Conclusions

In conclusion, poorly differentiated ovarian Sertoli-Leydig cell tumors are rare neoplasms that may present with marked diagnostic ambiguity and aggressive clinical behavior, particularly in elderly patients. In this case, inconclusive biopsies, overlapping histopathological features, and atypical endocrine findings complicated the diagnostic process, highlighting the importance of expert pathological review and multidisciplinary evaluation. Residual macroscopic disease and progression despite systemic therapy illustrate the therapeutic challenges encountered in advanced-stage disease, particularly in frail or comorbid patients in whom treatment tolerability must be carefully balanced against potential benefit. This case underscores the need for individualized treatment planning and early integration of supportive and palliative care strategies in patients with aggressive rare ovarian tumors.