TITLE:
Differential Diagnosis of a Pediatric Ovarian Tumor: The Pitfall of Juvenile Fibrosarcoma Versus Spindle Cell Embryonal Rhabdomyosarcoma
AUTHORS:
Idrissa Seriba Coulibaly, Chaibou Soumana, Akinfenwa Taoheed Atanda, Souleymane Ouattara, Maman Bachir Goni Dit Alassan, Fassouma Amadou Amani, Oumarou Habou, Ibrahim Dit Abraham Georges Thomas, Harissou Adamou, Sosthène Aimé Ouedraogo
KEYWORDS:
Pediatric Ovarian Tumor, Spindle Cell Embryonal Rhabdomyosarcoma, Juvenile Fibrosarcoma, Immunohistochemistry, Differential Diagnosis
JOURNAL NAME:
Open Journal of Pathology,
Vol.16 No.2,
February
14,
2026
ABSTRACT: Introduction: Ovarian tumors in children are rare, with a malignant rate of 10% - 20%. Beyond common epithelial or germ cell tumors, mesenchymal tumors like spindle cell embryonal rhabdomyosarcoma (ERMS) present significant diagnostic challenges due to their histological similarity to juvenile fibrosarcoma. This study reports a case of a 7-year-old girl to highlight how morphological overlap can lead to diagnostic errors and the critical necessity of immunohistochemistry (IHC) in establishing a diagnosis. Methods: A study was performed on a 7-year-old patient who was initially diagnosed with juvenile fibrosarcoma. Following the patient’s death, a morphological review was conducted to challenge the initial findings. The diagnostic process involved expanding the immunohistochemical panel from just CD34 and S100 to include myogenin, MyoD1, desmin, EMA, cytokeratin AE1/3, and vimentin to explore the possibility of ERMS. Results: Clinical Presentation: The patient presented with abdominal pain, dysuria, and a 9 cm right ovarian mass invading the peritoneum. Initial Findings: A diagnosis of juvenile fibrosarcoma was suggested based on morphology, and the patient received three cycles of Doxorubicin and Cisplatin. Outcome: The patient died two weeks after the third chemotherapy cycle. Morphological Review: Re-examination revealed a “cambium-like” tumor zone and rhabdoid cells with high mitotic activity, strongly suggesting spindle cell ERMS. IHC Results: Tumor cells expressed only vimentin; specific myogenic markers (myogenin/MyoD1) were unavailable locally, preventing formal confirmation despite strong suspicion of ERMS. Conclusion: Accurate classification of pediatric ovarian mesenchymal tumors requires more than just morphological vigilance; it necessitates robust immunohistochemical capacity. Strengthening diagnostic infrastructure and regional pathology networks is essential to avoid inappropriate management and improve patient outcomes in resource-limited settings.