Recurrent Metastatic Malignant Wolffian Tumour: A Rare and Aggressive Clinical Course

Wolffian tumours (female adnexal tumours of probable Wolffian origin, FATWO) are rare mesonephric duct-derived neoplasms with variable malignant potential and challenging diagnosis. A 68-year-old woman underwent complete resection for a left tubo-ovarian mass and was diagnosed with a localised Wolffian tumour with malignant potential. After 22 months of surveillance, she re-presented with malignant ascites and extensive peritoneal dissemination showing anaplastic transformation and underwent cytoreductive surgery. Adjuvant chemotherapy was poorly tolerated and ineffective, with rapid progression despite treatment, leading to best supportive care. This case highlights the diagnostic complexity and potential aggressive behaviour of malignant Wolffian tumours, the limited efficacy and tolerability of chemotherapy in advanced disease, and the need for early integration of palliative care when disease becomes refractory.