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ABSTRACT A patient had both ovaries affected by clearly demarcated colliding tumour masses of different gross appearance, histological features and immunohistochemical profiles, corresponding to bilateral collision papillary serous high-grade adenocarcinoma and fibrothecoma. Despite the applied chemotherapy, it led to a lethal outcome for the patient nearly a year after the surgery. Bilateral ovarian tumours raise the question of whether they are primary tumours or metastases. Simultaneous bilateral occurrence of surface epithelial tumours with other types of ovarian tumours is rare. Therefore, it poses a great challenge in proper differential diagnostics.
RESUMEN Una paciente tenía ambos ovarios afectados por masas tumorales en colisión, claramente demarcadas. Las mismas mostraban diferente aspecto macroscópico, y diferentes rasgos histológicos y perfiles inmunohistoquímicos, correspondientes a fibrotecomas y adenocarcinomas serosos papilares bilaterales de alto grado en colisión. A pesar de la quimioterapia aplicada, la condición condujo a un resultado fatal para la paciente, casi un año después de realizada la cirugía. Los tumores ováricos bilaterales plantean la cuestión de si se trata de tumores primarios o metástasis. La ocurrencia bilateral simultánea de tumores epiteliales superficiales con otros tipos de tumores ováricos es rara, y por tanto, plantea un gran desafío a la hora de realizar un diagnóstico diferencial adecuado.
Subject(s)
Humans , Female , Middle Aged , Ovarian Neoplasms/diagnosis , Thecoma/diagnosis , Adenocarcinoma/diagnosis , Immunohistochemistry , Fatal OutcomeABSTRACT
Objective: To analyze the clinical features of ovarian fibrothecoma complicated with ascites and high level of CA125. and to explore the causes of elevated CA125 level and its significance in identifying benign and malignant ovarian tumors. Methods: The clinical data of one patient with varian fibrothecoma complicated with ascites and high level of senim CA125; combined with relevant literature review, the clinical characteristics, diagnosis and treatment process, and the significance of CA125 in the differential diagnosis of benign and malignant ovarian tumors were analyzed. Results: The patient was admitted to hospital due to vaginal bleeding for 4 months and pelvic mass for 1 month. The diagnosis result was pelvic and abdominal mass arising from ovarian according to the preoperative color Doppler ultrasound, enhanced CT» serum CA125 level and physical examination, and was highly suspected as ovarian malignant tumor. Surgery treatment was performed; based on the intraoperative rapid pathological results and postoperative slow pathology, the patient was diagnosed as ovarian fibrothecoma; the operation was successful. The patient recovered well and discharged from hospital. The serum CA125 level was decreased to the normal range 1 month after operation. Conclusion; Identification and quantitative analysis of the glycosylation modification and specific glycan structure of CA125 from different sources can significantly improve the diagnostic specificity of CA125 for benign and malignant ovarian tumors.
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Presenting a case of endometrioid adenocarcinoma of the endometrium, benign cystic teratoma of one ovary, fibrothecoma in the other ovary and adenomyosis in the uterus. Such a combination of synchronous lesion is very rare and is not reported in the English medical literature.
Subject(s)
Female , Humans , Adenomyosis , Carcinoma, Endometrioid , Endometrial Neoplasms , Endometrium , Ovary , Teratoma , UterusABSTRACT
Objective To evaluate the MDCT and MRI findings of the ovarian thecofibroma.Methods 15 patients with 16 lesions of ovarian thecofibroma confirmed by pathology after surgery were analyzed retrospectively.MDCT was performed in 1 2 patients and MRI in 8.Results 16 lesions were all unilateral,of which 1 patient had 2 lesions on the same side.10 lesions were located in the right side of ovary,while 6 ones were in the left side.The shape of more lesions was round or oval,and that of huge lesions was lobulated. 14 lesions were well-defined.These tumors were solid in 4 lesions,mixed in 9,and cystic in 3.The largest diameter of tumors ranged from 20 to 220 mm with a mean value of (89±58.29)mm.Plain MDCT showed the substantial part of tumors with iso-den-sity or slight lower density with the mean CT value of (40±8)HU.There was no or slight enhancement in comparison with the mean CT values of (49±9)HU on enhanced MDCT.5 lesions with isointensity and 3 with slight hypointensity on T1-weighted ima-ges,and all the tumors with heterogeneous signal on T2-weighted images were found.6 lesions appeared isointensity with obscure nebulous high signal on T2-weighted.The capsules of 5 lesions showed incomplete ring with lower signal.There was high signal ring outside of tumor capsule on T2-weighted in 5 lesions.All of 8 lesions were enhanced slightly,and the cystic portion was lower signal on T1-weighted images and high signal on T2-weighted images.Among all patients,ascites was found in 10 cases (66.7%)and other kinds of tumors of ovarian or uterus in 13 cases (86.7%).Conclusion MDCT and MRI findings of the ovarian thecofibroma have cer-tain characteristics,which is helpful for the diagnosis and differential diagnosis.
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Objective To explore the CT features and differential diagnosis of ovarian fibrothecoma,and to compare with postoperative pathological findings.Methods The clinical data,CT appearances and pathological signs of 15 patients with ovarian fibrothecoma and 7 patients with granulosa cell tumor were analyzed retrospectively.The plain CT values and enhanced CT values(ΔCT)of fibrothecomas and granulosa cell tumors were compared with each other.Results The ovarian fibrothecomas showed solid or cystic-solid masses with well-defined margin,mild delayed enhancement or no obvious enhancement on CT.The CT features were correspond to the pathological signs. The plain CT values of fibrothecoma and granulosa cell tumor had no significant difference(t=0.745,P=0.467).The mean ΔCT values of fibrothecoma was significantly lower than that of granulosa cell tumor(t=2.537,P=0.041).Conclusion Ovarian fibrothecoma has characteristic CT features,combined with the clinical data,which may help to improve the diagnosis.
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Objective To evaluate the value of diffusion weighted imaging(DWI)combined with conventional MRI in the differential diagnosis between fibrothecomas and malignant pelvic solid tumors.Methods Conventional MRI and DWI of 23 fibrothecomas in 22 patients and 26 malignant pelvic solid tumors were analyzed retrospectively.ADC values between the two groups were compared by the Student's t-test.The receiver operating characteristic(ROC)curve was applied to determin the ability of the lowest and mean ADC values to differentiate thecomas/fibrothecomas from malignant pelvic solid masses.Group differences in shape,border,T2WI signal intensity,DWI signal intensity,enhancement degree and CA125 levels were compared with χ2test.Results In the fibrothecoma group,hypo-,iso-,hyper-and mixed intensity on T2WI accounted for 52.2%,17.4%,8.7% and 21.7%,respectively.In the malignant pelvic solid tumor group,all masses showed hyperintensity on T2WI.The mean ADC value of fibrothecomas[(1.24±0.30)×10-3mm2/s]was significantly higher than that of malignant pelvic solid tumors[(0.89 ± 0.22)×10-3mm2/s](t=4.571,P<0.001).In the ROC curve analysis,when the lowest ADC value of 1.01×10-3mm2/s was used as the cut-off value,sensitivity,specificity and accuracy were 78.3%,80.2% and 79.6%,respectively.There were significantly statistical differences between groups in shape,border,T2WI signal intensity,DWI signal intensity,enhancement degree and CA125 levels.Conclusion The combination of DWI and conventional M RI is of great value in the differential diagnosis between fibrothecomas and malignant pelvic solid tumors,which could provide references for gynecologists to make better choices of clinical treatment strategies.
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El fibrotecoma ovárico es una neoplasia poco frecuente y su localización extraovárica es más rara aún. Se observa generalmente como tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría, es benigno y puede ser funcionales o no. Actualmente solo se han reportado tres pacientes y solo una de ellas de localización retroperitoneal. Se presenta un caso de una paciente con fibrotecoma extraovárico gigante retroperitoneal. Se realizó a la paciente exéresis de la lesión sin complicaciones intra ni posoperatorias.
Ovarian fibrothecoma is a rare malignancy and its extraovarian location is even rarer. It is generally seen as unilateral solid tumor, of variable size, in premenopausal women. It is mostly benign and it can be functional or not. Currently only three patients have been reported and only one of retroperitoneal location. A case of a patient with giant retroperitoneal extraovarian fibrothecoma is presented in this paper. The patient underwent excision of the lesion showing no intraoperative or postoperative complications.
Subject(s)
Humans , Female , Adult , Ovarian Neoplasms/surgery , Retroperitoneal Neoplasms/surgery , Thecoma/surgeryABSTRACT
The term collision tumor refers to the coexistence of two adjacent but histological distinct tumors with no histological admixture at the interface. Collision tumors involving ovaries are extremely rare. A collision tumor composed of a dermoid cyst and fibrothecoma is extremely rare in menopausal women. The mechanism of the development of collision tumor is uncertain. During clinical evaluation, differentiation of characters of these ovarian tumors is important to decide appropriate treatment strategies and for good prognosis. We report an unusual clinical manifestation of the torsion of a dermoid cyst and fibrothecoma in the right ovary with postmenopausal bleeding.
Subject(s)
Female , Humans , Dermoid Cyst , Hemorrhage , Ovary , Postmenopause , PrognosisABSTRACT
El fibrotecoma ovárico es una neoplasia poco frecuente y su localización extraovárica más rara aún. Se observa por lo general, como tumor sólido unilateral, de tamaño variable, en mujeres premenopáusicas. En su mayoría es benigno y puede ser funcionales o no. En la actualidad se han reportado tres pacientes y solo una de ellas de localización retroperitoneal. Se realizó este trabajo con el objetivo de describir el diagnóstico y tratamiento de esta rara enfermedad. Argumentada a través, de la presentación de un caso de fibrotecoma extraovárico gigante retroperitoneal; se le efectuó a la enferma la exéresis de la lesión sin complicaciones intra ni posoperatorias.
Ovarian fibrothecoma is a rare neoplasm and its extraovarian location is even rarer. It is usually seen as unilateral solid tumor, of variable size, in premenopausal women. It is usually seen as unilateral solid tumor, of variable size, in premenopausal women. Mostly it is benign and it can be functional. At present, three patients have been reported and only one has it in retroperitoneal location. This paper was conducted to describe the diagnosis and treatment of this rare disease. Reasoned through the presentation of a case of a giant retroperitoneal extraovarian fibrothecoma; He will be performed at the patient's tumor was excision without intra or postoperative complications. The patient underwent the excision of the lesion without intra or postoperative complications.
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Objective To analyze the correlation between MRI features and pathological characterization of ovarian thecoma-fibro-ma.Methods MRI manifestations of 21 patients with ovarian thecoma-fibroma proved by pathological diagnosis were analyzed retro-spectively and compared with pathologic findings.Results The 21 cases involved 22 lesions (one patient had bilateral masses of the-cofibroma),including 13 fibrothecoma,4 thecofibroma and 5 fibroma.All lesions presented with well-defined margin,and cystic changes were found in 1 5 cases,7 lesions were solid masses ,1 9 lesions were round or oval masses ,2 lesions were lobulated mas-ses,and 1 lesion was irregular mass.The diameters of tumor ranged from 3.4 to 18.5 cm with mean diameter of 8.9 cm.On MR images,all lesions showed isointense or slight hypointense on T1 WI.On T2 WI,most tumors showed isointense or slight hypoin-tense,along with hyperintense cystic areas in 1 5 lesions,patchy slight hyperintense edema areas in 4 lesions,and homogeneous isointense or slight hypointense in 3 lesions.After contrast enhancement,all lesions demonstrated mild-to-moderate enhancement and delayed progressive enhancement slightly.13 cases associated with varied degrees of pelvic effusion,1 case with thickening of endometrium,and 1 case with endometrial carcinoma.Two patients had a higher level of CA125.Postoperative pathology demon-strated that all lesion were benign.Conclusion The MRI findings of the ovarian thecoma-fibroma are considerably characteristic and indirectly reflect pathology of tumor,thus beneficial to the correct diagnosis of tumor with relevant clinical information.
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Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumour that has mixed features of both fibroma and thecoma. The prevalence of ovarian fibrothecoma tumours is very rare and is reported to be about 1.2% of all ovarian tumours. We report a case of a 32-year-old woman who presented with acute menorrhagia with no previous medical, surgical or gynecological history. She was amenorrhic for four years after the insertion of a levonorgestrelreleasing intrauterine system (LNG-IUS) for contraception. The efficacy and location of LNG-IUS was reflected due to the sudden onset of menorrhagia. On pelvic examination and ultrasound the LNG-IUS could not be visualized and a uterine fibroid was noted. A diagnostic laparoscopy was done to identify the LNG-IUS, which revealed an incidental large ovarian mass on the left ovary. CA-125 level was elevated to 45 kU/L (Normal range <35 kU/L). Total abdominal hysterectomy, left salpingo-oopherectomy and cystectomy were performed. On histopathology, the mass was proven to be an ovarian fibrothecoma. No signs of malignancy were noted on peritoneal fluid cytology. The LNG-IUS was found inside the uterus. Our case is reported on the basis of the rare incidence of ovarian fibrothecoma and the possible effect it may have on the efficacy of LNG-IUS causing menorrhagia.
Subject(s)
Menorrhagia , Fibroma , Thecoma , Ovarian NeoplasmsABSTRACT
Two females aged 70 years and 45 years presented in OPD of Dept. of Gynecology with large abdominal lump and ascites. In both cases, clinical and radiological diagnosis of malignant ovarian tumor was made. Ascitic fluid cytology revealed absence of malignant cells. Panhysterectomy was performed. On histopathological examination, both cases were diagnosed as benign fibrothecoma with extensive cystic change. Postoperative follow-up for about six months was uneventful and both patients recovered completely.
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Meigs' syndrome is a benign ovarian tumor associated with ascites and pleural effusion. Elevated CA 125 in Meigs'syndrome is unusual clinical condition reported in few cases. We report here, a 49-year-old postmenopausal woman with right ovarian fibrothecoma with ascites, right pleural effusion and high serum levels of CA 125. Although postmenopausal women with ovarian tumor, ascites, pleural effusion, and elevation of CA 125 levels probably have malignant ovarian tumors, Meigs' syndrome must be considered in the differential diagnosis.
Subject(s)
Female , Humans , Middle Aged , Ascites , Diagnosis, Differential , Meigs Syndrome , Ovary , Pleural EffusionABSTRACT
Fibrothecoma is mesenchymal tumor deriving from the ovarian stroma composed of theca-like elements and fibrous tissues. Fibroma is rarely associated with Meigs' syndrome which consists of an ovarian fibroma, ascites, and pleural effusion. And also, sclerosing peritonitis associated with thecoma of the ovary is a rare, but intriguing phenomenon characterized by striking peritoneal reactive fibrosis. We have experienced a case of Meigs' syndrome and sclerosing peritonitis associated with fibrothecoma of the bilateral ovaries in a 57-year-old woman. We report a case with brief review of literatures.
Subject(s)
Female , Humans , Middle Aged , Ascites , Fibroma , Fibrosis , Meigs Syndrome , Ovary , Peritonitis , Pleural Effusion , Strikes, Employee , ThecomaABSTRACT
Fibrothecoma are mesenchymal tumors deriving from the ovarian stroma and consisting of theca-like elements and fibrous tissue. The reported incidence is between 0.4 and 8.0% of all ovarian tumors and this side variability can be attributed to the difficulty in differentiation fibrothecoma from ovarian fibroma or hyperplastic stroma nodules. A dermoid cyst is composed of well-differentiated derivatives of the three germ layers; ectoderm, mesoderm, and endoderm. We have experienced a case of ovarian fibrothecoma with mature cystic teratoma of the ipsilateral ovary and ovarian fibroma of the contralateral ovary in a 33-year-old woman. We report a case with brief review of literature.
Subject(s)
Adult , Female , Humans , Dermoid Cyst , Ectoderm , Endoderm , Fibroma , Germ Layers , Incidence , Mesoderm , Ovary , TeratomaABSTRACT
Meigs' sydrome is a relatively uncommon and the unusual condition of ascites and fluid in the chest associated with benign and solid tumors of the ovary with the gross appearance of a fibroma. The mechanism of this syndrome is not completely understood, but various lymphatics through the diaphragm seem the likely route for ascitic fluid into the chest. We present a case of Meigs' syndrome associated with fibrothecoma and elevate CA 125 with the brief review of literature.