Journal Article

DKFZ-2026-02504

http://join2-wiki.gsi.de/foswiki/pub/Main/Artwork/join2_logo100x88.png Genomics-Guided Management of Recurrent and Metastatic Female Adnexal Tumors of Probable Wolffian Origin: A Case Report and Review of Therapeutic Strategies

Lenk, M. ; Möhrmann, L.DKFZ* ; Horn, L.-C. ; Fröhling, S.DKFZ* ; Hübschmann, D.DKFZ* ; Einenkel, J.

2026
Karger Basel

Abstract: Introduction: Female adnexal tumors of probable Wolffian origin (FATWO) are exceptionallyrare neoplasms arising from mesonephric remnants. While usually considered to have abenign course, a subset demonstrates recurrent or metastatic potential, and no standardizedtreatment recommendations exist. Case Presentation: We report the case of a woman in herearly sixties with a primary ovarian FATWO, initially treated by complete surgical resection.Despite this, she developed multiple recurrences and ultimately metastatic disease. Thepatient underwent repeated cytoreductive surgeries and received systemic therapies including carboplatin/paclitaxel, bevacizumab maintenance, and pegylated liposomaldoxorubicin. Given the lack of established treatment options, comprehensive multi-omicsprofiling was performed within the Molecularly Aided Stratification for Tumor Eradication(MASTER) program, including extensive genomic analyses. Molecular characterizationidentified an alteration affecting the mitogen-activated protein kinase (MAPK) signalingpathway. The findings were discussed in a multidisciplinary molecular tumor board, whichrecommended targeted therapy with a mitogen-activated extracellular signal-regulatedkinase (MEK) inhibitor based on the detected pathway alteration. Followingreimbursement approval, treatment with binimetinib was initiated. However, at the timeof therapy initiation, the patient’s clinical condition had markedly deteriorated due toprogressive tumor burden. She was admitted to palliative care shortly thereafter andpassed away under supportive measures. Conclusion: This case illustrates the clinicalchallenges associated with recurrent and metastatic FATWO and underscores the potentialvalue of comprehensive molecular profiling in rare gynecologic tumors lacking standardizedtreatment strategies. To our knowledge, this represents the first reported case of recurrentFATWO undergoing extensive multi-omics analysis within a structured precision oncologyprogram with subsequent molecular tumor board-guided therapeutic recommendation.

Note: #DKTKZFB26# / #NCTZFB26# / SCOPUS

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Contributing Institute(s):

1. DKTK Koordinierungsstelle Dresden (DD01)
2. Translationale Medizinische Onkologie (B340)
3. DKTK HD zentral (HD01)
4. Innovations- und Service-Unit für Bioinformatik und Präzisionsmedizin (W015)
5. Koordinierungsstelle NCT Dresden (DD04)
6. Koordinierungsstelle NCT Heidelberg (HD02)

Research Program(s):

1. 312 - Funktionelle und strukturelle Genomforschung (POF4-312) (POF4-312)

Appears in the scientific report 2026

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Database coverage:
; ; Article Processing Charges ; Clarivate Analytics Master Journal List ; DOAJ Seal ; Ebsco Academic Search ; Emerging Sources Citation Index ; Fees ; IF < 5 ; JCR ; PubMed Central ; SCOPUS ; Web of Science Core Collection

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