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Ovarian fibroma

An ovarian fibroma is a benign ovarian tumour of sex cord / stromal origin. Although fibromas account for approximately 4% 2-3 of all ovarian neoplasms, they are the most common sex cord ovarian tumour.

Epidemiology

Fibromas occur at all ages but are most frequently seen in middle-aged women.

Clinical presentation

Fibromas are generally asymptomatic and are often detected at palpation during routine gynaecologic examination. Tumours can reach a large size at presentation.

Pathology

The tumour belongs to the same histopathologic spectrum as an ovarian thecoma / ovarian fibrothecoma. Fibromas have no (or very few) thecal cells and no (or minimal) estrogen activity.

It is composed of spindle cells forming variable amounts of collagen. Sectioning of a fibroma typically reveals a chalky-white surface that has a whorled appearance, similar to that of a uterine fibroid. Areas of oedema, occasionally with cyst formation, are also relatively common.

Associations

They are associated with ascites in 40% of cases and with pleural effusions in a small percentage of cases. 

Radiographic features

Ultrasound

On ultrasound, fibromas most commonly manifest as solid, hypoechoic masses with ultrasound beam attenuation.  As such, they may appear similar to a pedunculated subserosal uterine fibroid.

However, the sonographic appearance can be variable and some tumours can rarely have cystic components.

CT

Fibromas usually manifest as diffuse, slightly hypoattenuating masses with poor, very slow contrast enhancement. Calcification and bilaterality are both uncommon.

MRI

Signal characteristics include

  • T1: fibromas usually demonstrate homogeneous low signal intensity 
  • T2
    • fibromas appear as well-circumscribed masses with low signal intensity
    • may containin scattered hyperintense areas representing oedema or cystic degeneration.
    • a band of T2 hypointensity separating the tumour from the uterus on all imaging planes is also considered a characteristic feature.
  • T1 C+ (Gd): usually shows heterogenous enhancement 5

Treatment and prognosis

Ovarian fibromas are almost always benign 3

Complications

Differential diagnosis

General imaging differential considerations include


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