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Zhu M, Li J, Duan J, Yang J, Gu W, Jiang W. Bilateral ovarian fibromas as the sole manifestation of Gorlin syndrome in a 22-year-old woman: a case report and literature review. Diagn Pathol 2023; 18:118. [PMID: 37907964 PMCID: PMC10617060 DOI: 10.1186/s13000-023-01406-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Accepted: 10/24/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND Nevoid basal cell carcinoma syndrome (NBCCS, Gorlin syndrome) is a rare autosomal dominantly inherited disorder that is characterized by multisystem disorder such as basal cell carcinomas, keratocystic odontogenic tumors and skeletal abnormalities. Bilateral and/or unilateral ovarian fibromas have been reported in individuals diagnosed with NBCCS. CASE PRESENTATION A 22-year-old female, presented with low back pain, and was found to have bilateral giant adnexal masses on pelvic ultrasonography, which had been suspected to be malignant ovarian tumors. Positron emission tomography/computed tomography showed multiple intracranial calcification and skeletal abnormalities. The left adnexa and right ovarian tumor were resected with laparotomy, and pathology revealed bilateral ovarian fibromas with marked calcification. We recommended the patient to receive genetic testing and dermatological examination. No skin lesion was detected. Germline testing identified pathogenic heterozygous mutation in PTCH1 (Patched1). CONCLUSIONS The possibility of NBCCS needs to be considered in patients with ovarian fibromas diagnosed in an early age. Skin lesions are not necessary for the diagnosis of NBCCS. Ovarian fibromas are managed with surgical excision with an attempt at preserving ovarian function. Follow-up regime and counseling on options for future fertility should be offered to patients.
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Affiliation(s)
- Menghan Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China
| | - Jun Li
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China
| | - Jie Duan
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China
| | - Jing Yang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China
| | - Weiyong Gu
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200090, China
| | - Wei Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shenyang Road 128, Shanghai, 200090, China.
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Tan N, Jin KY, Yang XR, Li CF, Yao J, Zheng H. A case of death of patient with ovarian fibroma combined with Meigs Syndrome and literature review. Diagn Pathol 2022; 17:83. [PMID: 36253781 PMCID: PMC9575228 DOI: 10.1186/s13000-022-01258-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 09/15/2022] [Indexed: 11/10/2022] Open
Abstract
Ovarian fibroma is the most common benign pure stromal tumor. It has no specific clinical manifestation, most of which are pelvic or adnexal masses. 10-15% of cases with hydrothorax or ascites, after tumor resection, hydrothorax and ascites disappear, known as Meigs Syndrome. The elevated level of CA125 in a few patients was easily misdiagnosed as ovarian malignant tumor. A case of bilateral Ovarian fibroma associated with Meigs Syndrome is reported and the literature is reviewed in order to improve the understanding of the changes and avoid misdiagnosis.
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Affiliation(s)
- Na Tan
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Kai-Yuan Jin
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Xiao-Rong Yang
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Cheng-Fang Li
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Jin Yao
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China
| | - Hong Zheng
- Department of Pathology, Affiliated Hospital of Zunyi Medical University, Zunyi, Guizhou, China.
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3
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Hunter SM, Dall GV, Doyle MA, Lupat R, Li J, Allan P, Rowley SM, Bowtell D, Campbell IG, Gorringe KL. Molecular comparison of pure ovarian fibroma with serous benign ovarian tumours. BMC Res Notes 2020; 13:349. [PMID: 32698852 PMCID: PMC7376903 DOI: 10.1186/s13104-020-05194-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/17/2020] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Ovarian fibromas and adenofibromas are rare ovarian tumours. They are benign tumours composed of spindle-like stromal cells (pure fibroma) or a mixture of fibroblast and epithelial components (adenofibroma). We have previously shown that 40% of benign serous ovarian tumours are likely primary fibromas due to the neoplastic alterations being restricted to the stromal compartment of these tumours. We further explore this finding by comparing benign serous tumours to pure fibromas. RESULTS Performing copy number aberration (CNA) analysis on the stromal component of 45 benign serous tumours and 8 pure fibromas, we have again shown that trisomy of chromosome 12 is the most common aberration in ovarian fibromas. CNAs were more frequent in the pure fibromas than the benign serous tumours (88% vs 33%), however pure fibromas more frequently harboured more than one CNA event compared with benign serous tumours. As these extra CNA events observed in the pure fibromas were unique to this subset our data indicates a unique tumour evolution. Gene expression analysis on the two cohorts was unable to show gene expression changes that differed based on tumour subtype. Exome analysis did not reveal any recurrently mutated genes.
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Affiliation(s)
- Sally M Hunter
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Genevieve V Dall
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - Maria A Doyle
- Bioinformatics Core Facility Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Richard Lupat
- Bioinformatics Core Facility Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Jason Li
- Bioinformatics Core Facility Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Prue Allan
- Anatomical Pathology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Simone M Rowley
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia
| | - David Bowtell
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia.,The Department of Pathology, University of Melbourne, Parkville, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Ian G Campbell
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia.,The Department of Pathology, University of Melbourne, Parkville, Australia.,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Kylie L Gorringe
- Cancer Genomics Program, Peter MacCallum Cancer Centre, East Melbourne, Australia. .,The Department of Pathology, University of Melbourne, Parkville, Australia. .,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia. .,Peter MacCallum Cancer Centre, Locked Bag 1, A'Beckett Street, Melbourne, VIC, 8006, Australia.
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Parwate NS, Patel SM, Arora R, Gupta M. Ovarian Fibroma: A Clinico-pathological Study of 23 Cases with Review of Literature. J Obstet Gynaecol India 2016; 66:460-465. [PMID: 27821988 DOI: 10.1007/s13224-015-0717-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/22/2015] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The purpose of this study was to correlate the clinical findings, RMI-4 index and frozen section, in cases of ovarian fibroma with the final histopathology. METHODS This is a retrospective study of clinical and pathological features of 23 patients of ovarian fibroma. The patient's age ranged from 34 to 66 years (mean-49 years). The most common presenting symptom was abdominal pain. On clinical examination, the mean size of ovarian tumor was 9.5 cm, CA-125 levels were found to be raised in 14 patients, and it was associated with ascites in 10 patients. USG showed a well-circumscribed mass (with a mean size of 14 cm), on the left side in 14 cases and on the right side in 9 patients. RMI-4 was calculated in all the patients, and it revealed the possibility of a benign histology in 17 patients. All patients underwent exploratory laparotomy with the removal of ovarian tumor followed by frozen section examination. All but one (22/23) patient had positive correlation among frozen section and final histopathological findings. RESULT Ovarian fibroma generally tends to occur in post-menopausal women. All the patients in our study of ovarian fibroma were symptomatic, with the presence of palpable mass in majority of patients. RMI-4 Index correlated very well with benign nature of disease. Frozen section has an invaluable role at surgery; fertility-conserving surgery is the choice in young women. CONCLUSION Clinical findings, RMI-4 Index and frozen section, play vital roles before and during surgery in cases of benign ovarian tumors.
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Affiliation(s)
- Nikhil Sadanand Parwate
- Department of Gynaecologic Oncology, Gujarat Cancer And Research Institute, Civil Hospital Lines, Asarwa, Ahmedabad, 380016 Gujarat India ; Flat A/1604, Shah Arcade-2, Rani Sati Marg, Near Western Express Highway, Malad East, Mumbai, 400097 Maharashtra India
| | - Shilpa M Patel
- Department of Gynaecologic Oncology, Gujarat Cancer And Research Institute, Civil Hospital Lines, Asarwa, Ahmedabad, 380016 Gujarat India
| | - Ruchi Arora
- Department of Gynaecologic Oncology, Gujarat Cancer And Research Institute, Civil Hospital Lines, Asarwa, Ahmedabad, 380016 Gujarat India
| | - Monisha Gupta
- Department of Gynaecologic Oncology, Gujarat Cancer And Research Institute, Civil Hospital Lines, Asarwa, Ahmedabad, 380016 Gujarat India
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Okuda K, Noguchi S, Narumoto O, Ikemura M, Yamauchi Y, Tanaka G, Takai D, Fukayama M, Nagase T. A case of Meigs' syndrome with preceding pericardial effusion in advance of pleural effusion. BMC Pulm Med 2016; 16:71. [PMID: 27160723 PMCID: PMC4862177 DOI: 10.1186/s12890-016-0241-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 05/01/2016] [Indexed: 11/10/2022] Open
Abstract
Background Meigs’ syndrome is defined as the presence of a benign ovarian tumor with pleural effusion and ascites that resolve after removal of the tumor. The pathogenesis of the production of ascites and pleural effusion in this syndrome remains unknown. Aside from pleural effusion and ascites, pericardial effusion is rarely observed in Meigs’ syndrome. Here, we report the first case of Meigs’ syndrome with preceding pericardial effusion in advance of pleural effusion. Case presentation An 84-year-old Japanese non-smoking woman with a history of lung cancer, treated by surgery, was admitted due to gradual worsening of dyspnea that had occurred over the previous month. She had asymptomatic and unchanging pericardial effusion and a pelvic mass, which had been detected 3 and 11 years previously, respectively. The patient was radiologically followed-up without the need for treatment. Two months before admission, the patient underwent a right upper lobectomy for localized lung adenocarcinoma and intraoperative pericardial fenestration confirmed that the pericardial effusion was not malignant. However, she began to experience dyspnea on exertion leading to admission. A chest, abdomen, and pelvis computed tomography scan confirmed the presence of right-sided pleural and pericardial effusion and ascites with a left ovarian mass. Repeated thoracentesis produced cultures that were negative for any microorganism and no malignant cells were detected in the pleural effusions. Pleural fluid accumulation persisted despite a tube thoracostomy for pleural effusion drainage. With a suspicion of Meigs’ syndrome, the patient underwent surgical resection of the ovarian mass and histopathological examination of the resected mass showed ovarian fibroma. Pleural and pericardial effusion as well as ascites resolved after tumor resection, confirming a diagnosis of Meigs’ syndrome. This clinical course suggests a strong association between pericardial effusion and ovarian fibroma, as well as pleural and peritoneal fluid. Conclusions In female patients with unexplained pericardial effusion and an ovarian tumor, clinicians should consider the possibility of Meigs’ syndrome. Although a malignant disease should be suspected in all patients with undiagnosed pleural and/or pericardial effusion, Meigs’ syndrome is curable by tumor resection and should be differentiated from malignancy.
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Affiliation(s)
- Kenichi Okuda
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Satoshi Noguchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Narumoto
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masako Ikemura
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Yasuhiro Yamauchi
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Goh Tanaka
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Daiya Takai
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Masashi Fukayama
- Department of Pathology, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Takahide Nagase
- Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Affiliation(s)
- Niala Rambocas
- Gynaecological Oncology Centre, New Cross Hospital, Wolverhampton, UK.
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