Ovarian fibrosarcoma: A single-institution experience and a review of the literature

Ting-Ting Sun,Dong-Yan Cao,Peng Peng,Ning-Hai Cheng

doi:10.1186/s13048-020-00749-x

Abstract

Ovarian fibrosarcoma is an extremely rare and malignant sex cord-stromal tumor. Due to its low incidence and poor prognosis, until now, very few cases have been reported, and most of the reported cases have been sporadic. Therefore, the treatments and prognostic factors of ovarian fibrosarcoma are still debatable. Here, we report 5 cases of ovarian fibrosarcoma that presented at Peking Union Medical College Hospital over the past 20 years. The 5 patients were 41, 51, 54, 76, and 76 years of age when initial symptoms of pelvic mass or pain appeared. On ultrasound, this disease usually manifests as unilateral pelvic masses, within which uneven echo enhancement and some blood flow signals are observed. No significant increase was observed in the levels of preoperative tumor markers, such as serum CA125 and sex hormones. The final diagnosis depends on postoperative histopathological results since these tumors are easily misdiagnosed when intraoperative frozen sections are used for examination. Pathologic examinations showed that the tumor cells were spindle-shaped with moderate to severe atypia and high mitotic counts. The immunohistochemistry profile is not specific, but the positive rate of Ki-67 was consistent with the degree of malignancy and the prognosis of patients with this tumor. In addition, the tumor may also be positive for Vimentin, α-inhibin, SMA, estrogen receptor and progesterone receptor. Significant differences were observed in the surgical methods used, and no unified chemotherapy regimen has been established. The overall survival was > 15, >7, > 6, <1, and < 1 year for each patient. After reviewing the literature, evidence-based large-scale case studies were lacking. For treatments, complete cytoreductive surgery plus regimens typically used against malignant sex cord-stromal tumors, as described in the NCCN guidelines, are recommended. Due to its low incidence, both multicenter clinical studies and molecular studies are required to provide gynecologists with a better understanding and guidance for future management of patients with ovarian fibrosarcoma.

Highlights

Ovarian fibrosarcoma is a considerably rare neoplasm, as this tumor type accounts for less than 1% of all ovarian malignancies [1]
We present 5 cases of ovarian fibrosarcoma that presented at Peking Union Medical College
Ovarian fibrosarcoma is a rare ovarian malignant tumor with a poor prognosis, and the diagnosis of this tumor should be based on postoperative pathology rather than on intraoperative frozen sections

Summary

Introduction

Ovarian fibrosarcoma is a considerably rare neoplasm, as this tumor type accounts for less than 1% of all ovarian malignancies [1]. Case 2 A 41-year-old female was admitted with an abdominal mass that had appeared 2 months earlier This patient reported no additional complaints, such as abdominal pain or distension. A solid-cystic mass 3 cm in diameter was observed between the sigmoid colon and the bottom of the left side of the bladder. Case 5 A 54-year-old woman was admitted with fever and dull abdominal pain She had been postmenopausal for 18 months and had no abnormal vaginal bleeding. Vaginal ultrasonography revealed a cystic mass full of fine spots that was located in the right ovarian area; the mass had clear boundaries, irregular low echo protrusions on the wall and no blood flow signals on CDFI. 32.9 U/ml, after which the chemotherapy ended, and the patient died within 1 year after surgery (Table 1)

Findings

Discussion

Conclusions