Abstract

Background: The presentation of ovarian fibrothecoma is highly deceptive and it may be undiagonised till histopathology reveals the actual diagnosis. Hence, the clinician must be aware of such cases which may present as a diagnostic dilemma.

Introduction: Ovarian fibrothecomas are rare ovarian neoplasm. We report a case where clinical presentation was highly deceptive and suggestive of malignant tumor. However, ascitic fluid cytology revealed absent malignant cells. On histopathological examination, it was diagnosed as benign fibrothecoma with cystic changes. Postoperative follow-up for about six months was uneventful.

Case: A 45 year old female presented with large abdominal lump of 20 weeks size associated with pain abdomen. She was admitted for management and evaluation. Hematological and biochemical parameters were normal. USG revealed a large multilocular, predominantly cystic lesion 20.9x9.6x11.4 cm in pelvis. CECT revealed ovarian cystadenocarcinoma left ovary with locoregional mass effect, mild ascites and suspicious metastasis to internal iliac lymph nodes. Hence panhysterectomy and omentectomy was performed as radiological and preoperative clinical diagnosis was malignant ovarian tumor. On gross examination, a well encapsulated, multinodular cystic tumor of left ovary about 17x14x7 cm was identified. Cut surface was mostly solid with few cystic areas. On microscopic examination, multiple sections showed spindle shaped cells in storiform and palisading pattern. No mitotic activity was identified. On special staining, it was positive for vimentin. Hence, final diagnosis came to be as benign fibrothecoma of ovary

Conclusion: The accurate preoperative diagnosis of ovarian fibrothecoma with cystic changes could have prevented the extensive surgical intervention such as bilateral salpingo- oopherectomy with hysterectomy.

Keywords

Ovarian fibrothecoma, Ascites, Tumor, Thecomas, Degeneration, Laprotomy, Menstrual history, Salpingo-oopherectomy, Omentectomy, Abdominal hysterectomy, Cystic lesion, Uterus, Cervix, Malignancy, Odontogenic Keratocysts, Cystadenofibromas