Luteinized Fibroma of the Ovary With Minor Sex Cord Elements: An Incidental Finding

Abstract

Ovarian fibromas with minor sex cord elements are rare tumors, with very few reports in the published medical literature. On gross examination, the tumor resembles a fibroma, and diagnosis is based upon microscopic examination. By definition, the minor sex cord elements occupy less than 10% of tumor area, which emphasizes the need of meticulous histopathological examination. These tumors may be hormonally active and produce clinical features attributable to hyperestrogenic or hyperandrogenic states, or may be an incidental finding. Coexistent malignancy in these tumors has been documented. We report a case of a 52-year-old woman who presented with a right lower abdominal mass. After initial workup, the patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathological examination diagnosed luteinized fibroma of the right ovary that contained scattered minor sex cord elements that resembled Sertoli-like cells. After 6 months of follow-up, the patient was disease free and without any recurrence. We present this unique case and discuss its important differential diagnosis from other ovarian neoplasms, notably granulosa cell tumors, adenofibromas, metastatic carcinoids, ovarian fibromatosis, and Brenner tumor with a different prognosis. The importance of recognizing these tumors lies in their recognition as a separate entity, and the present case may add to the knowledge of age group, clinical behavior, and prognosis of these less reported ovarian neoplasms.