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Mitotically Active Cellular Fibroma of the Ovary Recurring After the Longest Interval of Time (16 yr): A Challenging Case With Systematic Literature Review. Int J Gynecol Pathol 2021; 40:441-447. [PMID: 33252401 DOI: 10.1097/pgp.0000000000000731] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cellular fibromas represent ~10% of ovarian fibromas. Mitotically active cellular fibromas show mild nuclear atypia but ≥4 mitoses/10 high-power fields: the clinical course is usually uneventful but literature review is lacking. A 34-yr-old woman underwent left oophorectomy for a 9-cm ovarian mitotically active cellular fibroma at another hospital. The tumor was cellular (spindle cells in fascicular and storiform patterns) revealing mild atypia and 4 nonatypical mitoses/10 high-power fields without necrotic areas. After 16 yr, the tumor recurred as a 5-cm peritoneal nodule on the anterior sigmoid wall near the sigmoid-rectal junction. Frozen section revealed a spindle cell tumor invading the intestinal tunica muscularis propria: a gastrointestinal stromal tumor was favored as previous history was unavailable at that time. Intestinal resection was performed: no residual tumor was found. The patient was followed-up for 8 yr without further recurrences. The peritoneal nodule showed 2 mitoses/10 high-power fields and pericellular reticulin staining. The tumor was variably positive for vimentin/bcl-2/melan-A/CD56/ER/PR/α-inhibin/CD10/calretinin, focally positive for desmin, negative for pan-cytokeratin/actin/EMA/CD34/HMB45/CD117/CD99/S100/synaptophysin. The Ki67-index was ~9%. To our systematic literature review, 7 additional recurrent cases were reported. We describe a mitotically active cellular fibroma recurring after the longest interval of time. Extensive sampling of difficult cases should exclude malignant areas. Moderate nuclear atypia, tumor rupture, adhesions to pelvic/abdominal organs, infarction with extraovarian involvement, and incomplete excision may lead to relapse but there are conflicting data: prolonged follow-up can be suggested in these cases.
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Murayama Y, Kamoi Y, Yamamoto H, Isogai J, Tanaka T. Meigs' syndrome mimicking heart failure with preserved ejection fraction: a case report. BMC Cardiovasc Disord 2020; 20:436. [PMID: 33028203 PMCID: PMC7542734 DOI: 10.1186/s12872-020-01718-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 09/30/2020] [Indexed: 11/24/2022] Open
Abstract
Background Meigs’ syndrome is a rare disease characterized by a triad of presentations, including benign ovarian tumor, ascites, and pleural effusion. However, a clinical diagnosis of Meigs’ syndrome remains challenging because pleural and ascitic effusions can be common findings in a variety of underlying conditions. Furthermore, these findings can often be misdiagnosed as pleural and peritoneal dissemination caused by potentially malignant tumors, leading to the administration of improper treatment. Case presentation We described a case of an 85-year-old postmenopausal female patient with atypical Meigs’ syndrome presenting with right-sided pleural effusion, notable leg edema, and trivial ascites, which was initially mistaken as heart failure with preserved ejection fraction. However, pleural effusion was totally ineffective against diuretic therapy. Subsequently, thoracentesis yielded serosanguineous exudative effusion. Moreover, refractory pleural effusions and abdominal/pelvic computed tomography and magnetic resonance imaging findings strongly suggested bilateral malignant ovarian tumors with pleural dissemination. Repetitive negative cytological results allowed the patient to undergo bilateral salpingo-oophorectomy. Finally, a definitive diagnosis of Meigs’ syndrome was made by confirming the presence of a benign mitotically active cellular fibroma of the ovary by pathology and that pleural effusion resolved following tumor resection. Conclusions Our case highlights the clinical importance of assessing Meigs’ syndrome in the diagnostic workup of pleural effusion in postmenopausal female patients. Given the favorable prognosis of Meigs’ syndrome, clinicians should consider surgical resection, even with potentially malignant ovarian tumors with accompanying pleural effusion, ascites, or both.
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Affiliation(s)
- Yoko Murayama
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan
| | - Yoshiro Kamoi
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan
| | - Hiroyuki Yamamoto
- Department of Cardiovascular Medicine, Narita-Tomisato Tokushukai Hospital, 1-1-1 Hiyoshidai, Tomisato, Chiba, 286-0201, Japan.
| | - Jun Isogai
- Department of Radiology, Asahi General Hospital, Asahi, Japan
| | - Takahiro Tanaka
- Department of Cardiology, Cardiovascular Center, Showa General Hospital, Tokyo, Japan
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Kulkarni R, Bhat R, Dhakharia V, Gangoli A, Sharma K. Mitotically active cellular fibroma of the ovary: a rare case and review of literature. SOUTHERN AFRICAN JOURNAL OF GYNAECOLOGICAL ONCOLOGY 2017. [DOI: 10.1080/20742835.2017.1361644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Rohini Kulkarni
- Department of Gynaecological Oncology, HCG Cancer Hospital, Bengaluru, India
| | - Rani Bhat
- Department of Gynaecological Oncology, HCG Cancer Hospital, Bengaluru, India
| | - Vibhawari Dhakharia
- Department of Gynaecological Oncology, HCG Cancer Hospital, Bengaluru, India
| | - Aparna Gangoli
- Department of Pathology, HCG Cancer Hospital, Bengaluru, India
| | - Kunal Sharma
- Department of Pathology, HCG Cancer Hospital, Bengaluru, India
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Rapid growth of mitotically active cellular fibroma of the ovary: a case report and review of the literature. Diagn Pathol 2016; 11:101. [PMID: 27770806 PMCID: PMC5075201 DOI: 10.1186/s13000-016-0554-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 10/15/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Mitotically active cellular fibroma (MACF) of the ovary, characterized by relatively high mitotic activity without severe atypia, represents a relatively new disease entity. MACF is categorized as a benign ovarian tumor. However, due to a limited number of case reports, its clinical and pathological features and optimum management remains largely undetermined. Herein, we report on a rare case of MACF that grew rapidly in size and was diagnosed on detailed pathological examination. CASE PRESENTATION A 44-year-old Japanese woman, who detected a myoma-like lesion 1-year earlier, was referred to our hospital when the follow-up examination demonstrated that the mass had increased in size. Magnetic resonance imaging revealed a T1 isointense and T2 hyperintense tumor (11 cm in diameter) in the right pelvic cavity. Laparoscopy confirmed the presence of a right ovarian tumor and laparoscopic right adnexectomy was performed. The tumor cells consisted of dense cellular proliferations of spindle fibroblast-like cells without significant cytological atypia. The mitotic activity index was estimated at >15 mitotic figures per 10 high-power fields. Reticulin staining and FOXL2 mutation analysis excluded the possibility of an adult granulosa cell tumor, and the patient was diagnosed with a MACF of the ovary. CONCLUSIONS To the best of our knowledge, we are the first to report on a case of rapid growth of a MACF of the ovary during follow-up. When an increase in the size of a solid ovarian mass is detected, a MACF should be considered as a differential diagnosis.
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Yamada T, Hattori K, Satomi H, Hirose Y, Nakai G, Daimon A, Hayashi A, Terai Y, Ohmichi M, Fukunaga M. Mitotically active cellular fibroma of the ovary: a case report and literature review. J Ovarian Res 2015; 8:65. [PMID: 26437718 PMCID: PMC4595272 DOI: 10.1186/s13048-015-0191-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2015] [Accepted: 09/28/2015] [Indexed: 11/25/2022] Open
Abstract
Background The ovarian cellular fibrous tumor with mitotic figure >4 per 10 high power field without moderate to severe atypia is defined as mitotically active cellular fibroma according to the 2014 World Health Organization classification. As this category is new and rare now, we described here a case of MACF and reviewed the literature. Case We present a case of mitotically active cellular fibroma of the ovary with 10-year history that was treated with laparoscopic surgery. Methods We reviewed the relevant literature using PubMed search system and analyzed the previous cases. Results To date, only 5 cases of mitotically active cellular fibroma have been reported. Our patient is the first case of mitotically active cellular fibroma of the ovary treated with laparoscopic surgery. Conclusion MACF of the ovary is a newly defined category and few cases have been reported, while prognostic factors have also not yet been fully characterized. Long-term clinical follow-up is necessary.
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Affiliation(s)
- Takashi Yamada
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Kimiaki Hattori
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Hidetoshi Satomi
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshinobu Hirose
- Department of Pathology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Go Nakai
- Department of Radiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Atsushi Daimon
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Atsushi Hayashi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Yoshito Terai
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Masahide Ohmichi
- Department of Obstetrics and Gynecology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka, 569-8686, Japan.
| | - Masaharu Fukunaga
- Department of Pathology, Jikei Daisan Hospital, 4-11-1, Izumihoncho, Komaeshi, Tokyo, 201-8601, Japan.
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Yıldırım N, Saatli B, Akalın F, Ulukuş Ç, Obuz F, Saygılı U. Mitotically active cellular fibroma of the ovary: A case report. Turk J Obstet Gynecol 2015; 12:53-55. [PMID: 28913042 PMCID: PMC5558406 DOI: 10.4274/tjod.11298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/09/2014] [Indexed: 12/01/2022] Open
Abstract
Fibromas are classified in a spectrum from fibromas to fibrosarcomas according to the number of mitosis they include. Malignant fibrosarcomas which have aggressive pattern show higher mitotic activity and nuclear atypia. Cellular fibromas with less than 4 mitotic figures under 10 high power fields (HPF) are benign. “Mitotically active cellular fibromas” that are classified between the cellular fibromas and fibrosarcomas, have ≥4 mitotic figures in 10 HPF but do not have nuclear atypia. A very few cases of mitotically active cellular fibromas have been reported in the literature. In this report, we present the case of mitotically active cellular fibroma in a patient who applied to our clinic with the complaint of pelvic mass.
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Affiliation(s)
- Nuri Yıldırım
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Bahadır Saatli
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Fatma Akalın
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
| | - Çağnur Ulukuş
- Dokuz Eylül University Faculty of Medicine, Department of Pathology, İzmir, Turkey
| | - Funda Obuz
- Dokuz Eylül University Faculty of Medicine, Department of Radiology, İzmir, Turkey
| | - Uğur Saygılı
- Dokuz Eylül University Faculty of Medicine, Department of Obstetrics and Gynecology, İzmir, Turkey
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Hasegawa A, Koga K, Asada K, Wada-Hiraike O, Osuga Y, Kozuma S. Laparoscopic ovarian-sparing surgery for a young woman with an exophytic ovarian fibroma. J Obstet Gynaecol Res 2013; 39:1610-3. [PMID: 23875949 DOI: 10.1111/jog.12107] [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: 11/25/2012] [Accepted: 02/12/2013] [Indexed: 11/29/2022]
Abstract
Ovarian fibroma can occur in young women of reproductive age. Despite its benign feature, most surgical removals are done in open surgery with oophorectomy. However, an ovarian-sparing tumor resection can be an option, especially for an exophytic type of fibroma, which accounts for more than half of ovarian fibromas. Here we report a case of exophytic ovarian fibroma in a young woman treated by laparoscopic ovarian-sparing surgery. A 27-year-old woman presented with a pelvic mass. Magnetic resonance imaging revealed an 11 cm × 8 cm solid mass connected to the normal-appearing left ovary by a pedicle-like structure. A clinical diagnosis of an exophytic ovarian fibroma was made, and laparoscopic ovarian-sparing surgery with an intraoperative pathological examination was planned. The tumor was resected by cutting the pedicle, morcellated in a pouch and removed. All procedures were performed laparoscopically and the affected ovary was completely preserved. Having confirmation of its benign characteristics by the intraoperative examination, no further excision was performed. The patient conceived 3 months after the surgery and no recurrence was reported. We propose that gynecologists should consider laparoscopic ovarian-sparing surgery for exophytic ovarian fibroma in women of reproductive age.
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Affiliation(s)
- Akiko Hasegawa
- Department of Obstetrics and Gynecology, The University of Tokyo, Tokyo, Japan
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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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