Ovarian fibrosarcoma: A single-institution experience and a review of the literature

Rare histopathological finding of ovarian pseudotumor: A case report

An inflammatory pseudotumor (IPT) is a benign, rare chronic inflammatory process that is destructive to normal histology of the involved organs. While IPT most frequently affects the lung and orbits, it can occur in almost any part of the body. Additionally, histopathological examination is often difficult to interpret, typically showing myofibroblasts and mixed inflammatory and spindle-shaped cells. The histopathological picture may resemble low grade fibrosarcoma with inflammatory cells, making the differentiation between benign and malignant diseases more difficult and potentially requiring specialized histopathological studies. In the present study, a 39-year-old healthy female patient with no history of sexual activity presented to The Specialty Hospital (Amman Jordan) in January 2023 with mild lower abdominal pain. A pelvic ultrasound scan showed a complex right ovarian cyst measuring 6.0x6.5 cm. Tumor markers were normal. The patient underwent laparotomy with an ovarian cystectomy and left ovarian, omental and peritoneal biopsies. The histopathology of the cyst was suggestive of IPT. Other histopathological results were normal. The patient was followed up for 1 year after surgery with no recurrence of the disease.

Relevance of Molecular Pathology for the Diagnosis of Sex Cord-Stromal Tumors of the Ovary: A Narrative Review

Ovarian sex cord-stromal tumors (SCSTs) account for 8% of all primary ovarian neo-plasms. Accurate diagnosis is crucial since each subtype has a specific prognostic and treatment. Apart from fibrosarcomas, stromal tumors are benign while sex cord tumors may recur, sometimes with a significant time to relapse. Although the diagnosis based on morphology is straightforward, in some cases the distinction between stromal tumors and sex cord tumors may be tricky. Indeed, the immunophenotype is usually nonspecific between stromal tumors and sex cord tumors. Therefore, molecular pathology plays an important role in the diagnosis of such entities, with pathognomonic or recurrent alterations, such as FOXL2 variants in adult granulosa cell tumors. In addition, these neoplasms may be associated with genetic syndromes, such as Peutz-Jeghers syndrome for sex cord tumors with annular tubules, and DICER1 syndrome for Sertoli-Leydig cell tumors (SLCTs), for which the pathologist may be in the front line of syndromic suspicion. Molecular pathology of SCST is also relevant for patient prognosis and management. For instance, the DICER1 variant is associated with moderately to poorly differentiated SLCTS and a poorer prognosis. The present review summarizes the histomolecular criteria useful for the diagnosis of SCST, using recent molecular data from the literature.

Ovarian fibrosarcoma: Diagnostic challenges and treatment options, a case report

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.

Score for the Overall Survival Probability Scores of Fibrosarcoma Patients after Surgery: A Novel Nomogram-Based Risk Assessment System

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.