Ovarian thecoma-fibroma groups: clinical and sonographic features with pathological comparison

Abstract

BackgroundOvarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. The objective of the study was to demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology.MethodsA total of 61 patients with surgically proven OTFG were enrolled in this retrospective study to demonstrate its clinical and sonographic features and to compare with pathological findings. Gray scale and color Doppler sonography were performed presurgically with either transabdominal or transvaginal approach to image pelvic structures and lesions. The clinical findings and sonographic appearances were compared with the types of the OTFG tumors based on the histopathological diagnosis.ResultsThe mean patient age was 53.57 (range, 26–86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi’s syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level (p < 0.01) and the amount of ascites fluid (p < 0.05).ConclusionsThe typical sonographic features of OTFG include adnexal hypoechoic masses with clear border and acoustic attenuation as well as minimal Doppler flow signals. All the aforementioned features could make ultrasound imaging as a assistent tool improve the preoperative diagnostic accuracy.

A giant fibroma associated with Meigs’ syndrome misdiagnosed as a giant myoma: a case report

“…Chen et al report that 63.93% of the lesions occur after menopause, with 65.57% in women aged 51 to 70 years. Most patients visited the hospital because of pelvic palpable masses, while 64% of these patients showed no obvious clinical symptoms [5,6]. Symptoms such as abdominal pain and abdominal bulging may occur in cases with large tumors with a diameter over 5 cm.…”

Ovarian fibroma/fibrothecoma with elevated serum CA125 level

“…Ovarian fibroma/fibrothecoma with elevated serum CA125 level is rarely encountered in clinical practice, and can be indexed in only 2 studies with small samples. [ 2 , 3 ] Chechia et al [ 3 ] measured serum CA125 level in 21 fibroma/fibrothecoma patients and found that 3 (14.2%) had values ≥ 35 U/mL. Chen et al [ 2 ] found that 12 (20.6%) had serum CA125 value ≥ 35 U/mL in 58 ovarian fibroma/fibrothecoma patients.…”

“…Ovarian fibroma/fibrothecoma is classified as sex cord stromal tumors, accounting for approximately 5% to 8% of all ovarian tumors and including 3 pathologic subtypes (fibroma, thecoma, and fibrothecoma) based on the different compositions of fiber and theca ingredients. [ 2 ] Most of ovarian fibromas/fibrothecomas occur in adolescents and young women, and show a solid pelvic or adnexal mass with benign biobehavior. About 10% to 15% of ovarian fibromas/fibrothecomas can be combined with ascites, however, less than 1% are combined with both ascites and hydrothorax, known as Meigs syndromes.…”

Acute Presentation of Ovarian Fibroma as a Pelvic Abscess – Case Report

“…They are often unilateral with a diameter smaller than 5 cm. Combined with clinical information and CA125, ultrasound imaging could be used as an imaging tool for improving the preoperative diagnostic accuracy [5]. It has been reported that 34% of ovarian fibromas were misdiagnosed preoperatively as uterine myoma [4].…”