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Zheng Y, Wang H, Weng T, Li Q, Guo L. Application of convolutional neural network for differentiating ovarian thecoma-fibroma and solid ovarian cancer based on MRI. Acta Radiol 2024; 65:860-868. [PMID: 38751048 DOI: 10.1177/02841851241252951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
BACKGROUND Ovarian thecoma-fibroma and solid ovarian cancer have similar clinical and imaging features, and it is difficult for radiologists to differentiate them. Since the treatment and prognosis of them are different, accurate characterization is crucial. PURPOSE To non-invasively differentiate ovarian thecoma-fibroma and solid ovarian cancer by convolutional neural network based on magnetic resonance imaging (MRI), and to provide the interpretability of the model. MATERIAL AND METHODS A total of 156 tumors, including 86 ovarian thecoma-fibroma and 70 solid ovarian cancer, were split into the training set, the validation set, and the test set according to the ratio of 8:1:1 by stratified random sampling. In this study, we used four different networks, two different weight modes, two different optimizers, and four different sizes of regions of interest (ROI) to test the model performance. This process was repeated 10 times to calculate the average performance of the test set. The gradient weighted class activation mapping (Grad-CAM) was used to explain how the model makes classification decisions by visual location map. RESULTS ResNet18, which had pre-trained weight, using Adam and one multiple ROI circumscribed rectangle, achieved best performance. The average accuracy, precision, recall, and AUC were 0.852, 0.828, 0.848, and 0.919 (P < 0.01), respectively. Grad-CAM showed areas associated with classification appeared on the edge or interior of ovarian thecoma-fibroma and the interior of solid ovarian cancer. CONCLUSION This study shows that convolution neural network based on MRI can be helpful for radiologists in differentiating ovarian thecoma-fibroma and solid ovarian cancer.
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Affiliation(s)
- Yuemei Zheng
- Department of Medical Imaging, Affiliated Hospital of Jining Medical University, Jining, PR China
| | - Hong Wang
- Department of Radiology, Tianjin First Central Hospital, Tianjin, PR China
| | - Tingting Weng
- School of Medical Imaging, Tianjin Medical University, Tianjin, PR China
| | - Qiong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, PR China
| | - Li Guo
- School of Medical Imaging, Tianjin Medical University, Tianjin, PR China
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Liu R, Li R, Fang J, Deng K, Chen C, Li J, Wu Z, Zeng X. Apparent diffusion coefficient histogram analysis for differentiating solid ovarian tumors. Front Oncol 2022; 12:904323. [PMID: 35978817 PMCID: PMC9376384 DOI: 10.3389/fonc.2022.904323] [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: 03/28/2022] [Accepted: 07/06/2022] [Indexed: 12/21/2022] Open
Abstract
Objective To evaluate the utility of apparent diffusion coefficient (ADC) histogram analysis to differentiate between three types of solid ovarian tumors: granulosa cell tumors (GCTs) of the ovary, ovarian fibromas, and high-grade serous ovarian carcinomas (HGSOCs). Methods The medical records of 11 patients with GCTs of the ovary (regions of interest [ROI-cs], 137), 61 patients with ovarian fibromas (ROI-cs, 161), and 14 patients with HGSOCs (ROI-cs, 113) confirmed at surgery and histology who underwent diffusion-weighted imaging were retrospectively reviewed. Histogram parameters of ADC maps (ADCmean, ADCmax, ADCmin) were estimated and compared using the Kruskal-WallisH test and Mann-Whitney U test. The area under the curve of receiver operating characteristic curves was used to assess the diagnostic performance of ADC parameters for solid ovarian tumors. Results There were significant differences in ADCmean, ADCmax and ADCmin values between GCTs of the ovary, ovarian fibromas, and HGSOCs. The cutoff ADCmean value for differentiating a GCT of the ovary from an ovarian fibroma was 0.95×10-3 mm2/s, for differentiating a GCT of the ovary from an HGSOC was 0.69×10-3 mm2/s, and for differentiating an ovarian fibroma from an HGSOC was 1.24×10-3 mm2/s. Conclusion ADCmean derived from ADC histogram analysis provided quantitative information that allowed accurate differentiation of GCTs of the ovary, ovarian fibromas, and HGSOCs before surgery.
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Affiliation(s)
- Renwei Liu
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Ruifeng Li
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Jinzhi Fang
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Kan Deng
- C&TS Clinical Science, Philips Healthcare, Guangzhou, China
| | - Cuimei Chen
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Jianhua Li
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Zhiqing Wu
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
| | - Xiaoxu Zeng
- Department of Radiology, Affiliated Longhua People’s Hospital Southern Medical University (Longhua People’s Hospital), Shenzhen, China
- *Correspondence: Xiaoxu Zeng,
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Zheng Y, Wang H, Li Q, Sun H, Guo L. Discriminating Between Benign and Malignant Solid Ovarian Tumors Based on Clinical and Radiomic Features of MRI. Acad Radiol 2022; 30:814-822. [PMID: 35810066 DOI: 10.1016/j.acra.2022.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 05/31/2022] [Accepted: 06/08/2022] [Indexed: 12/17/2022]
Abstract
RATIONALE AND OBJECTIVES To develop and validate a combined model integrating clinical and radiomic features to non-invasive discriminate between the benign and malignant solid ovarian tumors. MATERIALS AND METHODS A total of 148 patients with 156 solid ovarian tumors (86 benign and 70 malignant tumors) were included in this study. The dataset was split into the training and the test set with a ratio of 8:2 using stratified random sampling. 12 clinical features and 1612 radiomic features were extracted from each tumor. These features were selected by least absolute shrinkage and selection operator (Lasso). Three classification models were built using extreme gradient boosting (XGB) algorithm: clinical model, radiomic model, combined model. The area under the receiver operating characteristic curve (AUC), accuracy, precision and sensitivity were analyzed to evaluate the performance of these models. RESULTS All of the three models obtained good performances in differentiating benign with malignant solid ovarian tumors in both training and test sets. The AUC, accuracy, precision, sensitivity of clinical model and radiomic model in test set were 0.847 (95% confidence interval (CI), 0.707-0.986, p <0.01), 0.774, 0.769, 0.714, and 0.807 (95%CI, 0.652-0.961, p <0.05), 0.677, 0.643, 0.643, respectively. Combined model had the best prediction results, the AUC, accuracy, precision and sensitivity were 0.954 (95%CI, 0.862-1.0, p <0.01), 0.839, 0.909 and 0.714 in test set. CONCLUSION Radiomics based on machine learning can be helpful for radiologists in differentiating the benign and malignant solid ovarian tumors.
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Affiliation(s)
- Yuemei Zheng
- School of Medical Imaging, Tianjin Medical University, No. 1 Guangdong Road, Tianjin 300203, China
| | - Hong Wang
- Department of Radiology, Tianjin First Central Hospital, Tianjin, China
| | - Qiong Li
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Haoran Sun
- Department of Radiology, Tianjin Medical University General Hospital, Tianjin, China
| | - Li Guo
- School of Medical Imaging, Tianjin Medical University, No. 1 Guangdong Road, Tianjin 300203, China.
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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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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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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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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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8
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Saran S, Singh AP, Khanna T. Ovarian fibroma with torsion in a young female. Ann Afr Med 2019; 18:210-211. [PMID: 31823957 PMCID: PMC6918788 DOI: 10.4103/aam.aam_2_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Sonal Saran
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Abhay Pratap Singh
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
| | - Tanvi Khanna
- Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India
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9
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Spontaneous Abdominal Bleeding from an Infundibulopelvic Ligament Tear in a Patient with Large Ovarian Fibroma. Case Rep Obstet Gynecol 2019; 2019:9834915. [PMID: 31380131 PMCID: PMC6662441 DOI: 10.1155/2019/9834915] [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: 01/31/2019] [Revised: 05/22/2019] [Accepted: 07/02/2019] [Indexed: 11/17/2022] Open
Abstract
Ovarian fibromas are rare benign solid tumors of the ovary which are often difficult to differentiate from uterine leiomyomas preoperatively. The symptoms usually include abdominal discomfort and may have ascites and/or an elevation in CA-125 levels. There have been no publications of associated abdominal bleeding to date. The treatment is surgical removal via a laparoscopic or laparotomic approach. We present a case of a 19 cm unilateral ovarian fibroma with abdominal bleeding from a spontaneous right infundibulopelvic ligament (IPL) tear who underwent a laparoscopic and mini-laparotomic right salpingo-oophorectomy. Patients with large ovarian fibromas should be cautioned that abdominal bleeding and/or acute abdominal pain can occur and that a minimally invasive surgical approach is feasible.
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10
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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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Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M. Large twisted ovarian fibroma in menopausal women: a case report. Pan Afr Med J 2015; 20:322. [PMID: 26175813 PMCID: PMC4491469 DOI: 10.11604/pamj.2015.20.322.5998] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/15/2015] [Indexed: 11/11/2022] Open
Abstract
Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.
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Affiliation(s)
- Majdouline Boujoual
- Department of Gynecology-Obstetric, University of Medicine Tangier, Military Training Hospital Med V, Rabat, Morocco
| | - Ihsan Hakimi
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Morocco
| | - Jaouad Kouach
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Morocco
| | - Mohamed Oukabli
- Department of Pathology, Military Training Hospital Med V, Rabat, Morocco
| | | | - Mohammed Dehayni
- Department of Gynecology-Obstetric, Military Training Hospital Med V, Rabat, Morocco
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Cho YJ, Lee HS, Kim JM, Lee SY, Song T, Seong SJ, Kim ML. Ovarian-sparing local mass excision for ovarian fibroma/fibrothecoma in premenopausal women. Eur J Obstet Gynecol Reprod Biol 2014; 185:78-82. [PMID: 25528734 DOI: 10.1016/j.ejogrb.2014.11.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Revised: 11/19/2014] [Accepted: 11/27/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To evaluate the recurrence rate of ovarian fibroma/fibrothecoma and reproductive outcomes following ovarian-sparing local mass excision in premenopausal women. STUDY DESIGN A retrospective cohort study was performed at two gynecologic surgery centers using data collected between January 2005 and December 2011. It included premenopausal patients treated with ovarian-sparing local mass excision and pathologically proven ovarian fibroma/fibrothecoma who were followed up for at least 6 months. The recurrence of fibroma/fibrothecoma and pregnancy outcomes in those who wanted to conceive after local mass excision were collected and analyzed. RESULTS The mean age of the patients (n=50) was 33.3±6.9 years (range, 20-50 years), and the mean follow-up duration was 26.6±19.2 months (range, 6-88 months). Fibroma was present in 40 patients, fibrothecoma in 7, and cellular fibroma in 3. Natural conception occurred in 11 of the 12 patients who became pregnant during the follow-up period. On follow-up ultrasonography, one patient experienced recurrent disease, 50 months after initial surgery, resulting in a crude overall recurrence rate of only 2%. CONCLUSION Given the 2% recurrence rate of ovarian fibroma/fibrothecoma following ovarian sparing local mass excision, local mass excision appears to be an effective surgical option in women of reproductive age.
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Affiliation(s)
- Yeon Jean Cho
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Hee Suk Lee
- Department of Obstetrics and Gynecology, Dong-A University Medical Center, Dong-A University, College of Medicine, Busan, Republic of Korea
| | - Joo Myung Kim
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Republic of Korea
| | - Soo Yoon Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, Kwandong University College of Medicine, Seoul, Republic of Korea
| | - Taejong Song
- Department of Obstetrics and Gynecology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Republic of Korea.
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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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14
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Najmi Z, Mehdizadehkashi A, Kadivar M, Tamannaie Z, Chaichian S. Laparoscopic approach to a large ovarian fibroma: a case report. J Reprod Infertil 2014; 15:57-60. [PMID: 24696796 PMCID: PMC3955425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 12/29/2013] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant. CASE PRESENTATION We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran. CONCLUSION In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion.
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Affiliation(s)
- Zahra Najmi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Abolfazl Mehdizadehkashi
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author: Abolfazl Mehdizadehkashi, Minimally Invasive Surgery Research Center, Maziyar Mansoori St., Niayesh Ave., Sattar khan St., Tehran, Iran. E-mail:
| | - Maryam Kadivar
- Department of Pathology, Rasoul-e-Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Zeinab Tamannaie
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Shahla Chaichian
- Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran,Minimally Invasive Techniques Research Center of Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
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15
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Sharmila V, Saichandran S, Babu TA, Singh D. A rare case of bilateral ovarian fibroma presenting as Meigs syndrome. J OBSTET GYNAECOL 2013; 33:636-7. [PMID: 23919874 DOI: 10.3109/01443615.2013.799128] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- V Sharmila
- Department of Obstetrics and Gynecology, Indira Gandhi Medical College and Research Institute, Puducherry, India
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16
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Wilamarta M, Huang KG, Casanova J, Lee CL. Single-Sitting Laparoscopy for Large Pelvic Mass and Umbilical Hernia Through the Lee–Huang Portal. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Muliati Wilamarta
- Department of Obstetrics and Gynecology, Limijati Maternity and Child Hospital, Bandung, West-Java, Indonesia
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan Tao-Yuan, Taiwan
| | - Joao Casanova
- Department of Obstetrics and Gynecology, Porto Hospital Center, Matosinhos, Portugal
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou Medical Center and Chang Gung University College of Medicine, Kwei-Shan Tao-Yuan, Taiwan
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17
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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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18
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Takeda A, Imoto S, Sugiyama C, Nakamura H. Transvaginal Natural Orifice Specimen Extraction with Wound Retractor in Management of Large Ovarian Fibroma with Extensive Calcification by Laparoendoscopic Single-Site Surgery. J Gynecol Surg 2013. [DOI: 10.1089/gyn.2012.0121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Akihiro Takeda
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Sanae Imoto
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Chisato Sugiyama
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
| | - Hiromi Nakamura
- Department of Obstetrics and Gynecology, Gifu Prefectural Tajimi Hospital, Tajimi, Gifu, Japan
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19
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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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20
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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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