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Flissate F, Bensrhir I, Mahfoud H, Lakhdar A, Baidada A, Sassi S. Fibrothecoma a rare ovarian tumor: A case report. Int J Surg Case Rep 2024; 120:109771. [PMID: 38810296 PMCID: PMC11167356 DOI: 10.1016/j.ijscr.2024.109771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 05/31/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Fibroma, thecoma, and fibrothecoma collectively denote a range of non-cancerous sex cord-stromal tumors distinguished by the presence of fibroblastic stromal cells and/or cells resembling luteinized theca cells. CASE PRESENTATION In this report, we present a case study of a 52-year-old patient in whom this uncommon tumor was identified via MRI, highlighting the distinctive diagnostic and treatment considerations associated with it. CLINICAL DISCUSSION Ovarian fibrothecoma tumors are infrequent, constituting less than 4 % of all ovarian tumors. Although they may manifest at any age, they are more commonly observed in elderly and post-menopausal individuals. Diagnosis hinges on clinical and paraclinical data, yet definitive confirmation is predominantly achieved through anatomopathological examination. For younger patients, conservative surgery is usually favored, whereas peri- or post-menopausal individuals may undergo radical treatment. CONCLUSION Ovarian Fibrothecoma, though rare, are typically benign tumors frequently found in older patients. Diagnosis primarily relies on histological examination. Fortunately, the prognosis for these tumors is generally favorable.
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Affiliation(s)
- Farah Flissate
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco.
| | - Ibtissam Bensrhir
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Hounaida Mahfoud
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Amina Lakhdar
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Aziz Baidada
- Gynaecology-Obstetrics and Endoscopy Department, Maternity Souissi, University Hospital Center IBN SINA, University Mohammed V, Rabat, Morocco
| | - Samia Sassi
- Anatomopathology Department, Ibn Sina University Hospital Rabat, Morocco
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Guelzim Y, Bennasser A, Marrakchi S, Houssaini AS, Idoubba S, Boujida I, Jahid A, Allali N, Chat L, Haddad SE. Demons-Meigs syndrome caused by a giant ovarian fibroma: A case report. Radiol Case Rep 2024; 19:2585-2589. [PMID: 38645957 PMCID: PMC11026527 DOI: 10.1016/j.radcr.2024.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Revised: 03/03/2024] [Accepted: 03/09/2024] [Indexed: 04/23/2024] Open
Abstract
Demons-Meigs syndrome is a very rare entity. It combines a benign ovarian "fibroma-like" tumor with ascites and hydrothorax. The notion of benignancy is the key point. CA-125 levels are most of the time normal, but high levels can be observed in rare cases which makes it difficult to have a diagnostic. We present here the case of a 43-year-old female patient who presented with abdominopelvic pain. Imaging discovered a 30 cm large intraabdominal mass with ascites and bilateral pleural effusion. Surgical resection of the tumor was performed, and pathology identified an ovarian fibroma. No postintervention complications were observed, with resorption of the ascites and hydrothorax.
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Affiliation(s)
- Yousra Guelzim
- Department of Radiology, Pediatric Teaching Hospital, Rabat, Morocco
| | | | - Salma Marrakchi
- Department of Radiology, Pediatric Teaching Hospital, Rabat, Morocco
| | | | - Salwa Idoubba
- Department of Gynecology-Obstetrics and Endoscopy, Maternity Souissi hospital, Rabat, Morocco
| | - Ismail Boujida
- Department of Pathology, Ibn Sina Hospital, Rabat, Morocco
| | - Ahmed Jahid
- Department of Pathology, Ibn Sina Hospital, Rabat, Morocco
| | - Nazik Allali
- Department of Radiology, Pediatric Teaching Hospital, Rabat, Morocco
| | - Latifa Chat
- Department of Radiology, Pediatric Teaching Hospital, Rabat, Morocco
| | - Siham El Haddad
- Department of Radiology, Pediatric Teaching Hospital, Rabat, Morocco
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Bo J, Sun M, Wei C, Wei L, Fu B, Shi B, Fang X, Dong J. MRI combined with clinical features to differentiate ovarian thecoma-fibroma with cystic degeneration from ovary adenofibroma. Br J Radiol 2024; 97:1057-1065. [PMID: 38402483 DOI: 10.1093/bjr/tqae046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/11/2024] [Accepted: 02/21/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE To explore the value of magnetic resonance imaging (MRI) and clinical features in identifying ovarian thecoma-fibroma (OTF) with cystic degeneration and ovary adenofibroma (OAF). METHODS A total of 40 patients with OTF (OTF group) and 28 patients with OAF (OAF group) were included in this retrospective study. Univariable and multivariable analyses were performed on clinical features and MRI between the two groups, and the receiver operating characteristic (ROC) curve was plotted to estimate the optimal threshold and predictive performance. RESULTS The OTF group had smaller cyst degeneration degree (P < .001), fewer black sponge sign (20% vs. 53.6%, P = .004), lower minimum apparent diffusion coefficient value (ADCmin) (0.986 (0.152) vs. 1.255 (0.370), P < .001), higher age (57.4 ± 14.2 vs. 44.1 ± 15.9, P = .001) and more postmenopausal women (72.5% vs. 28.6%, P < .001) than OAF. The area under the curve of MRI, clinical features and MRI combined with clinical features was 0.870, 0.841, and 0.954, respectively, and MRI combined with clinical features was significantly higher than the other two (P < .05). CONCLUSION The cyst degeneration degree, black sponge sign, ADCmin, age and menopause were independent factors in identifying OTF with cystic degeneration and OAF. The combination of MRI and clinical features has a good effect on the identification of the two. ADVANCES IN KNOWLEDGE This is the first time to distinguish OTF with cystic degeneration from OAF by combining MRI and clinical features. It shows the diagnostic performance of MRI, clinical features, and combination of the two. This will facilitate the discriminability and awareness of these two diseases among radiologists and gynaecologists.
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Affiliation(s)
- Juan Bo
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
| | - Mingjie Sun
- Faculty of Graduate Studies, Wannan Medical College, Wuhu, Anhui 241002, China
| | - Chao Wei
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Longyu Wei
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Baoyue Fu
- Faculty of Graduate Studies, Bengbu Medical College, Bengbu, Anhui 233030, China
| | - Bin Shi
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Xin Fang
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
| | - Jiangning Dong
- Department of Radiology, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, Anhui 230001, China
- Department of Radiology, Western District, First Affiliated Hospital of University of Science and Technology of China, No.107 Huanhu East Road, Shushan District, Hefei, Anhui, 230031, China
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Iavarone I, Padovano M, Pasanisi F, Della Corte L, La Mantia E, Ronsini C. Meigs Syndrome and Elevated CA-125: Case Report and Literature Review of an Unusual Presentation Mimicking Ovarian Cancer. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1684. [PMID: 37763803 PMCID: PMC10535830 DOI: 10.3390/medicina59091684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 09/11/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Meigs syndrome is represented by a benign adnexal tumor, ascites, and hydrothorax. Even though the ovarian mass is often characterized by a fibroma-like origin, cancer antigen-125 (CA-125) serum levels could be elevated as in the development of ovarian cancer. Here, we present the case of a patient with Meigs syndrome and increased CA-125. Materials and Methods: We performed systematic research for articles including similar cases in PubMed, EMBASE, and Scopus in February 2023, adopting the string of idioms: "Meigs syndrome AND Cancer antigen 125", and following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Results: Eligible records were 25. Hydrothorax was right-sided in 10 cases over 25; left-sided in two patients over 25. Concerning ascites, two patients showed more than 6 L of ascitic fluid, whereas three patients had 6 L or less. CA-125 elevation ranged from 149 IU/mL to 3803 IU/mL. Adnexal mass histotypes were: struma ovarii (12 cases), thecomas (two cases), fibrothecomas (five cases), fibromas (five cases), and one sclerosing stromal tumor (SST). Conclusions: In postmenopausal women with elevated CA-125 serum levels and an adnexal mass suspicious for malignancy at ultrasound (US), ascites and pleural effusion, surgery, and histopathological examination are necessary. MS is a diagnostic option, with an excellent prognosis after exeresis of the mass.
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Affiliation(s)
- Irene Iavarone
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Michela Padovano
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Francesca Pasanisi
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences, and Dentistry, University of Naples Federico II, 80131 Naples, Italy
| | - Elvira La Mantia
- Pathology Unit, Department of Mental and Physical Health and Preventive Medicine, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy;
| | - Carlo Ronsini
- Department of Woman, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (I.I.); (M.P.); (F.P.); (C.R.)
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Sato N, Itakura Y, Yoshida Y, Akahira J, Fujishima F, Nakamura Y. Post-menopausal ovarian fibroma associated with steroid hormone synthesis: A case report. Taiwan J Obstet Gynecol 2023; 62:566-570. [PMID: 37407196 DOI: 10.1016/j.tjog.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/30/2023] [Indexed: 07/07/2023] Open
Abstract
OBJECTIVE Ovarian fibromas are benign, sex cord-stromal tumors occurring in both peri- and post-menopausal women. Generally, these tumors are non-functional and do not produce hormones. However, this case report proves the first case of steroid hormone synthesis in an ovarian fibroma by immunohistochemistry. CASE REPORT A 77-year-old post-menopausal woman presented with a left ovarian tumor, abnormal endometrial thickness, and high levels of estradiol (E2). The tumor was found to be a fibroma, which was positive for alpha-inhibin. We examined estrogen-producing enzymes using immunohistochemistry. The tumor was positive for estrogen receptor, progesterone receptor, 17β-hydroxysteroid dehydrogenase (HSD)-1, adrenal 4 binding protein/steroidogenic factor 1, 17β-HSD-5, steroid sulfatase, and P450c17. CONCLUSION This case study shows that E2 can be locally produced from circulating inactive steroids, by estrogen-producing enzymes. This is the first report of steroid hormone synthesis in an ovarian fibroma.
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Affiliation(s)
- Naomi Sato
- Iwate Prefectural Central Hospital, Department of Pathology, Morioka, Iwate, Japan; Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan.
| | - Yuko Itakura
- Japanese Red Cross Ishinomaki Hospital, Department of Pathology, Ishinomaki, Miyagi, Japan
| | - Yuji Yoshida
- Japanese Red Cross Ishinomaki Hospital, Department of Gynecology, Ishinomaki, Miyagi, Japan
| | - Junichi Akahira
- Sendai Kousei Hospital, Department of Pathology, Sendai, Miyagi, Japan
| | - Fumiyoshi Fujishima
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Yasuhiro Nakamura
- Division of Pathology, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Miyagi, Japan
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Liu J, Wei J, Yang Y, Wei J. Pathological discrimination between luteinized thecoma associated with sclerosing peritonitis and thecoma. Medicine (Baltimore) 2023; 102:e33911. [PMID: 37335673 DOI: 10.1097/md.0000000000033911] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Similarities between luteinized thecoma associated with sclerosing peritonitis (LTSP) and thecoma, cause difficulty in clinical differential diagnoses. To improve the situation, we selected 10 specified molecular pathological markers that are frequently used in clinical pathology of ovarian sex cord-stromal tumors to determine whether they exert a discriminatory effect. METHODS Applying immunohistochemistry, we analyzed the expression of alpha-1,6-mannosylglycoprotein 6-beta-n-acetylglucosaminyltransferase B (MGAT5B), nuclear receptor coactivator 3 (NCOA3), proliferation marker protein Ki-67 (MKI67), estrogen receptor, progesterone receptor, Vimentin, receptor tyrosine-protein kinase erbB-2, Catenin beta-1 (β-Catenin), CD99 antigen (CD99) and Wilms tumor protein (WT1) in 102 cases of diseases containing 11 LTSP and 91 thecoma. Whole-exome sequencing and fluorescence in situ hybridization were used to examine the MGAT5B-NCOA3 fusion gene in LTSP. Statistical analysis was performed using t test, one-way analysis of variance test, and post hoc test. RESULTS Six significant markers were verified for the discrimination between LTSP and thecoma, containing 4 upregulating indicators MGAT5B, NCOA3, MKI67, β-Catenin, and 2 downregulating markers CD99 and WT1 in luteinized cells. In addition, the MGAT5B-NCOA3 fusion gene was identified in LTSP for the first time with significantly rich expression compared to thecoma. CONCLUSIONS We verified 6 significant molecular pathological markers containing MGAT5B, NCOA3, MKI67, β-Catenin, CD99, and WT1 and identified MGAT5B-NCOA3 fusion gene in LTSP; this work will help clinicians to discriminate between medical conditions and treat patients accurately.
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Affiliation(s)
- Jia Liu
- Department of Obstetrics & Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science & Technology, Hubei Province, China
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Li MC, Polk SL, Myers RA. A midline pelvic mass: Ovarian fibroma appearing vaginal in nature. ULTRASOUND (LEEDS, ENGLAND) 2023; 31:47-50. [PMID: 36794115 PMCID: PMC9923148 DOI: 10.1177/1742271x221093750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/25/2022] [Indexed: 11/16/2022]
Abstract
Introduction Ovarian fibroma is an uncommon, benign, stromal neoplasm that is a mixture of collagen-producing mesenchymal cells. There are varying sonographic and computed tomography features described in literature of smaller scale studies. Case Report We describe a case of an ovarian fibroma presenting as a midline pelvic mass mimicking a vaginal cuff tumour in a 67-year-old patient with surgical history of a hysterectomy. Computed tomography and ultrasound were utilised to evaluate the mass and guide management of the patient. The mass was initially suspected on CT-guided biopsy as a vaginal spindle cell epithelioma amongst other potential differential considerations. With robot-assisted laparoscopic surgery and histologic analysis, the true diagnosis of an ovarian fibroma was reached. Discussion An ovarian fibroma is an uncommon, benign, stromal ovarian tumour, representing just 1-4% of all ovarian tumours. Its widely varying imaging features present a challenge when radiologically evaluating ovarian fibromas or pelvic tumours, as the differential diagnoses are extensive and ovarian fibromas are often misdiagnosed until surgical resection. We highlight the features of ovarian fibromas and the potential value of pelvic/transvaginal ultrasonography in management of ovarian fibroma and other pelvic masses. Conclusion The use of computed tomography and ultrasound aided in the diagnostic and treatment pathway of this patient with a pelvic mass. There is high utility of sonography in evaluating such tumours to elucidate salient features, expedite diagnosis, and guide further management.
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Affiliation(s)
- Michael C Li
- Morsani College of Medicine, University of
South Florida, Tampa, FL, USA
- Department of Radiology, Lehigh Valley Health
Network, Allentown, PA, USA
| | - Stuart L Polk
- Morsani College of Medicine, University of
South Florida, Tampa, FL, USA
- Department of Radiology, Lehigh Valley Health
Network, Allentown, PA, USA
| | - Ross A Myers
- Department of Radiology, Lehigh Valley Health
Network, Allentown, PA, USA
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Raičević S, Radoman K, Radović S, Vučković L, Vukmirović F. Fibrothecoma in a Virgo Intacta Adolescent with Elevated Levels of CA 125 and B-hCG: A Case Report. CHILDREN (BASEL, SWITZERLAND) 2022; 9:847. [PMID: 35740784 PMCID: PMC9221770 DOI: 10.3390/children9060847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
Ovarian fibromas are benign tumors that consist of spindle cells in bundles or storiformly arranged with collagen fibers in the stroma. Thecomas resemble theca interna ovarian cells, and there is lipid material in their cytoplasm. There is an overlap in histological and immunohistochemical characteristics of these two benign tumors, and the term "fibrothecoma" was coined to describe such cases. Their incidence is extremely rare in adolescents. The subject of our study is a 15-year-old, unmarried, virgo intacta patient who was referred to us due to profuse vaginal bleeding and the loss of consciousness. A right ovary ultrasound examination exposed the formation of a hyperechoic tumor with a diameter of 41.2 mm × 29.5 mm. Findings of cancer antigen 125 (CA 125) in the amounts of 621.1 U/mL and 142.87 mIU/mL of the B-human chorionic gonadotropin (B-hCG) serum were determined. After preoperative preparation, we operated on the patient to remove a tumor with a diameter of 37 mm × 30 mm × 22 mm, smooth outer surface, solid cross-section, and yellowish white color. The diagnosis of fibrothecoma was made based on pathohistological examination. An unusual finding of fibrothecoma in a virgo intacta adolescent with profuse vaginal bleeding and increased levels of CA 125 and B-hCG may serve as a basis for broader thinking about the pathology of juvenile bleeding.
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Affiliation(s)
- Saša Raičević
- Department of Gynecology and Obstetrics, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro
| | - Kristina Radoman
- College of Health Studies, Džona Džeksona 1, Podgorica 81000, Montenegro;
| | - Saša Radović
- Department of Paediatric Surgery, Clinical Center Montenegro, Children’s Diseases Institute, Podgorica 81000, Montenegro;
| | - Ljiljana Vučković
- Department of Pathology, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro; (L.V.); (F.V.)
| | - Filip Vukmirović
- Department of Pathology, Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica 81000, Montenegro; (L.V.); (F.V.)
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Nagawa K, Kishigami T, Yokoyama F, Murakami S, Yasugi T, Takaki Y, Inoue K, Tsuchihashi S, Seki S, Okada Y, Baba Y, Hasegawa K, Yasuda M, Kozawa E. Diagnostic utility of a conventional MRI-based analysis and texture analysis for discriminating between ovarian thecoma-fibroma groups and ovarian granulosa cell tumors. J Ovarian Res 2022; 15:65. [PMID: 35610706 PMCID: PMC9131674 DOI: 10.1186/s13048-022-00989-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 04/25/2022] [Indexed: 11/24/2022] Open
Abstract
Objective To evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI)-based characteristics and a texture analysis (TA) for discriminating between ovarian thecoma-fibroma groups (OTFGs) and ovarian granulosa cell tumors (OGCTs). Methods This retrospective multicenter study enrolled 52 patients with 32 OGCTs and 21 OTFGs, which were dissected and pathologically diagnosed between January 2008 and December 2019. MRI-based features (MBFs) and texture features (TFs) were evaluated and compared between OTFGs and OGCTs. A least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select features and construct the discriminating model. ROC analyses were conducted on MBFs, TFs, and their combination to discriminate between the two diseases. Results We selected 3 features with the highest absolute value of the LASSO regression coefficient for each model: the apparent diffusion coefficient (ADC), peripheral cystic area, and contrast enhancement in the venous phase (VCE) for the MRI-based model; the 10th percentile, difference variance, and maximal correlation coefficient for the TA-based model; and ADC, VCE, and the difference variance for the combination model. The areas under the curves of the constructed models were 0.938, 0.817, and 0.941, respectively. The diagnostic performance of the MRI-based and combination models was similar (p = 0.38), but significantly better than that of the TA-based model (p < 0.05). Conclusions The conventional MRI-based analysis has potential as a method to differentiate OTFGs from OGCTs. TA did not appear to be of any additional benefit. Further studies are needed on the use of these methods for a preoperative differential diagnosis of these two diseases. Supplementary Information The online version contains supplementary material available at 10.1186/s13048-022-00989-z.
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Affiliation(s)
- Keita Nagawa
- Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama, Japan.
| | - Tomoki Kishigami
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Fumitaka Yokoyama
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Sho Murakami
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Toshiharu Yasugi
- Department of Gynecology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Yasunobu Takaki
- Department of Radiology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, Japan
| | - Kaiji Inoue
- Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Saki Tsuchihashi
- Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Satoshi Seki
- Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama, Japan
| | - Yoshitaka Okada
- Department of Diagnostic Imaging, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka city, Saitama, Japan
| | - Yasutaka Baba
- Department of Diagnostic Imaging, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka city, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka city, Saitama, Japan
| | - Masanori Yasuda
- Department of Diagnostic Pathology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka city, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University, 38 Morohongou, Moroyama-machi, Iruma-gun, Saitama, Japan
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Aubert O, Wachowiak R, Roth C, Höhn AK, Lacher M, Mayer S. Resection of an Extraovarian Noniuteinized Thecoma in a 14-Year-Old Girl. European J Pediatr Surg Rep 2022; 10:e37-e40. [PMID: 35450099 PMCID: PMC9018130 DOI: 10.1055/s-0042-1742712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/20/2021] [Indexed: 11/03/2022] Open
Abstract
Thecomas are rare benign sex cord-stromal tumors that account for less than 1% of all ovarian tumors. They usually affect postmenopausal women and become symptomatic with abnormal bleeding. In adolescents, less than 10 cases have been reported so far, mainly with symptoms of hormonal disbalance. Extraovarian thecomas represent an even rarer entity, with only two cases described so far, none of them in the pediatric population. We report the case of a 14-year-old girl who presented with sudden-onset abdominal pain, dysuria, and fever, as well as highly elevated serum inflammation parameters. Ultrasound and magnetic resonance imaging (MRI) revealed a large, inhomogeneous pelvic mass (16 cm × 9 cm × 13 cm) with indistinct margins, suggestive of an infiltrative malignant teratoma or sarcoma. Laparoscopy confirmed a large mass of unknown origin. In contrast to the infiltrative character seen on preoperative MRI, the tumor could be easily exteriorized and resected after conversion to laparotomy. Ovaries, fallopian tubes, and uterus remained unaffected. Histopathology revealed a benign nonluteinized thecoma. The postoperative course and 19-month follow-up were uneventful.
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Affiliation(s)
- Ophelia Aubert
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Robin Wachowiak
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Christian Roth
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Anne K Höhn
- Division of Gynecologic, Breast and Perinatal Pathology, Institute of Pathology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Martin Lacher
- Department of Pediatric Radiology, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Steffi Mayer
- Department of Pediatric Surgery, University Hospital Leipzig, Leipzig, Sachsen, Germany
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11
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Bouab M, Touimi AB, El Omri H, Boufettal H, Mahdaoui S, Samouh N. Primary ovarian fibroma in a postmenopausal woman: A case report. Int J Surg Case Rep 2022; 92:106842. [PMID: 35202937 PMCID: PMC8881482 DOI: 10.1016/j.ijscr.2022.106842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/28/2022] Open
Abstract
Introduction Primary ovarian leiomyoma is a rare benign tumor of the ovary seen in women between 20 and 65 years old. Clinical, ultasonographic and tumor marker data remain the best preoperative approach currently available for ovarian tumours. Only pathological examination can establish the diagnosis. Case presentation We describe a case of unilateral, ovarian leiomyoma. The abdomino-pelvic Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a left adnexial mass. A hysterectomy without adnexal preservation was performed, and histological examination revealed a leiomyoma arising primarily in the ovary. The diagnosis was confirmed immunohistochemically. Discussion The tumor may be asymptomatic or may manifest with lower abdominal pain associated to metrorrhagia like in our case. The definitive diagnosis of these lesions is difficult prior to surgical removal. Because there is no pathognomonic symptoms or characteristic imaging findings. The correct diagnosis of an ovarian leiomyoma is confirmed immunohistochemically. Conclusion This rare tumor of the ovary should be considered in the differential diagnosis of solid ovarian masses. An immunohistochemical analysis is recommended for definitive diagnosis. Primary ovarian leiomyoma is one of the rarest solid tumours of the ovary. Differential diagnosis can be difficult from ovarian solid tumours. Unilateral and benign tumours can be treated with unilateral salpingo-oopherectomy.
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Affiliation(s)
- Maryem Bouab
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco.
| | - Ahmed Benjelloun Touimi
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Hajar El Omri
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Houssine Boufettal
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Sakher Mahdaoui
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
| | - Naima Samouh
- Department of Gynecology and Obstetrics, University Hospital Center Ibn Rochd, Casablanca 20100, Morocco; Faculty of Medicine and Pharmacy, Hassan II University of Casablanca, Casablanca, Morocco
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12
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Wang J, Yang Q, Zhang NN, Wang DD. Recurrent postmenopausal bleeding - just endometrial disease or ovarian sex cord-stromal tumor? A case report. World J Clin Cases 2022; 10:275-282. [PMID: 35071528 PMCID: PMC8727278 DOI: 10.12998/wjcc.v10.i1.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 09/09/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Postmenopausal bleeding (PMB) is a common gynecologic complaint among elderly women, and endometrial hyperplasia is a common cause of this bleeding. Ovarian fibromas are the most common type of ovarian sex cord-stromal tumor (SCST). They arise from non-functioning stroma, rarely show estrogenic activity, and stimulate endometrial hyperplasia, causing abnormal vaginal bleeding.
CASE SUMMARY We report herein the case of a 64-year-old Chinese woman who presented with recurrent PMB. A sex hormone test revealed that her estrogen level was significantly higher than normal, and other causes of hyperestrogenism had been excluded. The patient had undergone four curettage and hysteroscopy procedures in the past 7 years due to recurrent PMB and endometrial hyperplasia. The culprit behind the increase in estrogen level—an ovarian cellular fibroma with estrogenic activity—was eventually found during the fifth operation.
CONCLUSION Ovarian cellular fibromas occur insidiously, and some may have endocrine functions. Postmenopausal patients with recurrent PMB and endometrial thickening observed on ultrasonography are recommended to undergo sex hormone testing while waiting for results regarding the pathology of the endometrium. If the estrogen level remains elevated, the clinician should consider the possibility of an ovarian SCST and follow-up the patient closely, even if the imaging results do not indicate ovarian tumors. Once the tumor is found, it should be removed as soon as possible no matter the size to avoid endometrial lesions due to long-term estrogen stimulation. More studies are needed to confirm whether preventive total hysterectomy with bilateral salpingo-oophorectomy should be recommended for women with recurrent PMB exhibiting elevated estrogen levels, despite the auxiliary examination results not indicating ovarian mass. The physical and psychological burden caused by repeated curettage could be prevented using this technique.
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Affiliation(s)
- Jiao Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Qing Yang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Ning-Ning Zhang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
| | - Dan-Dan Wang
- Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
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13
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Palmieri A, ElSahwi K, Hicks V. Meigs syndrome presenting with severely elevated CA-125 level. BMJ Case Rep 2021; 14:14/3/e238931. [PMID: 33653838 PMCID: PMC7929823 DOI: 10.1136/bcr-2020-238931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 64-year-old woman referred to Gynaecological Oncology secondary to the finding of pelvic mass and ascites. Imaging showed multiple pelvic masses, with the largest mass measuring 20 cm in diameter, as well as bilateral pleural effusions and abdominal ascites, suspicious for ovarian carcinoma. Laboratory findings included elevated cancer antigen 125 (CA-125) of 2124 units/mL. The patient underwent an exploratory laparotomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy for pathological evaluation. Postoperatively, the patient had resolution of ascites and pleural effusion. Surgical pathology revealed a 26 cm right ovarian fibroma, confirming the diagnosis of Meigs syndrome. Despite the high suspicion for ovarian carcinoma in patients presenting with elevated CA-125 level, pelvic mass, ascites and pleural effusion, the diagnosis of Meigs syndrome cannot be excluded without pathological evaluation of mass.
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Affiliation(s)
- Alicia Palmieri
- Obstetrics & Gynecology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Karim ElSahwi
- Gynecology Oncology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
| | - Verda Hicks
- Gynecology Oncology, Jersey Shore University Medical Center, Neptune City, New Jersey, USA
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14
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Chandramohan A, Bhat TA, John R, Simon B. Multimodality imaging review of complex pelvic lesions in female pelvis. Br J Radiol 2020; 93:20200489. [DOI: 10.1259/bjr.20200489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Complex pelvic lesions can originate from various anatomical structures in the pelvis and pose a diagnostic dilemma due to a wide range of possible diagnoses. Accurate characterisation of these lesions would often require an algorithmic approach, which incorporates clinical findings, sequential use of multiple imaging modalities and a multiparametric approach. This approach usually aims at identifying key imaging features, which aid in anatomical localisation, morphology and tissue characterisation. There have been various attempts to standardise the lexicon used for describing adnexal masses in female patients; stratify their risk of cancer and suggest appropriate next steps in the management pathway. Through this review, we extend this approach to complex pelvic masses in female pelvis in general and will focus on optimal use of different imaging modalities to arrive at definitive diagnosis or meaningful differential diagnosis. We will also discuss potential pitfalls of imaging diagnosis and common mimics.
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Affiliation(s)
| | | | - Reetu John
- Department of Radiology, Christian Medical College, Vellore, India
| | - Betty Simon
- Department of Radiology, Christian Medical College, Vellore, India
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15
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Abdulrahman GO, Das N, Lutchman Singh K. The predictive role of thrombocytosis in benign, borderline and malignant ovarian tumors. Platelets 2020; 31:795-800. [PMID: 31665945 DOI: 10.1080/09537104.2019.1686755] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Ovarian cancer is a lethal gynecological malignancy. Although CA-125 is commonly measured in women with adnexal mass, it is estimated that it only has a positive predictive value (PPV) of 69% and a negative predictive value (NPV) of 88% for the detection of ovarian cancer. The aim of this study was to investigate the diagnostic significance and predictive impact of thrombocytosis in women with suspected or confirmed ovarian cancer. This was a retrospective study of women who had surgery for adnexal mass over a 48-month period between September 2014 and September 2018 at Swansea Gynecological Oncology Center in Wales, UK. A total of 294 women who underwent surgery for high-risk pelvic mass or biopsy-confirmed ovarian cancer were identified. 206 women (70%) had final histology confirming ovarian cancer, 54 women (18%) had benign tumors while 34 women (12%) had borderline tumors. 90/206 women (43.7%) with ovarian cancer had thrombocytosis prior to primary surgery or neoadjuvant chemotherapy compared to 8/54 (14.8%) for benign tumors and 4/34 (11.8%) for borderline tumors. Thrombocytosis was observed in 23.2%, 40%, 45.1%, and 65.1% of Stages I, II, III, and IV ovarian cancer, respectively. Thrombocytosis was a stronger predictor of ovarian malignancy in younger women of less than 60 years (p = .041). Overall, the positive likelihood ratio of platelet count in the detection of ovarian cancer was 2.61 while the negative likelihood ratio was 0.72, with a diagnostic odds ratio of 3.625. Thrombocytosis was strongly associated with advanced stage ovarian cancer (Stage III/IV) (p = .002). Interestingly, 4/8 (50%) women with thrombocytosis in the benign ovarian tumor group were diagnosed with ovarian fibroma/fibrothecoma, which often mimics advanced ovarian cancer at presentation. Predictive markers for borderline tumors continue to remain a challenge. We believe that there is a role for platelet count in primary care algorithm for women with suspected ovarian cancer. We suspect that platelets play a role in the metastasis of ovarian cancer.
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Affiliation(s)
- Ganiy Opeyemi Abdulrahman
- Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board , Swansea SA2 8QA, United Kingdom
| | - Nagindra Das
- Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board , Swansea SA2 8QA, United Kingdom
| | - K Lutchman Singh
- Swansea Gynaecological Oncology Centre, Swansea Bay University Health Board , Swansea SA2 8QA, United Kingdom.,Swansea University Medical School, Swansea University , Swansea SA2 8PP, United Kingdom
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16
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Clinical laboratory features of Meigs' syndrome: a retrospective study from 2009 to 2018. Front Med 2020; 15:116-124. [PMID: 32651935 DOI: 10.1007/s11684-019-0732-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 10/31/2019] [Indexed: 10/23/2022]
Abstract
Meigs' syndrome (MS), a rare complication of benign ovarian tumors, is easily misdiagnosed as ovarian cancer (OC). We retrospectively reviewed the clinical laboratory data of patients diagnosed with MS from 2009 to 2018. Serum carbohydrate antigen 125 and HE4 levels were higher in the MS group than in the ovarian thecoma-fibroma (OTF) and healthy control groups (all P < 0.05). However, the serum HE4 levels were lower in the MS group than in the OC group (P < 0.001). A routine blood test showed that the absolute counts and percentages of lymphocytes were significantly lower in the MS group than in the OTF and control groups (all P < 0.05). However, these variables were higher in the MS group than in the OC group (both P < 0.05). The neutrophil-to-lymphocyte ratio (NLR) was also significantly lower, whereas the lymphocyte-to-monocyte ratio was higher in the MS group than in the OC group (both P < 0.05). The NLR, platelet-to-lymphocyte ratio, and systemic immune index were significantly higher in the MS group than in the OTF and control groups (all P < 0.05). The hypoxia-inducible factor-1 mRNA levels were also significantly higher, whereas the glucose transporter 1, lactate dehydrogenase, and enolase 1 mRNA levels were lower in peripheral CD4+ T cells obtained preoperatively in a patient with MS than those in patients with OTF, patients with OC, and controls (all P < 0.05). The expression of these four glucose metabolism genes was preferentially restored to normal levels after the tumor resection of MS (P < 0.001). These clinical laboratory features can be useful in improving the preoperative diagnostic accuracy of MS.
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17
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Abdelazim IA, Abu-Faza M, Abdelrazek K, Amer OO, Shikanova S, Zhurabekova G. Ovarian Fibroma Commonly Misdiagnosed as Uterine Leiomyoma. Gynecol Minim Invasive Ther 2020; 9:36-38. [PMID: 32090012 PMCID: PMC7008642 DOI: 10.4103/gmit.gmit_131_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/11/2019] [Accepted: 04/25/2019] [Indexed: 11/04/2022] Open
Abstract
Ovarian fibroma usually misdiagnosed preoperatively as uterine leiomyoma. A 36-year-old woman, presented with abdominal pain and vomiting, provisionally diagnosed as complicated ovarian cyst. The transvaginal ultrasound and Doppler showed left solid adnexal mass with preserved ovarian blood flow. Magnetic resonance imaging showed a well-defined solid mass in the left side of the pelvis, measuring 8 cm × 10 cm most probably subserous uterine leiomyoma. At laparotomy, the solid ovarian mass was originating from the left ovary, and the microscopic examination confirmed the diagnosis of the ovarian fibroma. This report represents the preoperative misdiagnosis of the ovarian fibromas and the conservative ovarian surgery for the ovarian fibromas and the importance of the follow-up for future fertility and/or recurrence of the fibromas in young women.
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Affiliation(s)
- Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt.,Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait
| | - Mohannad Abu-Faza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait
| | - Khaled Abdelrazek
- Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Osama O Amer
- Department of Obstetrics and Gynecology, Ghamra Military Hospital, Cairo, Egypt
| | - Svetlana Shikanova
- Department of Obstetrics and Gynecology №1, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
| | - Gulmira Zhurabekova
- Department of Normal and Topographical Anatomy, Marat Ospanov, West Kazakhstan State Medical University, Aktobe, Kazakhstan
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18
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Damiani GR, Villa M, Licchetta G, Cesana MC, Dinaro E, Loverro M, Muzzupapa G, Pellegrino A. A rare case of recurrences of multiple ovarian fibrothecoma. J OBSTET GYNAECOL 2019; 41:158-159. [PMID: 31825295 DOI: 10.1080/01443615.2019.1677581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
| | - Mario Villa
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, Lecco, Italy
| | - Giulio Licchetta
- Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | | | - Edoardo Dinaro
- Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Matteo Loverro
- Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Giuseppe Muzzupapa
- Department of Obstetrics and Gynaecology, University of Bari, Bari, Italy
| | - Antonio Pellegrino
- Department of Obstetrics and Gynaecology, Alessandro Manzoni Hospital, Lecco, Italy
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19
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Shih JA, Garrett LA, Carbo AR. Meigs' Syndrome: A Sheep in Wolf's Clothing. Am J Med 2019; 132:e803-e804. [PMID: 31153867 DOI: 10.1016/j.amjmed.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 05/09/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Jenny A Shih
- Harvard Medical School, Boston, Mass; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass.
| | - Leslie A Garrett
- Harvard Medical School, Boston, Mass; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
| | - Alexander R Carbo
- Harvard Medical School, Boston, Mass; Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, Mass; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Mass
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20
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Tarlovskaya EI, Kamardina NA, Mazalov KV. [Demons-Meigs syndrome or cardiomyopathy: a difficult case of a differential diagnosis]. ACTA ACUST UNITED AC 2019; 59:64-68. [PMID: 31995727 DOI: 10.18087/10.18087/cardio.n447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 02/21/2019] [Accepted: 07/31/2019] [Indexed: 11/18/2022]
Abstract
The article presents an overview of the data related to Demons-Meigs syndrome and the clinical situation associated with a complex differential diagnosis between myocarditis with the formation of secondary cardiomyopathy and Demons-Meigs syndrome. A variety of clinical symptom complexes that are associated with Demons-Meigs syndrome is discussed. The concepts of classical and non-classical, full and incomplete Demons-Meigs syndrome are considered. The current views on the pathogenesis of the syndrome and the mechanism of the formation of ascites and pleural effusion are given.
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Affiliation(s)
- E I Tarlovskaya
- IFM FSBEI HE "Privolzhsky Research Medical University" MOH Russia
| | - N A Kamardina
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
| | - K V Mazalov
- Clinical Hospital №4 of the Federal health care institution Volga district medical centre of Federal medical-biological agency
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21
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Bagga R, Garg S, Muthyala T, Kalra J, Kumar Saha P, Arora A, Singla R, Singh T, Gupta N. Gorlin syndrome presenting with primary infertility and bilateral calcified ovarian fibromas. J OBSTET GYNAECOL 2019; 39:874-876. [PMID: 31020883 DOI: 10.1080/01443615.2019.1581752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Rashmi Bagga
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Shivani Garg
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Tanuja Muthyala
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Jasvinder Kalra
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Pradip Kumar Saha
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Aashima Arora
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Rimpy Singla
- a Department of Gynaecology and Obstetrics , PGIMER , Chandigarh , India
| | - Tulika Singh
- b Department of Radiology , PGIMER , Chandigarh , India
| | - Nalini Gupta
- c Department of Cytology and Gynecological Pathology , PGIMER , Chandigarh , India
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22
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Muratori L, Gorzegno G, Sperone P, Andreozzi A, Di Maio M, Scagliotti GV. Long term control of luteinized thecoma with sclerosing peritonitis with leuprorelin and tamoxifen treatment. Gynecol Oncol Rep 2019; 28:44-46. [PMID: 30859116 PMCID: PMC6396082 DOI: 10.1016/j.gore.2019.02.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/12/2019] [Accepted: 02/14/2019] [Indexed: 11/26/2022] Open
Abstract
Background Luteinized thecoma with sclerosing peritonitis (LTSP) is a very rare condition, and its clinical management is not evidence-based. Here we describe a case of long-term disease control achieved with leuprorelin and tamoxifen therapy. Case presentation A 18-year-old woman with acute abdomen underwent surgical removal of an ovarian mass and received diagnosis of LTSP. Treatment plan consisted of leuprorelin and tamoxifen, followed by a good instrumental response. After 5 years, leuprorelin was stopped, and the patient continued tamoxifen alone. Ten years after diagnosis, she is still disease free. Conclusion Even in the absence of solid evidence, the combination of leuprorelin and tamoxifen could be considered as a possible medical treatment of LTSP. Considering the limitations related to the rarity of disease, further studies are needed to improve its management. Luteinized thecoma with sclerosing peritonitis (LTSP) is a rare condition characterized by a very hard management. Few cases are described in literature and no evidences about the best treatment of this condition are available. We present a case of a very long control (ten year) of LTSP with tamoxifen and leuprorelin treatment. Based on the lack of evidences, this approach could be considered as treatment of LTSP.
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Affiliation(s)
- L Muratori
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - G Gorzegno
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - P Sperone
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - A Andreozzi
- Anatomopathology, Department of Pathology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
| | - M Di Maio
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Ordine Mauriziano, Corso Re Umberto 109, 10128 Turin, Italy
| | - G V Scagliotti
- Medical Oncology, Department of Oncology, University of Turin, Azienda Ospedaliera Universitaria San Luigi Gonzaga, Regione Gonzole 10, 10043 Orbassano, Turin, Italy
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23
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Yazawa H, Takiguchi K, Kato A, Imaizumi K. An Unusual Presentation of Ovarian Fibroma Originating from an Autoamputated Ovary. Gynecol Minim Invasive Ther 2019; 8:40-43. [PMID: 30783589 PMCID: PMC6367919 DOI: 10.4103/gmit.gmit_63_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Revised: 10/26/2018] [Accepted: 10/29/2018] [Indexed: 11/04/2022] Open
Abstract
We describe an extremely rare case of an unusually presented ovarian fibroma adherent to the sigmoid colon originating from an autoamputated ovary. A 64-year-old woman was referred to our hospital with an abnormal shadow that was approximately 4 cm in diameter in the pelvic cavity detected on abdominal X-ray imaging. Computed tomography demonstrated an irregularly shaped tumor with calcification in the pelvic cavity. Laparoscopy revealed that the tumor was adherent to the surface of the sigmoid colon with a discontinuous shell and empty cavity. The left ovary was lacking, although the left salpinx and right adnexa were in their normal locations. The tumor was carefully resected with cutting of the serosa of the sigmoid colon. The serosal defect was repaired with sutures. Postoperative histopathological diagnosis was old fibroma with calcification. To the best of our knowledge, this is the first reported case of extragonadal ovarian tumor originating from an autoamputated ovarian fibroma.
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Affiliation(s)
- Hiroyuki Yazawa
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Kaoru Takiguchi
- Department of Obstetrics and Gynecology, Ohta Nishinouchi Hospital, Koriyama, Japan
| | - Asami Kato
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
| | - Karin Imaizumi
- Department of Obstetrics and Gynecology, Fukushima Red Cross Hospital, Fukushima, Japan
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24
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Haghayeghi K, Hansen K, Quddus MR. Luteinized Fibrothecoma. Int J Surg Pathol 2018; 27:654-655. [PMID: 30520326 DOI: 10.1177/1066896918817372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Koorosh Haghayeghi
- 1 Women & Infants Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
| | - Katrine Hansen
- 1 Women & Infants Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
| | - M Ruhul Quddus
- 1 Women & Infants Hospital, Providence, RI, USA.,2 Brown University, Providence, RI, USA
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25
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Shen Y, Liang Y, Cheng X, Lu W, Xie X, Wan X. Ovarian fibroma/fibrothecoma with elevated serum CA125 level: A cohort of 66 cases. Medicine (Baltimore) 2018; 97:e11926. [PMID: 30142807 PMCID: PMC6112998 DOI: 10.1097/md.0000000000011926] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Ovarian fibroma/fibrothecoma with elevated serum OC125 antigen (CA125) is rarely encountered in clinical practice, and also easily misdiagnosed as epithelial ovarian carcinoma (EOC). The aim of this study was to investigate the clinicopathological features of ovarian fibroma/fibrothecoma with elevated serum CA125.In total, 580 patients who underwent primary surgery and pathologically diagnosed as ovarian fibroma/fibrothecoma were retrospectively analyzed. The clinicopathological parameters were collected and compared between the patients with elevated serum CA125 (>35 U/mL) and without. The immunoreactivity for CA125 in ovarian fibroma/fibrothecoma and epithelial cancer tissues was detected and compared by immunohistochemistry. Univariate and multivariate analyses were performed to identify factors associated with elevated serum CA125 level. The correlation between the immunoreactivity of CA125 in tissue and serum CA125 level was examined by Pearson correlation analysis.Elevated serum CA125 level (range 36.7-1848 u/m) was found in 66 of 580 (11.3%) ovarian fibroma/fibrothecoma patients. Univariate analysis showed that the elevated serum CA125 level was significantly correlated with tumor diameter ≥10 cm (P < .001), ascites (P < .001), and hydrothorax (P < .001). Multivariate analysis revealed that tumor diameter ≥10 cm and ascites were independently associated factors (P < .001 and < .001 respectively). Immunohistochemical staining showed that the expression of CA125 was negative in all fibroma/fibrothecoma tissues, but positive in all EOC tissues, and the immunoreactivity for CA125 was positively correlated with serum CA125 level in the EOC patients (P = .005).The elevated serum CA125 level in ovarian fibroma/fibrothecoma is nontumor originated and occurs more frequently in those with larger size tumor or Meigs syndrome.
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Affiliation(s)
- Yuanming Shen
- Women's Reproductive Health Laboratory of Zhejiang Province
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yun Liang
- Women's Reproductive Health Laboratory of Zhejiang Province
| | - Xiaodong Cheng
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Weiguo Lu
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xing Xie
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaoyun Wan
- Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Saal C, Jeandel R, Boukamel S, Yver M. [Fibrothecoma of the testis: A case report in an adult]. Ann Pathol 2018; 38:249-252. [PMID: 29803360 DOI: 10.1016/j.annpat.2018.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Accepted: 04/03/2018] [Indexed: 12/01/2022]
Abstract
Fibrothecal tumors belong to sex cord/stromal tumors (SCSTS). They represent 1 to 4.7 % of the organics tumors of ovary (Chechia et al., 2008) but are extremely rare in the testis, with only a few cases described in the literature. We report a new case of a fibrothecoma in the testis in an adult. The extemporaneous diagnosis was made in the same time of the surgical intervention. The castration has been avoided.
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Affiliation(s)
- Caroline Saal
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France.
| | - Roland Jeandel
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
| | - Samir Boukamel
- Service d'urologie, centre hospitalier de Meaux, 6-8, rue Saint-Fiacre, 77104 Meaux, France
| | - Matthieu Yver
- Service de pathologie, centre hospitalier de Marne-La-Vallée, 2-4, cours de la Gondoire, 77600 Jossigny, France
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Mohapatra V, Patra S, Nayak M, Gharei R, Sahoo N. Cellular Fibroma of Ovary Coexisting with Proliferative Endometrium Post Menopause: A Rare Presentation. J Clin Diagn Res 2017; 11:QD05-QD07. [PMID: 28892985 DOI: 10.7860/jcdr/2017/27199.10247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 05/30/2017] [Indexed: 11/24/2022]
Abstract
Ovarian fibromas are benign sex cord stromal tumours occurring in peri-menopausal and post-menopausal women. These tumours are composed of spindle fibroblastic cells producing collagen. They are almost always endocrine-inert and are rarely associated with hormone production. We report herein a case of a 60-year-old Indian woman presenting as post-menopausal bleeding. Imaging studies and endometrial biopsy revealed a right ovarian solid tumour coexisting with thickened proliferative endometrium, other causes of hyperoestrogenism being excluded in the woman. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. Histopathology showed cellular fibroma of right ovary and proliferative endometrium with foci of hyperplasia without atypia.
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Affiliation(s)
- Vandana Mohapatra
- Senior Resident, Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Susama Patra
- Additional Professor and Head, Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Mamita Nayak
- Senior Resident, Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Radhamohan Gharei
- Senior Resident, Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
| | - Nibedita Sahoo
- Senior Resident, Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), Bhubaneswar, Odisha, India
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Chen H, Liu Y, Shen LF, Jiang MJ, Yang ZF, Fang GP. Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison. J Ovarian Res 2016; 9:81. [PMID: 27876070 PMCID: PMC5120502 DOI: 10.1186/s13048-016-0291-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
Background Ovarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. The objective of the study was to demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology. Methods A total of 61 patients with surgically proven OTFG were enrolled in this retrospective study to demonstrate its clinical and sonographic features and to compare with pathological findings. Gray scale and color Doppler sonography were performed presurgically with either transabdominal or transvaginal approach to image pelvic structures and lesions. The clinical findings and sonographic appearances were compared with the types of the OTFG tumors based on the histopathological diagnosis. Results The mean patient age was 53.57 (range, 26–86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi’s syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level (p < 0.01) and the amount of ascites fluid (p < 0.05). Conclusions The typical sonographic features of OTFG include adnexal hypoechoic masses with clear border and acoustic attenuation as well as minimal Doppler flow signals. All the aforementioned features could make ultrasound imaging as a assistent tool improve the preoperative diagnostic accuracy.
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Affiliation(s)
- Hui Chen
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Yan Liu
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China.
| | - Li-Fei Shen
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Mei-Jiao Jiang
- Department of Obstetrics and Gynecology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Zhi-Fang Yang
- Department of Ultrasound, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
| | - Guo-Ping Fang
- Department of Pathology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, 200025, People's Republic of China
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Hugon-Rodin J, Kalhorpour N, Borghese B, Bordonne C, Just PA, Gompel A, Lahlou N. Inhibin A and inhibin B producing ovarian fibrothecoma revealed by suppression of follicle stimulating hormone (FSH) in a post-menopausal woman: report of the first case. Gynecol Endocrinol 2016; 32:872-874. [PMID: 27689825 DOI: 10.1080/09513590.2016.1222364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
In this report, we describe the first case ever reported in the literature, of an inhibin-A (INHA) and inhibin-B (INHB) producing fibrothecoma. A post-menopausal woman was referred to our unit because of follicle stimulating hormone (FSH) level below the reference interval for postmenopausal women. By contrast luteinizing hormone, hCG, and estradiol levels were within normal range. This discrepancy suggested the secretion of FSH inhibitory factors. INHB and INHA levels were markedly elevated for age, 475 pg/mL and 100 pg/mL, respectively. Ultrasonography and MRI showed a pelvic mass of indeterminate nature. Abnormal inhibin secretion is generally observed in granulosa cell tumors. In this case this etiology was unlikely because of low estradiol and AMH levels. Surgical exploration revealed a 10 cm mass of the left ovary proven histologically to be an ovarian fibrothecoma (OFT). After tumor removal, INHB and INHA levels decreased rapidly. Only three cases of OFT with an important secretion of INHB have been reported to date. INHA secretion has never been associated with OFT. There is a need to develop coupled hormone and imaging strategies to diagnose the source of INH secretion in case of FSH/LH discrepancy.
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Affiliation(s)
- Justine Hugon-Rodin
- a Gynecology Endocrinology Unit, Paris Descartes University, Port-Royal Cochin Hospital , Paris , France
| | - Négar Kalhorpour
- a Gynecology Endocrinology Unit, Paris Descartes University, Port-Royal Cochin Hospital , Paris , France
| | - Bruno Borghese
- b Department of Gynecology , Port-Royal Hospital, Paris Descartes University , Paris , France
| | - Corinne Bordonne
- c Department of Radiology , Hotel-Dieu Hospital , Paris , France
| | - Pierre-Alexandre Just
- d Department of Pathology , Cochin Hospital, Paris Descartes University , Paris , France , and
| | - Anne Gompel
- a Gynecology Endocrinology Unit, Paris Descartes University, Port-Royal Cochin Hospital , Paris , France
| | - Najiba Lahlou
- e Specialized Hormone Unit, Cochin Hospital, Paris Descartes University , Paris , France
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Ray A, Masch WR, Saukkonen K, Harrison BT. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 18-2016. A 52-Year-Old Woman with a Pleural Effusion. N Engl J Med 2016; 374:2378-87. [PMID: 27305196 DOI: 10.1056/nejmcpc1600612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Alaka Ray
- From the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Massachusetts General Hospital, and the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Harvard Medical School - both in Boston
| | - William R Masch
- From the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Massachusetts General Hospital, and the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Harvard Medical School - both in Boston
| | - Kai Saukkonen
- From the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Massachusetts General Hospital, and the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Harvard Medical School - both in Boston
| | - Beth T Harrison
- From the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Massachusetts General Hospital, and the Departments of Medicine (A.R., K.S.), Radiology (W.R.M.), and Pathology (B.T.H.), Harvard Medical School - both in Boston
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Okuda K, Noguchi S, Narumoto O, Ikemura M, Yamauchi Y, Tanaka G, Takai D, Fukayama M, Nagase T. A case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion. BMC Pulm Med 2016; 16:71. [PMID: 27160723 PMCID: PMC4862177 DOI: 10.1186/s12890-016-0241-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Meigs’ syndrome is defined as the presence of a benign ovarian tumor with pleural effusion and ascites that resolve after removal of the tumor. The pathogenesis of the production of ascites and pleural effusion in this syndrome remains unknown. Aside from pleural effusion and ascites, pericardial effusion is rarely observed in Meigs’ syndrome. Here, we report the first case of Meigs’ syndrome with preceding pericardial effusion in advance of pleural effusion. Case presentation An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month. She had asymptomatic and unchanging pericardial effusion and a pelvic mass, which had been detected 3 and 11 years previously, respectively. The patient was radiologically followed-up without the need for treatment. Two months before admission, the patient underwent a right upper lobectomy for localized lung adenocarcinoma and intraoperative pericardial fenestration confirmed that the pericardial effusion was not malignant. However, she began to experience dyspnea on exertion leading to admission. A chest, abdomen, and pelvis computed tomography scan confirmed the presence of right-sided pleural and pericardial effusion and ascites with a left ovarian mass. Repeated thoracentesis produced cultures that were negative for any microorganism and no malignant cells were detected in the pleural effusions. Pleural fluid accumulation persisted despite a tube thoracostomy for pleural effusion drainage. With a suspicion of Meigs’ syndrome, the patient underwent surgical resection of the ovarian mass and histopathological examination of the resected mass showed ovarian fibroma. Pleural and pericardial effusion as well as ascites resolved after tumor resection, confirming a diagnosis of Meigs’ syndrome. This clinical course suggests a strong association between pericardial effusion and ovarian fibroma, as well as pleural and peritoneal fluid. Conclusions In female patients with unexplained pericardial effusion and an ovarian tumor, clinicians should consider the possibility of Meigs’ syndrome. Although a malignant disease should be suspected in all patients with undiagnosed pleural and/or pericardial effusion, Meigs’ syndrome is curable by tumor resection and should be differentiated from malignancy.
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Affiliation(s)
- Kenichi Okuda
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Narumoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daiya Takai
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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Podfigurna-Stopa A, Czyzyk A, Katulski K, Moszynski R, Sajdak S, Genazzani AR, Meczekalski B. Recurrent endometrial hyperplasia as a presentation of estrogen-secreting thecoma - case report and minireview of the literature. Gynecol Endocrinol 2016; 32:184-7. [PMID: 26585670 DOI: 10.3109/09513590.2015.1113519] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Thecoma is a rare ovarian tumor, presenting usually in postmenopausal women as unilateral, benign, solid lesion. About 15% of affected patients develop endometrial hyperplasia (EH) and 20% are diagnosed with endometrial cancer. In this case report, we present 60-year-old women admitted because of recurrent spotting of 5 years duration, which started 1 year after menopause. In history, the patient underwent three times curettage procedures and once (1 year before admission) had estradiol levels typical for reproductive-age women. At admission, we found elevated serum levels of estradiol (222.5 pg/ml) and a small mass in the right ovary. The markers of germ cell tumors were negative. After the initial diagnosis, the patient was qualified for total abdominal hysterectomy with bilateral salpingo-oophorectomy. The histopathological examination and immunohistochemical staining confirmed the thecoma diagnosis. In follow-up examination after 8 weeks, we found decreased serum estradiol levels and relief of the symptoms. In conclusion, we want to underline that in cases of EH, especially in patients with a history of recurrences, the special attention should be paid for differential diagnosis. In such cases, the estrogen-secreting tumors should be excluded.
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Affiliation(s)
| | | | | | - Rafal Moszynski
- b Division of Gynecological Surgery , Poznan University of Medical Sciences , Poznan , Poland , and
| | - Stefan Sajdak
- b Division of Gynecological Surgery , Poznan University of Medical Sciences , Poznan , Poland , and
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Fremed MA, Levin TL, Sun KY, Weiser DA. Ovary preservation in the treatment of childhood Meigs syndrome. Pediatr Blood Cancer 2015; 62:2011-4. [PMID: 26011288 DOI: 10.1002/pbc.25586] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Accepted: 04/15/2015] [Indexed: 11/10/2022]
Abstract
Meigs syndrome, the combination of benign ovarian tumor, ascites, and pleural effusion, is present in a small percentage of ovarian fibromas and is infrequently reported in children. When associated with elevated CA-125 suspicion is raised for malignancy, often prompting aggressive surgical intervention. We present a case of childhood Meigs syndrome and review the relevant literature with emphasis on ovary preservation. Out of nine identified pediatric cases, one involved ovary sparing treatment and none recurred or progressed to malignancy. Our report highlights the importance of presurgical identification of Meigs syndrome in order to curtail salpingo-oophorectomy when feasible.
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Affiliation(s)
| | - Terry L Levin
- Department of Radiology, Division of Pediatric Radiology, Montefiore Medical Center, Bronx, New York
| | - Katherine Y Sun
- Department of Pathology, Montefiore Medical Center, Bronx, New York
| | - Daniel A Weiser
- Departments of Pediatrics and Genetics, Albert Einstein College of Medicine, Bronx, New York.,Division of Pediatric Hematology/Oncology, Children's Hospital at Montefiore, Bronx, New York
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de Santana Santos T, Vajgel A, Martins-Filho PRS, de Albuquerque Maranhao Filho AW, De Holanda Vasconcellos RJ, Frota R, Filho JRL. Nevoid Basal Cell Carcinoma Syndrome: A Long-Term Study in a Family. Craniomaxillofac Trauma Reconstr 2015; 9:94-104. [PMID: 26889355 DOI: 10.1055/s-0035-1558454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Accepted: 02/22/2015] [Indexed: 12/11/2022] Open
Abstract
We present a family case series with 10 individuals having nevoid basal cell carcinoma syndrome (NBCCS) with a 10-year follow-up. All articles published in the literature between 1967 and 2011 on familial Gorlin-Goltz syndrome in any language were surveyed to determine the mapping of cases per country of occurrence of this disease. All patients in the present series were presented with calcification of the falx cerebri, mild hypertelorism, and frontal bossing. Odontogenic keratocystic tumors, palmar and plantar pits, and multiple basal cell carcinomas occurred in 90, 40, and 20%, respectively, of the patients. One of the patients died of skin cancer. Diagnosis of odontogenic keratocyst tumors was confirmed by histopathological examination. NBCCS is a rare autosomal dominant cancer predisposition syndrome; it is important to recognize it when a patient has multiple odontogenic keratocyst tumors because life-long monitoring is essential for patient management.
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Affiliation(s)
- Thiago de Santana Santos
- Hospital Universitário, Universidade Federal de Sergipe, Rua Claudio Batista, Aracaju, Sergipe, Brazil
| | - André Vajgel
- Department of Oral and Maxillofacial Surgery, Pernambuco School of Dentistry, Camaragibe, Pernambuco, Brazil
| | | | | | | | - Riedel Frota
- Department of Oral and Maxillofacial Surgery, Pernambuco School of Dentistry, Camaragibe, Pernambuco, Brazil
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Guest Speakers Abstracts. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2015. [DOI: 10.5301/je.5000214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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A Unique Case of Extraovarian Sex-Cord Stromal Fibrosarcoma, With Subsequent Relapse of Differentiated Sex-Cord Tumor. Int J Gynecol Pathol 2015; 34:363-8. [PMID: 25760903 DOI: 10.1097/pgp.0000000000000151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Primary fibrosarcoma arising from ovarian sex-cord stroma is a very rare neoplasm, with only a few reports in the literature. These tumors have been reported to express inhibin which allows their distinction from fibrosarcomas of soft tissue. Here, we report a case of a fibrosarcoma arising in the broad ligament. Despite being totally separate from the ovary, the tumor was diagnosed as sex-cord stromal type on the basis of inhibin expression. Furthermore, this patient suffered a recurrence of her tumor in the pelvis, which showed both the fibrosarcomatous, as well as other sex-cord elements, confirming the sex-cord stromal differentiation of the sarcoma. To our knowledge, this is the first case of a sex-cord stromal fibrosarcoma arising from an extraovarian site. Furthermore, this is also the first case of a recurrent fibrosarcoma, which showed redifferentiation of the tumor into other sex-cord components.
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Macciò A, Madeddu C, Kotsonis P, Pietrangeli M, Paoletti AM. Large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe anemia treated by laparoscopic surgery. BMC Surg 2014; 14:38. [PMID: 24962423 PMCID: PMC4074309 DOI: 10.1186/1471-2482-14-38] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 06/11/2014] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The Meigs' syndrome is a rare but well-known syndrome defined as the triad of benign solid ovarian tumor, ascites, and pleural effusion. Meigs' syndrome always requires surgical treatment. However, the optimal approach for its management has not been sufficiently investigated. CASE PRESENTATION We report a patient with a large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe hemolytic anemia that was treated by laparoscopic surgery. This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. Considering the patient's serious clinical condition and assuming that she had Meigs' syndrome with a twisted large ovarian mass and possible hemolytic anemia, we first concentrated on effective medical management of our patient and chose the most appropriate surgical treatment after laparoscopic examination. The main aim of our initial approach was preoperative management of the anemia. Blood transfusions and glucocorticoid therapy resulted in stabilization of the hemoglobin level and normalization of the bilirubin levels, which confirmed the appropriateness of this approach. Laparoscopic surgery 4 days after admission enabled definitive diagnosis of the tumor, confirmed torsion and removed the bulky ovarian fibroma, resulting in timely resolution of symptoms, short hospitalization, relatively low morbidity and a rapid return to her social and professional life. CONCLUSIONS This case highlights the difficulties that may be encountered in the management of patients with Meigs' syndrome, including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the medical and surgical approach, and the adverse impact that Meigs' syndrome can have on the patient's condition, especially if it is associated with acute pain and severe anemia. The present case suggests that laparoscopic surgery for potentially large malignant tumors is feasible and safe, but requires an appropriate medical and gynecological oncology expertise.
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Affiliation(s)
- Antonio Macciò
- Department of Gynecologic Oncology, Businco Hospital, Regional Referral Center for Cancer Disease, via Edward Jenner, Cagliari 09121, Italy.
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Azizi S, Nourbakhsh M, Kheirandish R. Ovarian Fibrothecoma in an Arabian Mare: A Rare Case. J Equine Vet Sci 2014. [DOI: 10.1016/j.jevs.2013.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ramkumar S, Jyotsna VP, Mallick S, Kachhawa G, Kandasamy D, Kriplani A, Ammini AC. Bilateral thecoma presenting as premenopausal hirsutism: Laproscopic removal. Indian J Endocrinol Metab 2013; 17:S662-S664. [PMID: 24910832 PMCID: PMC4046596 DOI: 10.4103/2230-8210.123561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Hyperandrogenism is a common disorder among women in the reproductive age group. One of the rare causes for androgen excess is sex cord- stromal tumors of the ovary. These are usually unilateral. Here we report case of a 48 year old woman who presented with hyperandrogenism due to bilateral ovarian thecoma. Androgen levels normalized following resection of the tumor. This, to the best of our knowledge, is the first case of bilateral thecoma presenting as hirsutism in a premenopausal woman.
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Affiliation(s)
- S. Ramkumar
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - V. P. Jyotsna
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - S. Mallick
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Garima Kachhawa
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - D. Kandasamy
- Department of Radiology, All India Institute of Medical Sciences, New Delhi, India
| | - A. Kriplani
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi, India
| | - A. C. Ammini
- Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India
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Numanoglu C, Kuru O, Sakinci M, Akbayır O, Ulker V. Ovarian fibroma/fibrothecoma: retrospective cohort study shows limited value of risk of malignancy index score. Aust N Z J Obstet Gynaecol 2013; 53:287-92. [PMID: 23611791 DOI: 10.1111/ajo.12090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 03/13/2013] [Indexed: 01/10/2023]
Abstract
BACKGROUND Ovarian fibromas/fibrothecomas are uncommon benign tumours of ovary. Due to their solid structure, these benign tumours are sometimes confused with malignant tumours during clinical evaluation. AIMS To determine the clinico-pathological characteristics of ovarian fibroma/fibrothecoma and analyse the efficiency of risk of malignancy index (RMI) scoring system to distinguish malignancy among these tumours. METHODS Between November 2001 and February 2012, women with a pathological diagnosis of ovarian fibroma/fibrothecoma were identified. Depending on the menopausal status, serum CA-125 level and ultrasonographic findings, RMI scores were calculated for each of the patients. RESULTS During the study period, 43 ovarian fibroma/fibrothecoma (4.7%) were detected among 912 adnexal masses operated. The mean age of the women was 52.2 (range, 21-80 years). Upon calculating RMI scores, 33 women (76.7%) were classified as low risk and 10 women (23.3%) as high risk for malignancy. Sensitivity, specificity, positive predictive value and negative predictive value of the RMI scoring for identification of malignant lesions preoperatively were found as 0%, 76%, 0% and 97%, respectively. Final pathological diagnosis was ovarian fibroma in 13 (30%) women, fibrothecoma in 29 (67%) and fibrosarcoma in one woman (2%). CONCLUSION There are no specific markers for accurate preoperative diagnosis of ovarian fibroma/fibrothecoma. Moreover, according to our results, RMI scoring system does not aid clinicians in this issue either, with a high false-positive rate and very low sensitivity. Further studies with higher number of cases are needed to state clearly the role of RMI scores in preoperative discrimination of malignancy.
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Affiliation(s)
- Ceyhun Numanoglu
- Department of Obstetrics and Gynecology, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
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Yen P, Khong K, Lamba R, Corwin MT, Gerscovich EO. Ovarian fibromas and fibrothecomas: sonographic correlation with computed tomography and magnetic resonance imaging: a 5-year single-institution experience. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2013; 32:13-18. [PMID: 23269706 DOI: 10.7863/jum.2013.32.1.13] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To evaluate imaging characteristics of ovarian fibromas and fibrothecomas and to identify select clinical markers and imaging features to help in their diagnosis. METHODS Over a 5-year period, 18 of 29 women with histologically proven fibromas or fibrothecomas underwent sonography, computed tomography (CT), or magnetic resonance imaging (MRI). On review of the images, tumor size, solid component characteristics, and cystic components were evaluated. Age, cancer antigen 125 (CA-125), and Meig syndrome were assessed. RESULTS Eleven fibrothecomas and 7 fibromas were evaluated. Sonography was performed for 15 tumors, CT for 9, and MRI for 6. Mean age was 52.6 (range, 13-82) years. Mean tumor size was 8.8 (range, 2-18) cm. Seventy-two percent of the tumors were solid, and 28% had cystic components. On sonography, the solid components were isoechoic or hypoechoic compared to the uterus. On CT with contrast, 2 of 8 lesions (25%) showed enhancement. On T1-weighted MRI, 5 lesions (83%) showed an isointense signal, and 1 (17%) showed a hyperintense signal compared to the myometrium. On T2-weighted MRI, 4 of 6 lesions (67%) were hypointense; 1 (16.5%) was isointense; and 1 (16.5%) was hyperintense. Elevated CA-125 was present in 5 of 29 patients (28%). One had Meig syndrome. CONCLUSIONS For a cystic adnexal mass where the primary consideration is commonly an epithelial tumor, the possibility of a cystic stromal tumor should also be considered. Unlike previous studies reporting both T1 and T2 hypointensity, fibrothecomas and fibromas can also show T1 and T2 isointensity and, exceptionally, hyperintensity. Vascularity, shown by Doppler flow and MRI and CT enhancement, is a characteristic of some fibromas and fibrothecomas. Although CA-125 is elevated in some patients, a true correlation is difficult to assess. Meig syndrome is infrequent.
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Affiliation(s)
- Philip Yen
- Department of Radiology, University of California, Davis Medical Center, 4860 Y St, Suite 3100, Sacramento, CA 95817, USA
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Cho YJ, Lee HS, Kim JM, Joo KY, Kim ML. Clinical Characteristics and Surgical Management Options for Ovarian Fibroma/Fibrothecoma: A Study of 97 Cases. Gynecol Obstet Invest 2013; 76:182-7. [DOI: 10.1159/000354555] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 07/23/2013] [Indexed: 01/13/2023]
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Monteiro SB, Costa A, Paiva V. Mitotically active cellular ovarian fibroma with Meigs' syndrome and elevated CA-125: towards fertility preservation. J Pediatr Adolesc Gynecol 2012; 25:e107-9. [PMID: 22980413 DOI: 10.1016/j.jpag.2012.05.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 05/12/2012] [Accepted: 05/21/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Meigs syndrome is rare in women under 30 years of age and even more if associated with an elevated CA-125. In this case, malignancy was suspected and raised concerns about fertility preservation. CASE A 13-year-old girl presented with a 4-month amenorrhea, abdominal enlargement and dyspnea. Ultrasonography showed a 14-cm solid mass with ascites, bilateral pleural effusion and, analytically, elevated serum CA-125. Unilateral salpingo-oophorectomy was performed, with a 19 × 15 × 12 cm mass being disclosed from the right ovary. Final pathology diagnosed a mitotically active cellular ovarian fibroma (MACF), with no significant nuclear atypia. CONCLUSION MACF is a recent histopathologic entity. Despite the high count of mitotic figures, it is not associated with atypia, which contributes to favorable outcome. Although initial suspicions of malignancy, a conservative surgical intervention allowed fertility preservation. This was clinically appropriate and with no implications on survival and prognosis of these patients.
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Affiliation(s)
- Sofia B Monteiro
- Department of Obstetrics and Gynecology, São João Hospital, Porto, Portugal.
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Retroperitoneal extraovarian fibrothecoma mimicking a malignant epithelial ovarian carcinoma. Case Rep Obstet Gynecol 2012; 2012:281745. [PMID: 22928131 PMCID: PMC3426186 DOI: 10.1155/2012/281745] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 07/10/2012] [Indexed: 11/17/2022] Open
Abstract
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.
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Su F, Cummings KW, Krigman H, Ranganathan P. Meigs' syndrome: a rare cause of recurrent pleural effusion in scleroderma. Rheumatol Int 2012; 33:2647-51. [PMID: 22538500 DOI: 10.1007/s00296-012-2437-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Accepted: 04/15/2012] [Indexed: 01/13/2023]
Abstract
Meigs' syndrome represents a triad of pleural effusion, ascites, and an ovarian tumor, usually benign, occurring together. We describe here a case of Meigs' syndrome in a patient with systemic sclerosis, the first such report to our knowledge, in systemic sclerosis. A 53-year-old woman with systemic sclerosis presented with recurrent right-sided pleural effusion, which led to symptoms of shortness of breath, chest tightness, and a non-productive cough. Physical examination revealed a palpable, mobile mass in the right lower quadrant, in addition to typical physical features of scleroderma. Thoracentesis yielded exudative pleural fluid with cytology negative for malignancy. Pleural biopsy was consistent with inflammatory changes, but negative for malignancy. CT scan of the chest, abdomen, and pelvis revealed a soft tissue mass in the pelvis, which appeared to arise from the left ovary. The patient's cancer antigen 125 (CA-125) level was elevated at 222 U/mL (normal range, 0-30 U/mL). The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology of the left ovarian mass was consistent with an ovarian fibrothecoma, a benign tumor of the ovary. At her 1-month follow-up appointment, the patient had complete resolution of the right-sided pleural effusion. To date, at 10 months past the initial presentation, she has not had recurrence of pleural effusion. Although rare, Meigs' syndrome should be considered as a possible cause of recurrent serositis in women with rheumatologic diseases. Removal of the ovarian tumor leads to prompt resolution of the serositis.
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Affiliation(s)
- Feng Su
- Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Bilateral ovarian fibrothecoma. An uncommon cause of a large pelvic mass. Int J Surg Case Rep 2011; 2:29-31. [PMID: 22096681 DOI: 10.1016/j.ijscr.2010.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Accepted: 07/04/2010] [Indexed: 11/21/2022] Open
Abstract
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.
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Son CE, Choi JS, Lee JH, Jeon SW, Hong JH, Bae JW. Laparoscopic surgical management and clinical characteristics of ovarian fibromas. JSLS 2011; 15:16-20. [PMID: 21902936 PMCID: PMC3134689 DOI: 10.4293/108680810x12924466009087] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Ovarian fibromas may be misdiagnosed as uterine myoma or ovarian malignant tumor. Laparoscopic examination appears to be an effective and safe surgical approach for managing ovarian fibromas. Objective: This study aims to analyze the clinical characteristics and diagnostic features of ovarian fibromas and to evaluate the efficacy and safety of laparoscopic surgery for ovarian fibromas. Methods: We reviewed the records of 47 consecutive women who underwent laparoscopic or laparotomic surgeries and whose final histopathological diagnoses were ovarian fibroma, cellular fibroma, or fibrothecoma from January 1999 to August 2010. Results: During the study period, 49 tumors were removed from 47 women including 27 ovarian fibromas, 19 fibrothecomas, and 3 cellular fibromas. The preoperative diagnoses were ovarian fibroma in 25 women (53.2%) and uterine myoma in 16 women (34.0%). A high serum CA 125 level (>35U/mL) was observed in 15 women, and serum CA 125 level was significantly higher in women with ascites (P=<0.001). The tumors were removed surgically in all women, using the laparotomic approach in 16 women (34.0%) and the laparoscopic approach in 31 women (66.0%). The laparoscopic surgery had the advantages of shorter hospital stay and faster return of bowel activities compared to laparotomy. Conclusions: Ovarian fibromas are often misdiagnosed as uterine myomas, and sometimes mistaken for a malignant tumor of the ovary preoperatively. Laparoscopic surgery can be an effective and safe surgical approach for managing ovarian fibromas.
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Affiliation(s)
- Chang Eop Son
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea (South Korea)
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Lee ES, Kim TS, Yoo CW, Seo SS, Kim SK. A Case of Meigs' Syndrome: The (18)F-FDG PET/CT Findings. Nucl Med Mol Imaging 2011; 45:229-32. [PMID: 24900010 DOI: 10.1007/s13139-011-0093-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/22/2011] [Indexed: 10/18/2022] Open
Abstract
The findings of an ovarian mass with marked ascites and pleural effusion are highly suggestive of malignancy, especially in a postmenopausal female with an elevated level of CA-125. However, benign conditions such as Meigs' syndrome should be considered in the differential diagnosis if the primary mass shows benign features. (18)F-FDG is known to be useful to differentiate between malignant and benign diseases, and this utility is also promising in the case of ovarian tumor. We present here a case of Meigs' syndrome that was evaluated by (18)F-FDG PET/CT, and this helped the preoperative diagnosis be made. (18)F-FDG PET/CT is a promising modality to diagnose the pathological character of an ovarian tumor preoperatively, which can lead to a proper therapeutic plan.
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Affiliation(s)
- Eun Seong Lee
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
| | - Tae-Sung Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
| | - Chong Woo Yoo
- Department of Pathology, Research Institute and Hospital, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Sang-Soo Seo
- Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang-si Gyeonggi-do, Republic of Korea
| | - Seok-Ki Kim
- Department of Nuclear Medicine, Research Institute and Hospital, National Cancer Center, Madu 1-dong, Ilsandong-gu, 410-769 Goyang-si Gyeonggi-do, Republic of Korea
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