Presentation
Non-specific pelvic pain and feeling of pelvic fullness. No gynecologic symptoms. No past medical or surgical history.
Patient Data
There is a well-defined oval shape homogenous left adnexal lesion with adjacent ovarian follicles suggestive of an ovarian origin of the lesion. The lesion appears solid without cystic components, no fat or blood elements. It appears isointense on T1 and hypointense on T2. A diffuse hyperintense signal is seen on STIR images representing edema. The lesion measures about 6.5 x 6 x 5.5 cm. Delayed homogenous enhancement is noted.
Features are likely representing a benign left ovarian lesion with a fibrous component (fibroma most likely). Differential diagnoses include broad ligament/ large pedunculated uterine fibroid, however less likely.
The uterus has a normal internal structure. Normal right ovary.
Normal urinary bladder. Mild amount of pelvic free fluid.
There is no apparent lymphadenopathy.
The femoral heads are normally shaped and articulate normally with the acetabula. They have normal bone-marrow signal characteristics.
Histopathology report
Gross examination
Specimen received fixed in formalin solution, labeled with patient's name, consists of 4.5 x 3 cm ovarian tissue with attached 7 x 4.5 x 4.5 cm oval relatively circumscribed mass. On cutting the ovarian tissue is cystic and the cut surface of the mass is white tan in color and fibrotic. Multiple representative sections were submitted and embedded in seven cassettes.
Microscopic examination
Serial levels reveal an ovarian tumor composed of closely packed spindle stromal cells arranged in a storiform pattern of growth. Hyaline bands are present-centered mainly around blood vessels. Areas of edema were also detected. Cellular atypia is almost minimal and mitotic activity is also almost absent. No necrosis. The overall picture is consistent with fibroma. The attached ovarian tissue is unremarkable and contains few cystic follicles, dilated vascular channels and two corpus luteal cysts.
Final diagnosis
Left ovarian mass excision: fibroma
Case Discussion
Ovarian fibroma is a benign stromal/sex cord tumor and the commonest in this category. Middle age females are more commonly affected. The tumor size can be large at presentation as in this case. Many associations are known with this tumor, e.g. Meigs and Gorlin-Goltz syndromes. On ultrasound, it appears hypoechoic with acoustic shadowing, even in the absence of calcifications. On MRI, it has a low T2 signal which is considered a characteristic feature of fibrous origin tumors. On imaging, it can resemble a large pedunculated subserosal uterine leiomyoma.