Minimally Invasive Surgery as a Longitudinal Diagnostic and Restaging Tool in a Recurrent STK11-Altered Adnexal Tumor: A Case Report

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Background and Clinical Significance: Rare adnexal tumors with Wolffian or sex cord-like differentiation may undergo major diagnostic reclassification after integrated histologic and molecular review. The contribution of minimally invasive surgery to this process has rarely been described in detail. Case Presentation: We focused on the case of a 33-year-old woman underwent laparoscopic right salpingectomy in October 2021 for a right-sided tubo-adnexal lesion initially diagnosed as adult granulosa cell tumor and later reinterpreted as high-grade endometrioid carcinoma. Completion staging in February 2022 was negative. Positron emission tomography/computed tomography in January 2023 raised concern for recurrence, and exploratory laparoscopy in March 2023 documented peritoneal metastatic disease, followed by four cycles of cisplatin given within the then-prevailing carcinoma-based diagnostic framework. A second laparoscopic reassessment in October 2023 was negative. Because of multifocal abdominal relapse, the patient underwent major cytoreductive surgery in October 2024. Integrated pathologic and molecular review then documented serine/threonine kinase 11 alteration together with forkhead box L2 negativity, favoring classification within the STK11-altered adnexal tumor spectrum. After external review, everolimus plus anastrozole was started in May 2025. Imaging in late 2025 documented persistent pelvic recurrence, and salvage xipho-pubic laparotomy in December 2025 revealed extensive disease involving both ureters, the bladder base, the rectosigmoid wall, and parietal peritoneum; recurrent tissue showed cluster of differentiation 117 positivity. At the most recent available follow-up in April 2026, the patient had no documented death and remained under postoperative surveillance. Discussion and Conclusions: This case illustrates the diagnostic importance of repeated tissue reassessment and the practical value of minimally invasive surgery as a relatively low-burden means of resection, restaging, and tissue acquisition in a rare molecularly reclassified adnexal tumor.

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