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Mraihi F, Basly J, Slama F, Azouz E, Ayari A, Chelli D. Ovarian fibrosarcoma: Diagnostic challenges and treatment options, a case report. Int J Surg Case Rep 2023; 112:108938. [PMID: 37871372 PMCID: PMC10667754 DOI: 10.1016/j.ijscr.2023.108938] [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: 09/17/2023] [Revised: 10/08/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
INTRODUCTION Ovarian fibrosarcoma is a rare cancer. In the literature, there have been very few occurrences of fibrosarcoma with ascites. The presence of ascites complicates the diagnosis further, and is associated with a poor prognosis and has been linked to chemoresistance and metastasis. We present this case of an ovarian fibrosarcoma with ascites to provide a comprehensive overview of the clinical presentation, diagnostic evaluation and management of this pathology, which remains a challenge given the rarity of this entity. PRESENTATION OF CASE We report the case of a 60-year-old woman who was referred to our unit, because of abdominal bloating, sporadic pelvic pain and abdominal distension. Ultrasound showed a heterogeneous mass over the right adnexa with ascites. Serum tumour markers were within normal limits. During surgery, a total abdominal hysterectomy plus bilateral adnexectomy was performed. The final histopathological findings showed a well-differentiated fibrosarcoma. The patient was followed up regularly and no recurrence was seen 2 years after surgery. DISCUSSION Ovarian fibrosarcomas are uncommon cancers with no known risk factors. Diagnosis can be difficult, especially in the presence of ascites, and other diagnostic options should be considered. Pathological and immunohistochemistry investigations are required for a clear diagnosis. Early metastases and resistance to adjuvant chemotherapy characterize the prognosis of ovarian fibrosarcoma with ascites. CONCLUSIONS Ovarian fibrosarcoma with ascites is a rare and challenging ovarian disease, highlighting the need for postoperative pathology to make a clear diagnosis, complete cytoreductive surgery and individual consideration of adjuvant radiochemotherapy should be included in the management.
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Affiliation(s)
- Fathi Mraihi
- D Department at the Maternal Center of Tunis, Tunis, Tunisia.
| | - Jihene Basly
- D Department at the Maternal Center of Tunis, Tunis, Tunisia
| | - Feryal Slama
- D Department at the Maternal Center of Tunis, Tunis, Tunisia
| | - Eya Azouz
- Radiology Department at Rabta University hospital, Tunis, Tunisia
| | - Asma Ayari
- Anatomopathology Department at Rabta University hospital, Tunis, Tunisia
| | - Dalenda Chelli
- D Department at the Maternal Center of Tunis, Tunis, Tunisia
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Gastrointestinal Stromal Tumor with Repeated Multiple Cerebral Infarction Mimicking Ovarian Cancer with Trousseau’s Syndrome. Case Rep Obstet Gynecol 2022; 2022:5537990. [PMID: 35433066 PMCID: PMC9007665 DOI: 10.1155/2022/5537990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 03/18/2022] [Accepted: 03/28/2022] [Indexed: 01/17/2023] Open
Abstract
We report a case of gastrointestinal stromal tumor (GIST) with repeated multiple cerebral infarctions mimicking ovarian cancer. A 79-year-old postmenopausal woman had multiple cerebral infarctions with a giant pelvic tumor detected by computed tomography. Ovarian cancer with Trousseau's syndrome was suspected. Through laparoscopic biopsy on the tumor surface, she was diagnosed with left ovarian fibrosarcoma; although, the abdominal cavity could not be observed appropriately. Ovarian fibrosarcoma is an extremely rare tumor and still has no adequate treatment strategy. Complete resection was planned. The tumor was extremely fragile, and gelatinous that it easily bled. Meanwhile, the uterus and bilateral ovaries and fallopian tubes were all normal. The tumor invaded only the peritoneum near the left sacral uterine ligament and sigmoid colon, with no peritoneal dissemination. To completely remove the tumor, we performed total hysterectomy with bilateral salpingo-oophorectomy and omentectomy and sigmoidal and rectal resection with colostomy. Despite resuming her anticoagulant therapy on postoperative day 4, she had recurrent multiple strokes. On histopathological examination, tumor showed spindle cell proliferation with severe atypia, increased mitotic activity, and widespread necrosis. Immunohistochemical studies showed positive staining for c-kit, CD34, and DOG1. Thus, she was diagnosed with GIST. This case was rare and highly malignant, with a high risk of recurrence of GIST because of a giant ruptured tumor that had a mitotic activity of 36/10 high-power fields from the sigmoid colon. Multiple cerebral infarctions mimicking ovarian cancer recurred. Therefore, preoperative diagnosis of an atypical GIST was extremely difficult.
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3
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Score for the Overall Survival Probability Scores of Fibrosarcoma Patients after Surgery: A Novel Nomogram-Based Risk Assessment System. JOURNAL OF ONCOLOGY 2022; 2021:4533175. [PMID: 34976057 PMCID: PMC8716234 DOI: 10.1155/2021/4533175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 12/01/2021] [Indexed: 12/29/2022]
Abstract
Background The primary purpose of this study was to determine the risk factors affecting overall survival (OS) in patients with fibrosarcoma after surgery and to develop a prognostic nomogram in these patients. Methods Data were collected from the Surveillance, Epidemiology, and End Results database on 439 postoperative patients with fibrosarcoma who underwent surgical resection from 2004 to 2015. Independent risk factors were identified by performing Cox regression analysis on the training set, and based on this, a prognostic nomogram was created. The accuracy of the prognostic model in terms of survival was demonstrated by the area under the curve (AUC) of the receiver operating characteristic curves. In addition, the prediction consistency and clinical value of the nomogram were validated by calibration curves and decision curve analysis. Results All included patients were divided into a training set (n = 308) and a validation set (n = 131). Based on univariate and multivariate analyses, we determined that age, race, grade, and historic stage were independent risk factors for overall survival after surgery in patients with fibrosarcoma. The AUC of the receiver operating characteristic curves demonstrated the high predictive accuracy of the prognostic nomogram, while the decision curve analysis revealed the high clinical application of the model. The calibration curves showed good agreement between predicted and observed survival rates. Conclusion We developed a new nomogram to estimate 1-year, 3-year, and 5-year OS based on the independent risk factors. The model has good discriminatory performance and calibration ability for predicting the prognosis of patients with fibrosarcoma after surgery.
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Tada Y, Yasunaga M, Tomonobe H, Yamada Y, Hori E, Okugawa K, Yahata H, Oda Y, Kato K. A Case of Malignant Phyllodes Tumor of the Breast Metastasizing to the Ovary. Int J Surg Pathol 2021; 30:427-431. [PMID: 34761702 DOI: 10.1177/10668969211056912] [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: 11/16/2022]
Abstract
Phyllodes tumors of the breast are uncommon, and 6.2% of phyllodes tumors behave in a malignant fashion. The metastatic spread of malignant phyllodes tumor is mainly hematogenous to lung and bone, and malignant phyllodes tumor metastasizing to the ovary is rare, with only 2 cases reported. We report the third case of metastatic malignant phyllodes tumor to the ovary with a focus on the differential diagnosis of ovarian cancer.
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Affiliation(s)
- Yukiko Tada
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Masafumi Yasunaga
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Tomonobe
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Yuichi Yamada
- Department of Anatomic Pathology, Graduate School of Medical Science, 145181Kyushu University, Fukuoka, Japan
| | - Emiko Hori
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Kaoru Okugawa
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Hideaki Yahata
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Science, 145181Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Department of Gynecology and Obstetrics, Graduate School of Medical Science, 145181Kyushu University Hospital, Fukuoka, Japan
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5
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Comprehensive review of imaging features of sex cord-stromal tumors of the ovary. Abdom Radiol (NY) 2021; 46:1519-1529. [PMID: 33725145 DOI: 10.1007/s00261-021-02998-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/03/2021] [Accepted: 02/11/2021] [Indexed: 10/21/2022]
Abstract
Sex cord-stromal tumors of the ovary (SCST) are uncommon ovarian tumors arising from sex cord and/or stromal cells of the ovaries. They may be nonfunctional and asymptomatic or functional presenting with hyperestrogenic, hyperandrogenic or cushingoid symptoms. They present in a wide age group of women, mostly in early stages and follow a nonaggressive clinical course after surgical resection. They differ from more prevalent epithelial ovarian tumors which tend to present in older women in advanced stages with poor prognosis. Some of SCSTs are associated with clinical syndromes. We will review imaging features on ultrasound, computed tomography and magnetic resonance imaging, epidemiology and clinical presentations of these tumors.
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Sun TT, Cheng NH, Cao DY, Peng P. Ovarian fibrosarcoma: A single-institution experience and a review of the literature. J Ovarian Res 2020; 13:142. [PMID: 33292402 PMCID: PMC7724700 DOI: 10.1186/s13048-020-00749-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/03/2020] [Indexed: 11/10/2022] Open
Abstract
Ovarian fibrosarcoma is an extremely rare and malignant sex cord-stromal tumor. Due to its low incidence and poor prognosis, until now, very few cases have been reported, and most of the reported cases have been sporadic. Therefore, the treatments and prognostic factors of ovarian fibrosarcoma are still debatable. Here, we report 5 cases of ovarian fibrosarcoma that presented at Peking Union Medical College Hospital over the past 20 years. The 5 patients were 41, 51, 54, 76, and 76 years of age when initial symptoms of pelvic mass or pain appeared. On ultrasound, this disease usually manifests as unilateral pelvic masses, within which uneven echo enhancement and some blood flow signals are observed. No significant increase was observed in the levels of preoperative tumor markers, such as serum CA125 and sex hormones. The final diagnosis depends on postoperative histopathological results since these tumors are easily misdiagnosed when intraoperative frozen sections are used for examination. Pathologic examinations showed that the tumor cells were spindle-shaped with moderate to severe atypia and high mitotic counts. The immunohistochemistry profile is not specific, but the positive rate of Ki-67 was consistent with the degree of malignancy and the prognosis of patients with this tumor. In addition, the tumor may also be positive for Vimentin, α-inhibin, SMA, estrogen receptor and progesterone receptor. Significant differences were observed in the surgical methods used, and no unified chemotherapy regimen has been established. The overall survival was > 15, >7, > 6, <1, and < 1 year for each patient. After reviewing the literature, evidence-based large-scale case studies were lacking. For treatments, complete cytoreductive surgery plus regimens typically used against malignant sex cord-stromal tumors, as described in the NCCN guidelines, are recommended. Due to its low incidence, both multicenter clinical studies and molecular studies are required to provide gynecologists with a better understanding and guidance for future management of patients with ovarian fibrosarcoma.
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Affiliation(s)
- Ting-Ting Sun
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Ning-Hai Cheng
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Dong-Yan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China
| | - Peng Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Shuaifuyuan No. 1, Dongcheng District, 100730, Beijing, China.
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7
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Zhang Z, Yao A, Xin Q, Shi Y, Zhang A. Nuclear Atypia Is a Necessary Factor for Diagnosis of Primary Ovarian Fibrosarcoma: A Case Report and Literature Review. Gynecol Obstet Invest 2020; 85:437-445. [PMID: 33011729 DOI: 10.1159/000510875] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 08/10/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Primary ovarian fibrosarcoma is a rare malignant tumor with few case reports. The current opinion in diagnosis preferring mitotic activity was questioned as there is a large amount of heterogeneity in prognosis between cases. We report a case of primary ovarian fibrosarcoma, and a literature review was performed according to the latest diagnostic trends. This is the first study to review the prognostic factors of primary ovarian fibrosarcoma according to the latest trend in diagnosis. CASE PRESENTATION A 50-year-old woman with primary ovarian fibrosarcoma is reported. The patient was admitted to the hospital due to increasing abdominal girth. Physical examination and CT scan showed a giant mass from the suprapubic area to the xiphoid region which filled her entire abdominopelvic cavity. Frozen sections were performed during an operation to resect, and the pathology report indicated a high degree of malignancy. Because of the degree of malignancy, a bilateral salpingo-oophorectomy and omentectomy were performed. Histopathological examination and immunohistochemical staining confirmed the diagnosis of primary ovarian fibrosarcoma. During the operation, the tumor ruptured, which placed the patient in a FIGO stage IC1. After surgery, the patient received 6 courses of combination chemotherapy, consisting of etoposide, bleomycin, and cisplatin. The patient has been free from disease without evidence of recurrence at 5 months after the initial diagnosis. CONCLUSIONS Herein we report a case of primary ovarian fibrosarcoma and reviewed all published cases in English. Following the latest trend of diagnosis, multiple prognostic factors were used to determine survival prognosis. These included nuclear atypia, FIGO stage, mitotic counts, treatment methods, and tumor size. Only nuclear atypia was found to be associated with patient prognosis (p < 0.05). FIGO stage (p = 0.383), mitotic count per 10 hpfs (p = 0.155), treatment methods (p = 0.185), and tumor size (p = 0.972) were not found to be associated with survival prognosis. Nuclear atypia was an important factor in prognosis of patients. Using surgery with adjuvant medical treatment was inconclusive regarding patient survival.
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Affiliation(s)
- Zhidong Zhang
- Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China,
| | - Ailin Yao
- Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China
| | - Qi Xin
- Pathology Department, Tianjin Third Central Hospital, Tianjin, China
| | - Yi Shi
- Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China
| | - Aihua Zhang
- Gynecology and Obstetrics Department, Tianjin Third Central Hospital, Tianjin, China
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Winarto H, Hellyanti T, Purbadi S, Sutrisno S. Rapidly recurring ovarian fibrosarcoma after optimal debulking surgery in a 46-year-old woman. BMJ Case Rep 2020; 13:13/7/e234757. [PMID: 32646936 DOI: 10.1136/bcr-2020-234757] [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
Ovarian fibrosarcoma is an extremely rare tumour with no universally accepted guidelines for treatment. We present a 46-year-old nulliparous woman with ovarian fibrosarcoma who mainly presented with a painful abdominal enlargement. Optimal debulking surgery was performed, and a specimen of the tumour was examined. A frozen section examined during surgery revealed spindle cell morphology, raising the suspicion of ovarian fibrosarcoma, which was later confirmed by immunohistochemistry staining. Our patient refused to undergo chemotherapy and died 3 months after surgery due to tumour recurrence. Although no clear consensus exists for administering chemotherapy for fibrosarcoma, some published case reports have shown a lower chance of recurrence and better prognosis in patients who undergo chemotherapy compared with our patient.
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Affiliation(s)
- Hariyono Winarto
- Department of Obstetrics and Gynaecology, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia .,Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Tantri Hellyanti
- Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia.,Department of Anatomical Pathology, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia
| | - Sigit Purbadi
- Department of Obstetrics and Gynaecology, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
| | - Sutrisno Sutrisno
- Department of Obstetrics and Gynaecology, Dr Cipto Mangunkusumo Hospital, Central Jakarta, Indonesia.,Faculty of Medicine, Universitas Indonesia, Central Jakarta, Indonesia
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Miura M, Suzuki S, Shibata K, Kajiyama H, Kikkawa F. Estrogen producing ovarian fibrosarcoma: A case report. NAGOYA JOURNAL OF MEDICAL SCIENCE 2019; 81:171-176. [PMID: 30962667 PMCID: PMC6433630 DOI: 10.18999/nagjms.81.1.171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Fibrosarcoma is an extremely rare malignant sex-cord stromal tumor. Fibrosarcoma is generally unknown as an estrogen producing tumor. This report presents, for the first time, a case of estrogen producing ovarian fibrosarcoma in an 83-year-old female. We performed total hysterectomy, bilateral salpingo-oophorectomy and omentectomy. Histopathologically, the tumor of the left ovary had high cellularity, cellular atypia and 10-15 mitotic counts per 10 high power fields. The tumor contained small components composed of cells that were similar to Sertoli cells. In an effort to examine which component was producing estrogen, we checked aromatase expression; but both components were positive. We could not explain which component was producing estrogen. Postoperative clinical stage was IA. As she was geriatric patient, we did not recommend adjuvant chemotherapy. There were no signs of recurrence or increase in serum estradiol level at two years after the operation.
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Affiliation(s)
- Mayo Miura
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shiro Suzuki
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kiyosumi Shibata
- Department of Obstetrics and Gynecology, Banbuntane Hotokukai Hospital, Fujita Health University, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Fumitaka Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kurtmen BT, Dokumcu Z, Divarci E, Serin G, Ergun O, Ozok G, Celik A. Primary Ovarian Fibrosarcoma-An Unusual Tumor in an Adolescent: Case Report and Review of the Pediatric Literature. J Pediatr Adolesc Gynecol 2017; 30:655-658. [PMID: 28502829 DOI: 10.1016/j.jpag.2017.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/30/2017] [Accepted: 05/02/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Primary ovarian fibrosarcomas are rare and usually observed in perimenopausal and postmenopausal women. To our knowledge, to date, there are only 3 reports of ovarian fibrosarcoma in childhood and adolescence in the English-language literature. In this report, we aimed to present to our knowledge, the first pediatric case with advanced stage primary ovarian fibrosarcoma and to compare with previous cases. CASE A 14-year-old teenage girl was admitted because of a giant abdominal mass. Imaging techniques revealed a giant heterogeneous and vascular ovarian mass. Salpingo-oophorectomy along with staging procedures were performed. Pathologic examination confirmed grade III ovarian fibrosarcoma with severe nuclear atypia and high mitotic count. Because of pulmonary metastasis, she received 4 courses of adjuvant combination chemotherapy (Ewing protocol). The patient withstood the treatment well and is disease-free at 2 years of follow-up. CONCLUSION Fibrosarcoma of the ovary is an uncommon neoplasm with poor prognosis. To our knowledge, the presented patient is the first pediatric case with advanced staged primary ovarian fibrosarcoma to be treated with surgery and adjuvant chemotherapy.
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Affiliation(s)
- Bade T Kurtmen
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Zafer Dokumcu
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Emre Divarci
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Gürdeniz Serin
- Department of Pathology, Ege University Faculty of Medicine, İzmir, Turkey
| | - Orkan Ergun
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Geylani Ozok
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey
| | - Ahmet Celik
- Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey.
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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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Zong L, Lin M, Fan X. Mitotically active cellular fibroma of ovary should be differentiated from fibrosarcoma: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:7578-7582. [PMID: 25550794 PMCID: PMC4270577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Accepted: 11/01/2014] [Indexed: 06/04/2023]
Abstract
The clinicopathologic characteristic of mitotically active cellular fibroma is significantly different from the malignant behavior of ovarian fibrosarcoma. Therefore, it's very important to differentiate mitotically active cellular fibroma from ovarian fibrosarcoma. We report a case in which a 39-year-old woman was found with an ovarian tumor measuring 105 × 71 × 47 mm. The tumor ruptured and adhered to the peritoneum. Microscopic examination showed densely cellular spindle-shaped tumor cells. The cellular atypia was mild. The Ki-67 proliferation index was approximately 10%. The patient remained free of tumor for more than 66 months without any adjuvant chemotherapy after operation. After reviewing the literature, we diagnosed this case as mitotically active cellular fibroma rather than ovarian fibrosarcoma. It is very important to differentiate these two tumors because of the marked differences in treatment modalities and prognosis between them. The ovarian fibrous tumors with mitotic figures ≥ 4 per 10 high-power fields but no severe nuclear atypia should be mostly diagnosed as mitotically active cellular fibroma of ovary. The correct diagnosis is the key to avoid excessive treatments.
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Affiliation(s)
- Lin Zong
- Department of Gynecology, Nanshan Hospital Afflicated to Guangdong Medical CollegeShenzhen, Guangdong Province, China
| | - Ming Lin
- Department of Pathology, Nanshan Hospital Afflicated to Guangdong Medical CollegeShenzhen, Guangdong Province, China
| | - Xinmin Fan
- Health Science Center, Shenzhen UniversityShenzhen, China
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Zhao F, Chen Y, Wu Q, Wang Z, Lu J. Prognostic value of CD117 in cancer: a meta-analysis. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:1012-1021. [PMID: 24696718 PMCID: PMC3971304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2013] [Accepted: 01/03/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The prognostic value of CD117 expression in cancers has been evaluated for several years while the results remain controversial. We thus performed a systematic review and meta-analysis of studies assessing the impact of CD117 expression on overall survival (OS) and disease-free survival (DFS) to clarify this issue. METHODS We searched Pubmed, Embase and Web of Science to identify studies on the prognostic impact of CD117 expression in cancers. A total of 4,458 patients from 39 eligible studies were included in the analysis. Pooled risk ratios (RRs) with 95% confidence interval (95% CI) were calculated to estimate the effect using random-effects model. RESULTS The analysis indicated that CD117 had significant association with poor OS of osteosarcoma (OR=1.36, 95% CI=1.03-1.79, I2=0%, fixed model) and renal carcinoma (OR=4.86, 95% CI=2.72-8.67, I2=0%, fixed model).However, no significant association between CD117 and DFS was found in overall studies. CONCLUSIONS CD117 expression might be a predictive factor of poor prognosis in some surgically treated cancers, particularly in renal carcinoma.
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Affiliation(s)
- Fuyou Zhao
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui 233000, China
| | - Yuqing Chen
- Department of Respiratory Diseases, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui 233000, China
| | - Qiong Wu
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui 233000, China
| | - Zian Wang
- Department of Medical Oncology, The First Affiliated Hospital of Bengbu Medical CollegeBengbu, Anhui 233000, China
| | - Jie Lu
- Department of Microbiology, Bengbu Medical CollegeBengbu, Anhui 233000, China
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Cellular fibroma of the ovary with multiloculated macroscopic characteristics: case report. Case Rep Med 2012; 2012:283948. [PMID: 22567015 PMCID: PMC3332172 DOI: 10.1155/2012/283948] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 01/08/2023] Open
Abstract
Ovarian fibroma is the commonest benign tumor of the ovarian stroma. The cellular subtype accounts for around 10% of ovarian fibromatous tumors. The cellular fibroma is a tumor of uncertain malignant potential that may recur or be associated with peritoneal implants. Usually these are solid tumors, sometimes with small areas of cystic degeneration. This case is reported to highlight an unusual feature for an ovarian fibroma: the tumor was predominantly cystic with a small solid part; the multiple cavities contents consisted of viscous liquid that solidified under room temperature. The multiloculated cysts, the mucinous contents, and the solid areas simulated a borderline mucinous ovarian tumor on both CT scan and gross pathologic examination.
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