Giant malignant ovarian fibrothecoma involved with retroperitoneal structures mimicking a retroperitoneal sarcoma

A 36 kg Giant Ovarian Fibroma with Meigs Syndrome: A Case Report and Literature Review of Extremely Giant Ovarian Tumor

Ovarian tumors can get extremely giant to occupy the whole abdominal cavity. We report a case of 36 kg solid ovarian tumor, which was the largest ovarian solid tumor that have been ever reported. A 54-year-old woman presented to our hospital with a chief complaint of markedly distended abdominal wall. Preoperative imaging examinations revealed that most of the tumor was uniform and its density was like that of subcutaneous fat. Pleural effusion was detected in the right thoracic region. We organized a multidisciplinary team and successfully resected the right adnexa. The patient had an uneventful postoperative course, and she was discharged on the 7^th postoperative day and diagnosed with a fibroma of the ovary with Meigs syndrome. A comprehensive literature search revealed 48 cases of extremely giant ovarian tumor in these 20 years. Six out of 48 cases are solid. Twelve out of 48 cases are malignant or borderline malignant, and patients' age and tumor size/weight were not related to the frequency of malignancy/borderline malignancy. As many as 4 out of 48 patients died before their first hospital visit or early after surgery. Clinicians should consider a considerable high mortality and frequency of severe surgical complications when planning the treatment strategy for extremely giant ovarian tumors.

Value of 3.0 T diffusion-weighted imaging in discriminating thecoma and fibrothecoma from other adnexal solid masses

Background

To investigate the value of diffusion-weighted imaging (DWI) at 3.0 T (3T), and especially the apparent diffusion coefficient (ADC), in discriminating ovarian thecoma from other adnexal solid masses.

Methods

Eighteen thecomas or fibrothecomas, 14 ligamentous leiomyomas, and 24 other ovarian solid tumors underwent prospective DWI magnetic resonance imaging (MRI) in addition to routine MRI on a 3T MRI machine. The baseline characteristics, components, and conventional MRI and DWI-MRI signals for the thecomas were recorded. The ADC values (ADCs) were measured for each group and compared.

Results

The thecomas often appeared as homogeneous isointensity (17/18) on T1-weighted images (T₁WI; 11/18) or T₂WI (11/18) on DWI-MRI, with minor (9/18) or mild (6/18) enhancement. The mean ADC value for thecoma (1.20 ± 0.45 × 10⁻³ mm²/s) was almost equal to that of the other solid ovarian masses (1.26 ± 0.51 × 10⁻³ mm²/s), but lower than that for leiomyoma (1.48 ± 0.42 × 10⁻³ mm²/s), although not significantly so. There was a significant difference (p = 0.043) in the ADCs of the benign ovarian solid masses (1.16 ± 0.47 × 10⁻³ mm²/s) and leiomyomas (1.48 ± 0.42 × 10⁻³ mm²/s).

Conclusions

There is no significant difference in ADC between thecoma and other adnexal solid masses, but the ADCs of thecomas are lower than those of leiomyomas.

Retroperitoneal extraovarian fibrothecoma mimicking a malignant epithelial ovarian carcinoma

Background. Fibrothecomas are benign sex cord-stromal tumors which rarely originate outside of the ovary. To date, two such cases have been reported in the literature. We report the third case of an extraovarian fibrothecoma and the first presenting similarly to a metastatic epithelial ovarian cancer. Clinical History. We describe a 62-year-old woman with history, physical examination, and imaging suggestive of metastatic ovarian cancer. CA-125 was elevated at 1291 U/mL. Paracenteses were negative for malignant cells and core biopsy showed spindle cell proliferation. A primary debulking surgery for a presumed ovarian cancer was planned. Method and Results. At surgery, 6 liters of ascites were drained. The uterus, ovaries, peritoneum, and omentum were normal. An 18 × 11 × 7 cm retroperitoneal mass was found between the left ureter and the sigmoid mesocolon, wrapped with sigmoid colon. Fallopian tubes and ovaries were normal. The mass was resected en bloc with the sigmoid colon, uterus, ovaries, and omentum. Microscopically, there was spindle cell proliferation typical of fibrothecoma. No ovarian tissue was identified in association with the tumor. Conclusion. This third case of extraovarian fibrothecoma highlights the importance of obtaining histologic evidence of malignancy prior to initiating neoadjuvant chemotherapy for a presumed ovarian cancer.

Bilateral ovarian fibrothecoma. An uncommon cause of a large pelvic mass

Ovarian fibrothecomas are uncommon tumors of gonadal stromal cell origin. They account for 3-4% of all ovarian tumors and in 90% of the cases are unilateral. Here, we describe a rare case of a bilateral ovarian fibrothecoma in a postmenopausal woman who presented with a large pelvic mass and metrorrhagia. Diagnostic evaluation and surgical management are discussed along with a brief review of the literature. Although rare, ovarian fibrothecoma should be considered in patients presenting with a large pelvic mass and postmenopausal bleeding. Radical surgery is the preferred management strategy for postmenopausal women with bilateral ovarian fibrothecomas and is associated with a good prognosis.