VM*, Parulekar SV**
Second year Postgraduate student, ** Professor and Head, Department
of Obstetrics and Gynaecology, Seth G.S. Medical College & KEM
Hospital, Mumbai, India.)
ovarian fibroma is a rare benign tumor which grows from the
connective tissue of the ovarian cortex.
the sex cord-stromal tumors, fibromas are the most commonly
encountered subtype accounting for almost two-thirds of neoplasms in
this group. We present an unusual case of Fibroma of the ovary
presenting later in life.
thecomas and fibro-thecomas are rare
benign tumors which grow from the connective tissue of the ovarian
The mean age of occurrence is 45-55 years.[1,2] They are classified
cord-stromal tumors which also include tumors composed of granulosa
cells, theca cells, Sertoli cells, Leydig cells, and fibroblasts of
stromal origin, singly or in various combinations.[3,4] According to
the WHO, thecoma-fibroma tumors are classified into the following
tumor with minor sex cord elements
ring cell stromal tumor
are benign tumors developing in the postmenopausal women (over 40
years of age). They usually present as unilateral, solid, firm to
hard masses with a bosselated external surface, off white to pearly
white in color. They can be bilateral, and usually measure more than
6 cm in diameter. The consistency may be soft and cyst formation is
common if edema is associated with the tumor.[5,6] The cut surface
shows a whorled pattern with a grayish white stroma and occasional
areas of calcification. We present an unusual case of fibroma of the
ovary presenting later in life and its surgical management.
65 year old postmenopausal woman was referred from a peripheral
hospital in view of a large left ovarian cyst (6.2x7.8 cm) diagnosed
on ultrasonography (plates not available). She had pain in the left
side of the lower abdomen for 7 months, dull aching in nature with no
aggravating and relieving factors. She also perceived a mass in her
lower abdomen which had gradually progressed in size over 3 months,
non tender and of firm consistency. She was a known case of
hypertension diagnosed 12 years ago, receiving T. Amlodipine 5mg OD
and T. Aspirin 150 mg OD. She had attained menopause 16 years ago,
her previous cycles being regular. She had 3 full term normal
deliveries followed by tubal ligation done 24 years ago. On
examination her vital parameters were within normal limits, blood
pressure was 130/80 mm Hg, and general and systemic examination
revealed no abnormality. Per abdomen examination revealed a solitary,
intraperitoneal, firm to hard mass of 14 to 16 weeks' size arising
from the pelvis. It had free side to side mobility. The cervix and
vagina appeared healthy on per speculum examination. On vaginal
examination the uterus appeared to be of normal size, pushed to the
left and posteriorly by an anterolateral firm to hard mass of about
7x8 cm. A provisional diagnosis of left ovarian tumor was made.
smear was atrophic inflammatory. Her hemogram, plasma sugara levels,
liver and renal function test results were within normal limits.
Contrast enhanced computerized tomography (CECT) of the abdomen and
pelvis showed a well defined left ovarian cyst measuring 10 cm in
diameter, causing smooth extrinsic impression on the fundus of the
urinary bladder. The fat planes were preserved and minimal fluid was
noted in pouch of Douglas. Tumor marker CA-125 was 14.49 U/ml.
1. CECT showing ovarian mass.
2. Ovarian fibroma is seen during laparotomy.
exploratory laparotomy was performed under epidural anaesthesia
through a vertical midline infraumbilical incision. Peritoneal fluid
was collected for cytology. In situ findings were of a normal sized
uterus with a normal right ovary and fallopian tube. A 6x8x9 cm
solid, firm to hard, off white to pearly white colored mass was noted
on the left side arising from the left ovary, free from other pelvic
structures. Left salpingo-oophorectomy was done and specimen sent for
frozen section. Frozen section was suggestive of sex cord stromal
tumour favoring thecoma-fibroma. Total abdominal hysterectomy with
right salpingo-ophorectomy was done. Infracolic omentectomy was also
performed to complete the procedure. Post operative course was
uneventful and patient was discharged on the 5th
post operative day.
histopathology report revealed a mildly cellular spindle cell tumor
replacing the entire left ovary. The cells were arrange in multiple
fascicles, storiform pattern and in sheets suggestive of left ovarian
sex cord stromal tumour – fibroma.
fibromas are predominantly benign tumors occurring in the
postmenopausal group. Most of these tumors are asymptomatic with the
clinical presentation being of vague abdominal pain and discomfort.
Sometimes the patient may appreciate a mass in her abdomen which is
firm to hard in consistency. They are stromal tumors composed of
spindle, oval or round cells producing collagen. Fibromas are
usually solid, unilateral, spherical or oval, with a bosselated
surface and a glistening white or pearly white appearance.
Preoperative diagnosis is difficult. Diagnosis can be aided by
imaging and tumor markers. CA 125 is not specific but can be used to
suspect malignant change. Elevated CA-125 is usually associated with
the presence of ascites[10,11] CECT is helpful in delineating the
tumor, its origin and preservation of fat planes. Fibroma should be
differentiated from stromal hyperplasia and fibrothecoma. Diagnosis
is confirmed only on histopathology. The treatment consists of
surgical resection of the tumor which is associated with very low
recurrence rates and
laparoscopic surgery can be an effective and safe alternative
approach. Laparoscopic assisted vaginal hysterectomy can also be done
, the tumour being removed in an endobag.
case presented here was unusual in some respects. The solid tumor was
perceived to be a cystic tumor on ultrasonography as well as on CECT.
There appears to be an error of both of these investigations. The
tumor was much larger than the average size of a fibroma at the time
of presentation. Its frozen section report did not diagnose a fibroma
and hence, especially considering her age,
a total abdominal hysterectomy with bilateral salpingo-oophorectomy
with an infracolic omentectomy was performed, though the peritoneal
fluid did not show any malignant cells.
fibromas are benign tumours of the the ovary, difficult to diagnose
pre-operatively and can clinically and biochemically mimic ovarian
cysts, tuboovarian mass, uterine myoma or ovarian malignancy. CA 125
levels are not specific for diagnosis but with imaging are helpful to
decide the course of treatment which usually consists of surgical
resection either by laparotomy or laparoscopic approach.
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Manjrekar VM, Parulekar SV. Ovarian Fibroma: An Unusual Case. JPGO 2016. Volume 3 No. 2. Available from: http://www.jpgo.org/2016/03/ovarian-fibroma-unusual-case.html