Ovarian Fibroma Commonly Misdiagnosed as Uterine Leiomyoma

Mucin-Producing Lobular Breast Carcinoma Metastasis to an Ovarian Fibroma: Histopathological and Immunohistochemical Analysis of a Rare Case and Literature Review

Breast cancer stands as the primary cause of cancer-related mortality among women worldwide, often presenting with distant metastases upon diagnosis. Ovarian metastases originating from breast cancer represent a range of 3-30% of all ovarian neoplasms. Case Report: Herein, we present the histopathological, histochemical, and immunohistochemical findings of a rare case involving mucin-producing lobular breast carcinoma metastasizing to an ovarian fibroma in an 82-year-old female previously diagnosed with lobular breast carcinoma. Histopathological examination of the excised tissues revealed a biphasic neoplasm characterized by tumor cells expressing AE-1/AE-3 cytokeratin, mammaglobin, GCDFP-15, inhibin, and calretinin. Positive mucin staining was observed using histochemical techniques, and reticulin fibers were demonstrated using the Gordon-Sweets technique. A final diagnosis of mucin-producing lobular breast carcinoma metastatic to a benign ovarian fibroma was rendered. Conclusion: The occurrence of metastatic breast carcinoma overlaid on an ovarian tumor represents a rare and diagnostically challenging scenario.

A case report of two pelviscopic resections of fibrothecomas originating from the left ovary with recurrence after ten years

RATIONALE

Fibrothecomas are benign ovarians tumors. These are solid sex-cord-stromal tumors, accounting for 1% to 4.7% of all ovarian neoplasms. Their recurrence rate is known to be only 2% following ovarian sparing local mass excision. We report an uncommon case of 2 pelviscopic resections of fibrothecomas originating from the left ovary with recurrence after 10 years in a 34-year-old woman.

PATIENT CONCERNS

A 34-year-old married woman was diagnosed with 41 mm sized left ovarian recurrent fibrothecoma. We performed mass excision pelviscopically the first time 10 years ago. She gave birth to her second baby at 7 years after the first surgery. Ten years after the first surgery, fibrothecoma recurred on the same ovary with size larger than before.

DIAGNOSES

At the time of its first occurrence 10 years ago, the ultrasound scan revealed a 34 × 23 mm-sized solid hypoechoic mass with well-demarcated margins and minimal Doppler flows. Ultrasound findings at the time of recurrence 10 years later showed the same findings, with its size increased to 41 × 40 mm. Final pathologic findings showed left ovarian fibrothecoma.

INTERVENTIONS

After her admission to the hospital, we performed pelviscopic removal of left ovarian fibroma. Microscopic examination revealed predominantly bland spindle cells with collagenous stroma, showing fascicular and storiform growth.

OUTCOMES

Surgeries were successful. The patient had been followed-up regularly for 3 years after last surgery. She did not experience any complications. She remained disease-free.

LESSONS

Repetitive local mass excision appears to be an effective surgical option in women of reproductive age. Although there is a sufficient possibility of recurrence several years to decades after only mass excision, mass excision is more appropriate than total oophorectomy in women of childbearing age. Pelviscopic surgery is recommended.

Ovarian Fibroma Presents As Uterine Leiomyoma in a 61-Year-Old Female: A Case Study

Uterine leiomyoma should be considered when a female patient reports symptoms of abdominal pressure and abnormal vaginal bleeding. However, the symptoms of a uterine leiomyoma are vast and overlap with other possible diseases that are difficult to distinguish even with imaging studies. This is why it is important for physicians and healthcare providers to keep an open mind and have a broad differential diagnosis.  In this case study, we present a 61-year-old postmenopausal female patient who presented to the emergency department with complaints of pelvic and abdominal pain, as well as vomiting and diarrhea. She was admitted for observation. A complete blood count (CBC), comprehensive metabolic panel (CMP), and urinalysis revealed no abnormalities; a pelvic ultrasound and CT scan reported possible adnexal torsion. The patient remained stable and the pain had subsided when she was seen the next morning by her gynecologist (GYN) who discharged her to follow-up in the office. Subsequent examinations that aided in the diagnosis included, but were not limited to pelvic and transvaginal ultrasounds, an abdominal and pelvic CT, and a pelvic MRI. In this case, the MRI revealed an 11-cm mass that could represent a torsioned pedunculated necrotic fibroid originating from the uterus. Radiology recommended surgical removal. Upon removal and review of the pathology of the mass, it was revealed to be a torsioned, partially necrotic fibroma that had originated from the ovary and not from the uterus, as imaging had originally suggested.

A midline pelvic mass: Ovarian fibroma appearing vaginal in nature

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.

Surgical Treatment of a Rare Case of Ovarian Fibroma Associated With Elevated CA125 Levels in a Patient of Reproductive Age: A Case Report

Small ovarian fibromas (< 10cm) associated with elevated serum CA125 levels are rarely encountered, particularly in women of reproductive age. We report a rare case diagnosed in a 35-year-old patient after adnexectomy for a solid ovarian mass of approximately 5cm in maximum diameter, accompanied by elevated serum CA125 levels. In preoperative evaluation, no signs of inflammation from the genital tract were found, and no medical history of endometriosis, uterine leiomyomas, or non-gynecological cancer was reported. Intraoperative frozen section biopsy of surgical specimen obtained from the ovarian tumor had negative evaluation for malignancy. Histological examination of the surgical specimen confirmed the diagnosis of ovarian fibroma. The postoperative course was uneventful. Two months after surgery, the blood serum CA125 levels were within normal ranges. The patient is assessed at regular intervals in the gynecology outpatient clinic. In this paper, based on the data of the modern literature, a brief review of this rare nosological entity is made.

The value of contrast-enhanced ultrasonography in differential diagnosis of benign and malignant ovarian sex cord stromal tumors

BACKGROUND

Sex cord-stromal tumors (SCSTs) are uncommon neoplasms that are typically difficult to diagnose before surgery due to limited experience in their medical imaging. Contrast-enhanced ultrasonography (CEUS) can evaluate the microvessel density of tumors, and the microvessel density of malignant tumors is significantly greater than that of benign tumors, so this provides a method for CEUS to differentiate benign and malignant tumors.

METHODS

The CEUS diagnoses of 31 patients with pathologically confirmed SCSTs were retrospectively analyzed and compared to conventional ultrasound-based diagnoses. Based on the pathological results, the patients were divided into benign and non-benign groups. Using pathology as the gold standard, four-table data were used to evaluate the authenticity of conventional ultrasonography and CEUS.

RESULTS

Among these 31 SCST patients, only the size of the lesion and the stripy hypoenhancement on CEUS differed significantly between the benign group and the non-benign group (P<0.05). In the benign group (n=25), 22 patients showed sparse stripes of hypoenhancement, 1 showed no enhancement, and 2 showed hyperenhancement. In 5 cases of malignant SCSTs, 4 showed hyperenhancement (with non-enhanced areas inside the tumor), and 1 showed sparse strips of hypoenhancement; in 1 case of borderline SCST, the tumor showed uniform hyperenhancement. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of the conventional ultrasound diagnoses for the 31 SCST patients were 52.0%, 16.7%, 72.2%, 7.7%, and 45.2%, respectively. In relation to CEUS, sparse strips of hypoenhancement or no enhancement were valuable diagnostic criteria for diagnosing benign SCSTs. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy rate of CEUS were 92.0%, 83.3%, 95.8%, 71.4%, and 90.3%, respectively. The accuracy of CEUS was higher than that of conventional US, and the difference was statistically significant (χ2=14.467, P=0.000).

CONCLUSIONS

Sparse strips of hypoenhancement or no enhancement on CEUS are the characteristic manifestations of benign SCSTs, and hyperenhancement (with a non-enhanced area observable inside the mass) may be suggestive of malignant tumors. CEUS significantly improved the differentiation of benign and malignant SCSTs.

MRI-based nomogram for differentiation of ovarian fibrothecoma and broad ligament myoma

Currently, there are no effective approaches for differentiating ovarian fibrothecoma (OF) from broad ligament myoma (BLM). This retrospective study aimed to construct a nomogram prediction model based on MRI to differentiate OF from BLM. The quantitative and qualitative MRI features of 41 OFs and 51 BLMs were compared. Three models were established based on the combination of these features. The ability of the models to differentiate between the two cancers was assessed by ROC analysis. A nomogram based on the best model was constructed for clinical application. The three models showed good performance in differentiating between OF and BLM. The areas under the curve (AUC) of the models based on quantitative and qualitative variables were 0.88 (95% CI: 0.79–0.96) and 0.85 (95% CI: 0.76–0.93), respectively. The combined model designed from the significant variables exhibited the best diagnostic performance with the highest AUC of 0.92 (95% CI: 0.86–0.98). Calibration of the nomogram showed that the predicted probability matched the actual probability well. Analysis of the decision curve demonstrated that the nomogram was clinically useful. Relative T1 value, stone paving sign, enhancement patterns, and ascites were identified as valuable predictors for identifying OF or BLM. The MRI-based nomogram can serve as a preoperative tool to differentiate OF from BLM.

Reversible decreased ovarian reserve after conservative ovarian surgery for benign lesion other than endometrioma - case report

A 36-year-old woman presented with abdominal pain and diagnosed provisionally as complicated ovarian cyst. The trans-vaginal ultrasound (TVS) done for the studied woman showed, well-defined solid mass, measuring 10 × 8 cm related to the anterior uterine wall most probably subserous uterine leiomyoma or ovarian fibroma. The TVS finding of left solid mass was confirmed by the magnetic resonance imaging (MRI). At laparotomy, the solid mass was originating from the left ovary and the right ovary and uterus were completely normal. The left ovarian mass excised (confirmed as ovarian fibroma by histological examination), and more than half of the left ovary was preserved during surgery. The pre-operative ovarian reserve hormones, anti-Müllerian hormone (AMH), follicle stimulating hormone (FSH), and luteinizing hormone (LH) were completely normal. Post-operative follow-up of the studied woman showed regular menstrual rhythm and duration, elevated FSH and LH for one year after surgery and both the FSH and LH returned to normal levels at the end of the first post-operative year.

This report represents the finding of reversible decrease ovarian reserve (RDOR) after conservative ovarian surgery for benign lesion other than endometrioma to minimise normal ovarian tissue damage during surgery as much as possible and to counsel women at risk of DOR that any ovarian surgery may be associated with further decrease in the ovarian reserve and reproductive ability.