , they are composed of spindle - shaped cells , arranged in intersecting fascicles with variable amount of collagen and intermingled sex cord elements .
sex cord components vary in appearance between fully differentiated granulosa cells and indifferent tubular structures resembling immature sertoli cells .
differential diagnoses include ovarian fibromatosis , brenner tumor , and adenofibromas . in ovarian fibromatosis , there is a proliferation of spindle - shaped cells with abundant collagen formation and focal areas of edema .
the epithelial aggregates of brenner tumor are composed of transitional cells or mucinous cells . in adenofibroma ,
the glands are abundant , larger , and tubular and more variable in size when compared to uniform tubules of minor sex cord elements . in 1983 ,
young and scully reported seven cases of fibromatous tumors of the ovary , of which five cases were ovarian fibroma with minor sex cord elements and the other two were luteinized thecoma and stromal - leydig cell tumor with minor sex cord elements .
two out of these seven cases also had well - differentiated adenocarcinoma in the endometrium .
zhang et al . reported 50 cases of luteinized thecomas and stromal leydig cell tumors .
they found the presence of sex cord elements with granulosa cell morphology in only two of 50 cases .
a case of mucinous cystadenoma coexisting with stromal tumor with minor sex cord elements was reported by yang et al .
ovarian stromal tumor with minor sex cord elements is a rare tumor , which may be hormonally active predisposing to carcinoma endometrium .
meticulous histopathological examination is essential for identication of the sex cord elements even if potential source of estrogen like the coma is present .
patients diagnosed with such tumors need regular follow - up as the clinical behavior and risk of recurrence in these patients require further evaluation .
 ovarian stromal tumor with minor sex cord elements is a rare tumor . 
 it is composed of predominantly fibrothecomatous tumor with scattered minor sex cord elements in less than 10% of the tumor area . 
 these tumors may be hormonally active and predispose to carcinoma endometrium . 
 a case of ovarian fibroma  
 thecoma with minor sex cord elements in which coexistent endometrial carcinoma was also discovered is being reported . though thecoma may be a predisposing factor for endometrial cancer , meticulous histopathological examination of the ovary may reveal additional sources of estrogen like granulosa cell aggregates as in our patient . 
 such patients would require long - term follow - up to detect any recurrence of granulosa cell tumor . 