Decoding Fibrothecal Tumors of the Ovary A Rare Yet Benign Ovarian Neoplasm

Introduction

Fibrothecal tumors of the ovary represent a rare and diagnostically challenging entity in gynecological oncology. Affecting fewer than 4% of all ovarian tumors, these growths typically occur in post-menopausal women and often mimic malignant ovarian pathologies. In this insightful case report, researchers from the University Hospital Center Ibn Sina in Morocco present the clinical journey of a 59-year-old woman diagnosed with a large fibrothecoma following exploratory surgery.
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Case Highlights and Clinical Insights

• Patient Profile: 59-year-old, nulligravida, post-menopausal woman.
• Symptoms: Pelvic pain, abdominal distension, fatigue, and weight loss.
• Initial Assessment: Pelvic ultrasound indicated a solid-cystic ovarian mass (ORADS 4). Elevated CA-125 levels (1693.60 IU/ml).
• Imaging Support: CT scan showed a large heterogeneous mass displacing adjacent organs with effusion but no metastases.

Surgical Approach and Histopathology

• Procedure: Total hysterectomy with bilateral adnexectomy, omentectomy, and appendectomy.
• Findings:
  • Right ovarian mass diagnosed as fibrothecoma.
  • Left adnexa revealed dystrophic changes but no malignancy.
  • Appendix displayed chronic inflammation.
  • Uterus showed benign myomas.
• Follow-up: Scheduled at 1, 3, 6, and 12 months post-op; patient recovered uneventfully before being lost to follow-up after one year.

Diagnostic and Treatment Considerations

• Origin & Behavior: Fibrothecal tumors originate from ovarian stromal tissue and are primarily benign.
• Symptoms: Varying based on hormone secretion—estrogen-producing tumors may lead to endometrial hyperplasia.
• Preferred Imaging:
  • Ultrasound – solid mass with regular contours.
  • MRI – hyposignal on T2-weighted sequences due to fibrous content.
  • CT Scan – useful for surgical planning.
• Definitive Diagnosis: Relies on histopathological confirmation showing spindle cells within a collagenous stroma.

Clinical Implications & Broader Perspective

The American College of Obstetricians and Gynecologists (ACOG) emphasizes the need for individualized assessment when treating adnexal masses, especially in postmenopausal women, where the balance between malignancy suspicion and benign pathology like fibrothecoma must be carefully evaluated (ACOG Guidelines).

Read the Full Case Study

Read the full study at https://doi.org/10.29328/journal.cjog.1001177

Further Reading & Related Resources

• Benign Ovarian Tumors
• Explore More in Gynecologic Oncology

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