Ovarian Fibrothecoma Research Articles

A Rare Case of Virilizing Ovarian Fibrothecoma in A Teenage Girl

Ovarian fibrothecomas comprise tumors in the spectrum of ovarian sex cord / stromal tumors where there are components of both an ovarian fibroma and an ovarian thecoma. They account for 3-4% of all ovarian tumors. Most occur in adult women, with 65% in postmenopausal women. However, it represents only 2% of pediatric ovarian tumors. They are the most common benign solid ovarian tumor. The tumors are usually hormonally inactive but can be estrogenic or sometimes androgenic. Here we are reporting a rare case of a 15-year-old girl presenting with primary amenorrhea, severe hirsutism and finally diagnosed with ovarian fibrothecoma. After surgical removal of the tumor, a dramatic response was observed as the patient developed menarche. She was relieved of her hirsutism by laser therapy later, but her deep voice remained the same. CBMJ 2024 January: vol. 13 no. 01 P: 95-97

Ovarian fibrothecoma: about 2 cases: Review of the literature

Introduction: Ovarian fibroma is a rare tumor representing 1 to 4% of all ovarian tumours, poses a diagnostic problem preoperatively to assess their benign or malignant character, especially if associated with Demons Meigs syndrome.Clinically can be complicated making an array of surgical emergency.Magnetic resonance imaging(MRI) is more effective in diagnosing fibroids ovarian.Its treatment is surgical and the anatomopathological study confirms the diagnosis. Presentation of the cases: 1) a 62-year-old patient admitted for chronic pelvic pain in whom examination finds a hypogastric arch with slight pelvic tenderness, pelvic ultrasound objectified a pelvic mass of 10 cm heterogeneous, in pre vesico uterine and on MRI a bulky mass above the bladder of strongly ovarian origin evoking a fibrothecoma ovarian. The patient underwent a laparotomy with the discovery of a mass 10 cm in the right appendix with performance of an adnexectomy and the anatomopathological examination returned in favor of ovarian fibrothecoma. 2) a 45-year-old patient consults in the emergency room for intense pelvic pain, the examination finds a defense at the level of the right iliac fossa with perception of a mass firm, on pelvic ultrasound: the fallopian tube is the seat of a hydrosalpinx with an image 7 cm hypoechogenic, BHCG negative, benefited from a mini laparotomy with discovery of a solid mass of 8x6 cm attached to the fallopian tube and the right ovary with two towers of turns, we carried out a detorsion then a resection of the mass and the examination pathology came back in favor of ovarian fibrothecoma Conclusion: Ovarian fibroids are rare benign tumors, their diagnosis is based first on the clinic supplemented by explorations radiological especially ultrasound and in some cases MRI.Nevertheless, the diagnosis definitive is histological.

Ovarian fibrothecoma in an adolescent: A case report

Ovarian fibrothecoma in an adolescent: A case report

A case report of bilateral benign Ovarian Fibrothecoma coincidental with ascites: an unconventional co-occurrence.

We present the case of a 54-year-old female who presented complaining only of a slow progressive increase in the abdominal contour associated with vague abdominal pain. Our preoperative radiological imaging revealed multiple ovarian and uterine masses. Surgical intervention in the form of a hysterectomy with bilateral salpingo-oophorectomy was achieved. Histopathological analysis revealed bilateral benign ovarian fibrothecoma with benign uterine leiomyomas. The patient underwent an uneventful postoperative recovery. Ovarian Fibrothecoma is a rare gynecological pathology. The uniqueness of our case stems from the rarity of its bilateral occurrence and in rare occasions, their occurrence is accompanied by ascites. This kind of co-occurrence should be differentiated from other rare presentations, such as Meigs Syndrome. Therefore, documentation is necessary to circumvent misdiagnoses and to abate the resulting patient morbidity. To further highlight the value of our case, it is to the best of our knowledge, the first documented case of this pathology from our country.

Ovarian Fibrothecoma Masquerading as Heterotopic Pregnancy.

Ovarian Fibrothecoma Masquerading as Heterotopic Pregnancy.

CT review of ovarian fibrothecoma.

The aim of this study was to investigate the CT imaging characteristics of ovarian fibrothecoma which may aid in the differentiation from early stage epithelial tumours. Comparison of 36 patients (41 lesions) with pathologically proven ovarian fibrothecoma tumours and 36 (52 lesions) serous papillary carcinomas (SPCs) lesions. We noted their laterality, size, density, calcifications, Hounsfield units (HUs) and introduced a novel HU comparison technique with the psoas muscle or the uterus. Patients' clinical findings such as ascites, pleural effusion, carbohydrate antigen-125 levels, and lymphadenopathy findings were also included. Average age was 67.8 and 66 across the fibrothecoma and SPC cohort respectively. Fibrothecoma tumours had diameters ranging from 24 to 207 mm (Median: 94 mm). 80.6% of the fibrothecoma cohort had ascites which was comparable to the 72.2% in the SPC cohort. 70.7% of fibrothecoma tumour favour a purely to predominantly solid structural configuration (p < 0.001). The average HU value for the fibrothecoma solid component was 44 ± 11.7 contrasting the SPC HU value of 66.8 ± 15. The psoas:tumour mass ratio demonstrated a median of 0.7, whereas SPCs shows a median of 1.1 (p < 0.001). Suspicion of ovarian fibrothecoma should be considered through interrogation of their structural density configuration, low psoas to mass HU ratio and a presence of ascites. CT imaging can be a useful tool in diagnosing fibrothecoma tumours and subsequently reducing oncogynaecological tertiary centre referrals, financial burden and patient operative morbidity and mortality.

MRI-based nomogram for differentiation of ovarian fibrothecoma and broad ligament myoma

Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a nomogram prediction model based on MRI to differentiate OF from BLM. The quantitative and qualitative MRI features of 41 OFs and 51 BLMs were compared. Three models were established based on the combination of these features. The ability of the models to differentiate between the two cancers was assessed by ROC analysis. A nomogram based on the best model was constructed for clinical application. The three models showed good performance in differentiating between OF and BLM. The areas under the curve (AUC) of the models based on quantitative and qualitative variables were 0.88 (95% CI: 0.79–0.96) and 0.85 (95% CI: 0.76–0.93), respectively. The combined model designed from the significant variables exhibited the best diagnostic performance with the highest AUC of 0.92 (95% CI: 0.86–0.98). Calibration of the nomogram showed that the predicted probability matched the actual probability well. Analysis of the decision curve demonstrated that the nomogram was clinically useful. Relative T1 value, stone paving sign, enhancement patterns, and ascites were identified as valuable predictors for identifying OF or BLM. The MRI-based nomogram can serve as a preoperative tool to differentiate OF from BLM.

Meigs syndrome with pleural effusion as initial manifestation: A case report

BACKGROUNDMeigs syndrome is a rare neoplastic disease characterized by the triad of benign solid ovarian tumor, ascites, and pleural effusion. In postmenopausal women with pleural effusions, ascites, elevated CA-125 level, and pelvic masses, the probability of disseminated disease is high. Nevertheless, the final diagnosis is based on its histopathologic features following surgical removal of a mass lesion. Here we describe a case of Meigs syndrome with pleural effusion as the initial manifestation.CASE SUMMARYA 52-year-old woman presented with a 2-mo history of dry cough and oppression in the chest and was admitted to our hospital due to recurrent pleural effusion and gradual worsening of dyspnea that had occurred over the previous month. Two months before admission, the patient underwent repeated chest drainage and empirical anti-tuberculosis treatment. However, the pleural fluid accumulation persisted, and the patient began to experience dyspnea on exertion leading to admission. A computed tomography scan of the chest, abdominal ultrasound, and magnetic resonance imaging confirmed the presence of right-sided pleural effusion and ascites with a right ovarian mass. Serum tumor markers showed raised CA-125. With a suspicion of a malignant tumor, the patient underwent laparoscopic excision of the ovarian mass and the final pathology was consistent with an ovarian fibrothecoma. On the seventh day postoperation, the patient had resolution of the right-sided pleural effusion.CONCLUSIONDespite the relatively high risk of malignancy when an ovarian mass associated with hydrothorax is found in a patient with elevated serum levels of CA-125, clinicians should be aware about rare benign syndromes, like Meigs, for which surgery remains the preferred treatment.

PELVIC ORGAN PROLAPSE AND INGUINAL HERNIA AGGRAVATED BY OVARIAN FIBROTHECOMA WITH ASCITES

We present a case of pelvic organ prolapse and inguinal hernia worsened by a benign ovarian tumor with ascites. A 61-year-old woman was referred to us complaining of feeling of something protruding from her vagina. She was diagnosed with Stage III cystocele. Behavioral therapy was administered as she had only slight subjective symptoms. She visited us eight months later due to a rapid aggravation of cystocele and voiding difficulty. She subsequently developed acute abdominal pain caused by incarcerated inguinal hernia. Abdominal ultrasound, MRI and CT showed a 10.6×9.0 cm pelvic mass with ascites. As an ovarian cancer with peritoneal dissemination was suspected, she immediately underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and colposuspension. Pathological diagnosis was fibrothecoma, a benign ovarian tumor. Postoperative course was uneventful, and ascites quickly disappeared in a manner similar to Meigs syndrome. Although no procedure was done to manage inguinal hernia, it was unproblematic for 18 months, after that it worsened, necessitating hernial repair. She had no recurrence of prolapse or ascites.Increased intra-abdominal pressure due to abdominal mass or ascites can worsen prolapse and hernial diseases such as inguinal, umbilical, and abdominal hernia. In this case, ovarian fibrothecoma with ascites seemed to be responsible for worsening of the prolapse and inguinal hernia. To conclude, it is important to consider background diseases when examining patients with prolapse and coexisting hernial diseases.

Coexistence of Stump Appendicitis and Ovarian Fibro-Thecoma in a Young Women with Recurrent Right Iliac Fossa Pain During Pregnancy; A Rare Case Report

Ovarian Fibro-thecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian Fibro-thecoma is Uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumors. We describe a rare case of Fibro-thecoma in a 27- year women with a history of recurrent right iliac fossa pain during pregnancy associated with fever and vomiting with previous history of laparotomy for appendicular abscess 10 years back. She presented to us during pregnancy with this complain for which she was managed conservatively. She did not maintain her follow up regularly at our hospital and visited again after delivery of her baby with a still birth outcome with a newly diagnosed complex bilateral ovarian cyst demonstrated on ultrasound and computed tomography showed inflammatory Right sided tubo-ovarian mass along with inflammatory thickening of ileum in right lower quadrant adjacent to right ovarian mass lesion. The patient underwent laparotomy for this with the removal of mass along with the removal of appendicular stump for appendicular stump appendicitis which was diagnosed intraoperatively. The finding from histopathological examination of the mass was consistent with the diagnosis of Fibro-thecoma.

LARGE BENIGN OVARIAN TUMOR MIMICKING LATE STAGE MALIGNANT OVARIAN TUMOR

Ovarian fibrothecoma is a rare, benign neoplasm of the sex cords and stroma of the ovary. Patients may present with abdominal pelvic pain and / or distension, and sometimes postmenopausal bleeding. Large tumors (&gt; 10cm) are often associated with pleural and peritoneal effusion mimicking an advanced ovarian malignancy (Deimon –Meigs syndrome). We report 2 cases of giant fibrothecoma associated with ascites and pleurisy. Both patients were postmenopausal. The ovarian tumor was discovered during an increase in abdominal volume in the first patient and as part of the etiological workup of encysted pleurisy in the second. The clinical examination made it possible to objectify a tumor with abdominopelvic development of size greater than 10 cm, the clinical examination also noted, in the two patients, a right basithoracic dullness in favor of a pleurisy and an ascites of average abundance suggesting in the first place a malignant tumor of the ovary, with peritoneal carcinoma. the two patients underwent a pelvic ultrasound, supplemented by an abdominal pelvic CT scan objectifying the presence of a large ovarian mass with pleural and peritoneal effusions. Exploratory laparotomy was required in both patients and underwent an extemporaneous examination which was consistent with the definitive pathological examination in both patients. Both patients underwent total hysterectomy with bilateral adnexectomy and omentectomy with multiple biopsies as the clinical picture was highly suggestive of malignancy. The postoperative follow-up was simple with total regression of peritoneal and pleural effusions in the two cases of Demons-Meigs syndrome. The definitive pathological examination revealed a fibrothecoma. Fibrothecal tumors remain a real challenge from a diagnostic and therapeutic point of view. The fear of cancer is even greater in the presence of Demons-Meigs syndrome. The management of these tumors requires a good clinical and radiological analysis, and it is the histological examination that confirms the diagnosis. The surgery corresponds, in post-menopausal patients, to a hysterectomy with bilateral adnexectomy, while conservative treatment by unilateral adnexectomy is entirely justified in young women who still want fertility.

Ovarian fibrothecoma—Causing menstrual disorder and hirsutism: Case report and review of literature

Fibrothecomas are solid tumors of the ovary. They have been described as rare ovarian neoplasms with varied clinical manifestations. It is an uncommon tumor that originates from stromal cells accounting for 3–4% of all ovarian tumors. We present a case of a 23-year-old nulliparous undergraduate who presented to our outpatient department with secondary amenorrhea, hirsutism, and acne of one-year duration. Her symptoms worsened overtime that necessitated her presentation. Clinical examination revealed signs of hyperandrogenism with a 16-week-sized abdominopelvic mass. She had surgical excision of the mass after work-up. Her menses returned and other signs of hyperandrogenism resolved. Histopathology confirmed fibrothecoma.

English

English

MALDI-MSI-A Step Forward in Overcoming the Diagnostic Challenges in Ovarian Tumors.

This study presents the use of matrix-assisted laser desorption and ionization mass spectrometry imaging (MALDI-MSI) directly on the tissue of two ovarian tumors that often present a diagnostic challenge, a low-grade serous borderline ovarian tumor and ovarian fibrothecoma. Different spatial distribution of m/z values within the tissue samples was observed, and regiospecific peaks were identified. Among the 106 peaks in the borderline ovarian tumor five, regiospecific peaks (m/z: 2861.35; 2775.79; 3368.34; 3438.43; 4936.37) were selected using FlexImaging software. Subsequently, the distribution of those selected peaks was visualized on the fibrothecoma tissue section, which demonstrated the differences in the tissue homo-/heterogeneous structure of both tumors. The comparison with the histopathological staining of the ovarian borderline tumor tissue section, obtained during serial sectioning, showed a close correlation of the molecular map with the morphological and histopathological features of the tissue and allowed the identification of different tissue types within the sample. This study highlights the potential significance of MSI in enabling morphological characterization of ovarian tumors as well as correct diagnosis and further prognosis than thus far seen in the literature. Osteopontin, tropomyosin and orosomucoid are only a couple of the molecules investigated using MALDI-MSI in ovarian cancer research. This study, in line with the available literature, proves the potential of MALDI-MSI to overcome the current limitations of classic histopathological examination giving a more in-depth insight into the tissue structure and thus lead to the more accurate differential diagnosis of ovarian tumors, especially in the most challenging cases.

A Case Report of Ovarian Fibrothecoma in a Premenopausal Women with Recurrent Menorrhagia

BACKGROUND: Ovarian fibrothecoma is a rare, benign, sex cord-stromal neoplasm, with a typically unilateral location in the ovary, characterized by mixed features of both fibroma and thecoma. Ovarian fibrothecoma is uncommon tumor of gonadal stromal cell origin accounting for 3-4% of all ovarian tumours.&#x0D; CASE PRESENTATION: We presented a rare case of a 46-year-old patient with recurrent menorrhagia in the past two years with no previous medical, surgical or gynecological history. She underwent two times curettage procedures. At the admission to hospital ultrasonography showed a homogenous solid right ovarian mass of size 2.5 cm x 3.5 cm. Endometrial curettage revealed simple hyperplasia of the endometrium. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was carried out. Histopathology confirmed fibrothecoma of the ovary, proliferative endometrium with hyperplasia without atypia and multiple uterine fibroids.&#x0D; CONCLUSION: In all patients presenting with recurrent menorrhagia and adnexal tumor the possibility of a granulosa cell tumor must be kept in mind during evaluation.

Triple negative lobular breast carcinoma metastatic to an ovarian fibrothecoma

ABSTRACT A postmenopausal woman with lobular breast carcinoma metastatic to a large ovarian fibrothecoma is presented. The two metastatic tumor nodules were grossly subtle and could have been overlooked in the background of the large ovarian stromal tumor. Thorough sampling of the tumor for histologic examination and supporting immunohistochemical stains were important in establishing the diagnosis. Differential diagnostic considerations are discussed.

Oocyte Cryopreservation before Tumorectomy in Gorlin-Goltz Syndrome with Recurrent Ovarian Fibroma: A Case Report

Background: Gorlin-Goltz syndrome is a very rare syndrome that reportedly occurs in 1 of 235,800 people in Japan. The proportion of women with Gorlin-Goltz syndrome complicated with an ovarian fibroma ranges from 12.5% to 17.0%. Some surgical cases of Gorlin-Goltz syndrome with an ovarian tumor have been reported. However, no studies have mentioned subsequent fertility preservation by using oocyte cryopreservation process. Case: In this case report, the patient with Gorlin-Goltz syndrome underwent laparotomy for bilateral ovarian fibrothecoma at 15 years of age. At 20 years of age, a recurrent ovarian tumor was detected in the remaining ovary. During the follow-up, we detected an increase in its size. As tumor torsion requiring left salpingo-oophorectomy was possible, tumorectomy was considered. However, her anti-Mullerian hormone level was low. As she was at risk for premature ovarian failure after tumorectomy, we planned to cryopreserve her oocytes to preserve her fertility before tumorectomy. Outcome: When the patient underwent surgery, the diameter of her left ovarian tumor was found to have increased to 56 mm. Egg collection was performed twice, and two oocytes were cryopreserved. Subsequently, she underwent tumorectomy of the left ovarian tumor. No recurrence has been observed. Conclusion: If a recurrent ovarian tumor is detected in patients with Gorlin-Goltz syndrome and a low anti-Mullerian hormone level, cryopreservation of oocytes before tumorectomy may be effective for preserving their fertility.

Computed tomography and magnetic resonance imaging features of ovarian fibrothecoma.

The aim of the present study was to investigate the imaging characteristics of ovarian fibrothecoma. The cases of 25 female patients with pathologically confirmed ovarian fibrothecomas were retrospectively reviewed. Tumor location, size, density, signal intensity, cystic degeneration, calcification, enhancement pattern and ascites were assessed by computed tomography (CT) (n=20) and magnetic resonance imaging (MRI) (n=5). Clinical and histological features were also evaluated. The results revealed that 23 (92.0%) patients were postmenopausal, with a mean age ± standard deviation (SD) of 60.7±10.8 years old. All 25 tumors were unilateral and a thickened endometrium was observed in 7 (28.0%) patients. In total, 24 (96.0%) tumors appeared to have well-defined boundaries, with 1 (4%) tumor exhibiting an obscure boundary. Tumors had a mean size of 9.8±5.3 cm. Solid and predominantly solid masses were found in 16 cases (64.0%), and cystic and predominantly cystic masses were found in 9 patients (36.0%). Solid regions of masses exhibited hypodensity or isodensity in 24 patients (96.0%), with 1 patient (4.0%) exhibiting hyperdensity. The mean CT value (± SD) was 44.2±12.8 HU (range, 31-79HU) in unenhanced images. All masses exhibited isointensity or slight hypointensity on T1-weighted imaging, and tumor parenchyma also exhibited slight hypointensity or isointensity on T2-weighted imaging compared with the myometrium, with or without areas of patchy hyperintensity. Contrast-enhanced CT or MRI scans were performed on 19 patients, and the solid components (94.7%) exhibited mild to moderate enhancement in 18 patients and 1 patient (5.3%) exhibited intense enhancement. Tumor size was positively correlated with the tumor cystic degeneration (r=0.77, P<0.001) and ascites (r=0.41, P<0.001). Therefore, ovarian fibrothecoma typically presents as solid or predominant solid masses with clear boundaries; the parenchyma of the tumor exhibits isodensity on CT scans, slight hypointensity or isointensity on MRI and mild enhancement following contrast-medium injection. The thickened endometrium observed in postmenopausal woman may also be a valuable imaging feature.

Ovarian Fibrothecoma with Acute Torsion and Extensive Cystic Degeneration after Long Quiescence in a Young Patient

Ovarian Fibrothecoma with Acute Torsion and Extensive Cystic Degeneration after Long Quiescence in a Young Patient

Ovarian Fibrothecoma in a Holstein cow: A Case report

A 5-year-old Holstein cow was referred to the Veterinary Medicine Hospital, Urmia University, Urmia, Iran, with abnormal estrous cycle. At rectal palpation, the unilateral ovary enlargement was detected. On transrectal ultrasonography view, the left ovary had uniformly hyperechogenic areas. The affected ovary was removed by ovariectomy and sent for histopathological examination. Histopathological evaluation revealed fibroblastic cells producing collagen fibers and theca cells containing lipids. Based on histopathological features, diagnosis of fibrothecoma was confirmed. This case reports an extremely rare fibrothecoma in cow.