{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T09:12:33Z","timestamp":1778145153673,"version":"3.51.4"},"reference-count":15,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T00:00:00Z","timestamp":1778112000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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.<\/jats:p>","DOI":"10.3390\/diagnostics16101415","type":"journal-article","created":{"date-parts":[[2026,5,7]],"date-time":"2026-05-07T08:01:39Z","timestamp":1778140899000},"page":"1415","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimally Invasive Surgery as a Longitudinal Diagnostic and Restaging Tool in a Recurrent STK11-Altered Adnexal Tumor: A Case Report"],"prefix":"10.3390","volume":"16","author":[{"given":"Antonio","family":"Maccio","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gybecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"},{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Neri","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gybecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"},{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Valerio","family":"Vallerino","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology and Gybecological Oncology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6895-042X","authenticated-orcid":false,"given":"Sonia","family":"Nemolato","sequence":"additional","affiliation":[{"name":"Unit of Anatomic Pathology, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5387-4068","authenticated-orcid":false,"given":"Gabriele","family":"Sole","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1319-6556","authenticated-orcid":false,"given":"Elisabetta","family":"Pusceddu","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care Unit, Liver Transplantation Center, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1788-5322","authenticated-orcid":false,"given":"Paolo Albino","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Oncological Surgery, Azienda di Rilievo Nazionale ed Alta Specializzazione \u201cG. Brotzu\u201d, Piazza A. Ricchi 1, 09121 Cagliari, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1002\/1097-0142(197303)31:3<671::AID-CNCR2820310328>3.0.CO;2-K","article-title":"Female adnexal tumor of probable Wolffian origin","volume":"31","author":"Kariminejad","year":"1973","journal-title":"Cancer"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.3109\/00313020903273084","article-title":"Is female adnexal tumour of probable Wolffian origin a benign lesion? 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