Ovarian fibromatosis

Last revised by Joshua Yap on 11 May 2023

Ovarian fibromatosis refers to a rare benign phenomenon where there is tumor-like ovarian enlargement due to diffuse ovarian fibrosis.

It may have a predilection towards younger pre-menopausal females (age range around 13-39 years) with a mean age of presentation of 25 years 5.

There can be different presentations such as menstrual irregularity, abdominal pain, and infrequently hirsutism and virilisation 5.

It is characterized by a proliferation of collagen-producing spindle cells surrounding normal ovarian structures. It is sometimes considered a complication of massive ovarian edema 5.

The echogenicity of ovarian fibromatosis on ultrasound can be variable; preserved ovarian follicles may be seen along the periphery of the mass.

May show a relatively hyperdense (to myometrium), homogeneous, solid and variably enhancing solid ovarian mass.

It is characterized by the presence of ovarian infiltration and enlargement with partial sparing of normal ovarian structures.

  • T1: hypointense

  • T2: thick hypointense rim, known as the "black garland sign" 4

  • T1 C+ (Gd)

    • parenchymal phase: no significant enhancement of the fibrous component

    • delayed phase: the fibrous component may minimally enhance

Ovarian fibromatosis is a benign, non-neoplastic condition. It is sometimes managed with a salpingo-oophorectomy.

It was first described by R H Young and R E Scully in 1984 2.

Imaging differential considerations include other solid ovarian masses such as:

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