Rare Ovarian Sex Cord-Stromal Tumor: Diagnostic Pitfalls and Clinical Management.

Poorly differentiated Sertoli-Leydig cell tumors of the ovary are exceptionally rare and often difficult to classify, frequently requiring expert pathology review. Their clinical course can be aggressive, and therapeutic decisions are particularly complex in older patients with comorbidities. We describe a woman in her seventies who presented with advanced disease and underwent extensive cytoreductive surgery, followed by systemic chemotherapy. Despite an initial partial response, she experienced disease progression with recurrent ascites and peritoneal carcinomatosis. This case illustrates the diagnostic pitfalls, the importance of multidisciplinary evaluation, and the therapeutic dilemmas encountered when standard regimens fail. It also underscores the need to balance oncological benefit with quality-of-life considerations in elderly patients with rare ovarian malignancies.