Retroperitoneal Extraovarian Fibrothecoma Mimicking a Malignant Epithelial Ovarian Carcinoma

Abstract

Background. Fibrothecomas are benign sex cord-stromal tumors which rarely originate outside of the ovary. To date, two such cases have been reported in the literature. We report the third case of an extraovarian fibrothecoma and the first presenting similarly to a metastatic epithelial ovarian cancer. Clinical History. We describe a 62-year-old woman with history, physical examination, and imaging suggestive of metastatic ovarian cancer. CA-125 was elevated at 1291 U/mL. Paracenteses were negative for malignant cells and core biopsy showed spindle cell proliferation. A primary debulking surgery for a presumed ovarian cancer was planned. Method and Results. At surgery, 6 liters of ascites were drained. The uterus, ovaries, peritoneum, and omentum were normal. An 18 × 11 × 7 cm retroperitoneal mass was found between the left ureter and the sigmoid mesocolon, wrapped with sigmoid colon. Fallopian tubes and ovaries were normal. The mass was resected en bloc with the sigmoid colon, uterus, ovaries, and omentum. Microscopically, there was spindle cell proliferation typical of fibrothecoma. No ovarian tissue was identified in association with the tumor. Conclusion. This third case of extraovarian fibrothecoma highlights the importance of obtaining histologic evidence of malignancy prior to initiating neoadjuvant chemotherapy for a presumed ovarian cancer.

Extraovarian Fibroma With Minor Sex Cord Elements: A Case Report and Literature Review

“…To date, only 23 cases of extraovarian SCST have been reported in the English-language literature to our knowledge. 1-23 The ages of the patients, including the present case, ranged from 22 to 78 years (median, 53 years). The chief complaints referred to an intra-abdominal mass or hormonal manifestation such as an irregular menstrual cycle or postmenopausal bleeding.…”

“…Extraovarian sex cord–stromal tumor (SCST) is extremely rare, and preoperative determination is challenging, especially within the differential diagnosis based on imaging tests. 1-23 Furthermore, ovarian stromal tumor with minor sex cord elements is also a rare tumor that was first described by Young and Scully in 1982. 24-33 This tumor may pose a diagnostic dilemma on histological examination.…”

A Case Report of Ovarian Fibrothecoma in a Premenopausal Women with Recurrent Menorrhagia

“…In this case, the tumor size was small, without ascites, and with an intact capsule. Some studies reported benign ovarian thecoma associated with hydrothorax and elevated CA 125 tumor marker, which mimicked an ovarian malignancy [15], [16], [17]. In a study by Ramkumar et al, bilateral thecoma presented as premenopausal hirsutism with hyperandrogenism [18].…”

Meig’s Syndrome with Elevated CA 125: Case Report with a Journey through Literature

“…The fibro thecomas are the most common solid ovarian tumors [12]. The most common histological types reported as being associated to this syndrome are: cellular fibroma, fibro thecoma, fibroma, thecoma, granulosa cell tumor and benign Brenner tumor [1,2,5,7].…”