“…However, in asymptomatic cases during puberty and the subsequent period, the diagnosis of HWWS is delayed, and unusual presentations of HWWS, including renal or vaginal hemorrhage, endometriosis, infertility, and benign and malignant tumors of the genitourinary system, have been observed ( Jindal et al, 2009 ). With regard to HWWS-associated malignant gynecological cancer, only 11 cases, including ours, have been reported in the English literature ( Watanabe et al, 2012 , Kaba et al, 2013 , Cordoba et al, 2017 , Kusunoki et al, 2018 , Oka et al, 2020 , Mei, 2020 , Tanase et al, 2021 , AlMulhim and AlRasheed, 2021 , Kobayashi et al, 2021 ). Given the rarity of this condition, we believe that reporting individual cases is important for establishing an optimal diagnostic method and treatment.…”