An ovarian cystadenofibroma (CAF) is a relatively uncommon benign epithelial ovarian tumour where the fibrous stroma remains a dominant component of the neoplasm. As a group they are thought to represent ~1.7 % of all benign ovarian tumours 3.
Although generally classified as an epithelial tumour, a cystadenofibroma contains both epithelial and stromal components.
Recognised histological sub types include 3,5
- serous cystadenofibroma of the ovary
- mucinous cystadenofibroma of the ovary
- endometrioid cystadenofibroma of the ovary
- clear cell cystadenofibroma of the ovary
- mixed cystadenofibroma of the ovary
Lesions can be bilateral in ~15% of cases.
Almost all cystadenofibromas are predominantly cystic on ultrasound with septations seen in ~30% of cases. Papillary projections or solid nodules have be sonographically seen in just over 1/2 of cases. Vascularisation can be present in just under 1/2 of cases with typical pattern of peripheral vascularisation with scattered vessels of high blood flow impedance 9.
They can have a either a pure cystic or complex cystic pattern with the solid components having a nodular or trabecular pattern 3.
Reported signal characteristics in general include
- T2: due to the stromal components the fibrous septa often have low signal while the cystic components can have high signal; this may give a "black sponge" like appearance 7.
- T1 C+ (Gd): septated component may show moderate enhancement 8
Treatment and prognosis
They generally tend to be benign tumours although the degree of epithelial proliferation and its relation to the stromal component of the tumour can used for their classification as benign, borderline or malignant 5.
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- 8. Kim KA, Park CM, Lee JH et-al. Benign ovarian tumors with solid and cystic components that mimic malignancy. AJR Am J Roentgenol. 2004;182 (5): 1259-65. AJR Am J Roentgenol (full text) - Pubmed citation
- 9. Alcázar JL, Errasti T, Mínguez JA et-al. Sonographic features of ovarian cystadenofibromas: spectrum of findings. J Ultrasound Med. 2001;20 (8): 915-9. J Ultrasound Med (abstract) - Pubmed citation
- 10. Eurorad teaching files : Case 9059