Presentation
Abdominopelvic pain and palpable pelvic mass on physical exam.
Patient Data
A sizeable well-defined mass with heterogeneous enhancement and central cystic degeneration in the right adnexa, measuring about 106× 83× 81 mm. The right ovary couldn't be defined separately from the mentioned mass. There is no sign of local invasion and no regional lymphadenopathy.
The hepatic attenuation value is less than that of the spleen, suggesting fatty liver.
A 20 mm cyst is seen in the left renal sinus.
The patient underwent a total abdominal hysterectomy and right-sided salpingo-oophorectomy.
Histopathology evaluation confirmed ovarian stromal cell tumour with mild to moderate nuclear atypia and mitotic counts of 0-5 per 10HPF. Further immunohistochemistry result was negative for Calretinin, Inhibin, Desmin, EMA and CK, and positive for Vimentin. CD34 is also reported positive in a few cells and vessel walls.
Final diagnosis: ovarian fibrosarcoma, grade I
Case Discussion
Ovarian fibrosarcoma is a very rare malignant ovarian tumour and accounts for less than 1% of all ovarian malignancies. It is usually seen in peri- or post-menopausal women and has a poor prognosis. Due to its low incidence and poor prognosis, until now, very few cases have been reported.
It can be de novo or arise from an ovarian fibroma as a malignant transformation. The diagnosis is based on pathological evaluation, and immunohistochemistry helps to confirm.
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