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LETTER TO EDITOR
Year : 2019  |  Volume : 18  |  Issue : 4  |  Page : 210-211  

Ovarian fibroma with torsion in a young female


Department of Radiology, Subharti Medical College, Meerut, Uttar Pradesh, India

Date of Web Publication05-Dec-2019

Correspondence Address:
Dr. Sonal Saran
Flat No 1, Ramanand Bhawan, R-Enclave, Subhartipuram, Subharti Medical College, Meerut - 250 005, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aam.aam_2_19

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How to cite this article:
Saran S, Singh AP, Khanna T. Ovarian fibroma with torsion in a young female. Ann Afr Med 2019;18:210-1

How to cite this URL:
Saran S, Singh AP, Khanna T. Ovarian fibroma with torsion in a young female. Ann Afr Med [serial online] 2019 [cited 2020 Apr 7];18:210-1. Available from: http://www.annalsafrmed.org/text.asp?2019/18/4/210/272402



Sir,

A 30-year-old female presented with acute abdominal pain, initially localized over the right iliac fossa and later progressed to involve complete abdomen. The pain was present for >24 h at the time of admission. She had a history of fullness in the pelvis for 6 months, for which she did not undergo any investigation or treatment. On palpation, the abdomen was tender with evidence of a firm mass in the region of the umbilicus. She immediately had a bedside ultrasonography followed by contrast-enhanced computed tomography, which revealed a large well-defined heterogeneous mass [Figure 1] and [Figure 2] in the left half of the abdomen and a thick cord-like structure connecting it with the uterus which was tilted toward the mass. The right ovary was not visualized, and the lesion showed heterogonous postcontrast enhancement. There was the presence of minimal ascites. The patient was posted for surgery with the provisional diagnosis of benign right ovarian mass with torsion. At surgery, a large 13 cm × 10 cm × 6 cm right ovarian mass was excised [Figure 3] which on histopathological evaluation proved to be a benign ovarian fibroma [Figure 4].
Figure 1: Transabdominal ultrasound evaluation showing the presence of a well-defined heterogeneous mass in the lower abdomen in midline with the presence of internal cystic changes (a). Uterus and urinary bladder were normal (b). However, the uterus was slightly pulled toward the mass. The left ovary was normal (c). The right ovary was not separately visualized from the mass

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Figure 2: Contrast-enhanced computed tomography showing the presence of a large well-defined solid heterogeneous mass in the left half of the abdomen (a and b) and a thick cord-like structure connecting it with the uterus which was thereby tilted toward the mass. The right ovary was not visualized, and the lesion showed heterogeneous postcontrast enhancement. Relationship of mass with the uterus and associated minimal ascites were nicely depicted on the coronal section (a). u: Uterus, UB: Urinary bladder, Triangle: Ascites, Star: Mass

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Figure 3: Surgical specimen of the mass excised

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Figure 4: (a-c) Microscopic features of the mass excised showing the presence of encapsulated tumor composed of lobules having closely packed spindle stromal cells with bipolar scanty cytoplasm. The cells are at places seen in sheets and interlacing bundles. There is no evidence of mitosis. Overall diagnosis is in favor of fibroma

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Ovarian fibroma, a mesenchymal neoplasm, is the most common benign solid tumor of the ovary, generally diagnosed in perimenopausal and postmenopausal females.[1] It frequently presents as a large mass undergoing torsion causing acute abdominal pain. It can be associated with ascites and pleural effusion as in Meigs syndrome. It can also be seen with uterine fibroids suggesting hormonal stimulation as common etiology. Infertility and hirsutism can be rarely associated with ovarian fibromas.[1],[2]

Radiological evaluation is needed for characterization and preoperative evaluation of the tumor. Ultrasound evaluation often shows a large mass with heteroechoic appearance in the adnexal region displacing the uterus and inseparable from one of the ovaries. Minimal ascites, lack of Doppler activity, and a twisted pedicle are additional findings in cases of torsion. Computed tomography shows a well-defined solid heterogeneous mass with delayed postcontrast enhancement. Diagnostic criteria for torsion include adnexal mass in the midline or toward the contralateral half of the pelvis along with deviation of the uterus toward the mass and frequent presence of free peritoneal fluid. Imaging differentials include large pedunculated subserosal uterine leiomyoma, thecoma, and fibrothecoma.[3],[4] The management requires complete surgical removal followed by immunohistochemical analysis for definitive diagnosis.[5]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Yen P, Khong K, Lamba R, Corwin MT, Gerscovich EO. Ovarian fibromas and fibrothecomas: Sonographic correlation with computed tomography and magnetic resonance imaging: A 5-year single-institution experience. J Ultrasound Med 2013;32:13-8.  Back to cited text no. 1
    
2.
Macciò A, Madeddu C, Kotsonis P, Pietrangeli M, Paoletti AM. Large twisted ovarian fibroma associated with Meigs' syndrome, abdominal pain and severe anemia treated by laparoscopic surgery. BMC Surg 2014;14:38.  Back to cited text no. 2
    
3.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics 2008;28:1355-68.  Back to cited text no. 3
    
4.
Vandermeer FQ, Wong-You-Cheong JJ. Imaging of acute pelvic pain. Clin Obstet Gynecol 2009;52:2-20.  Back to cited text no. 4
    
5.
Son CE, Choi JS, Lee JH, Jeon SW, Hong JH, Bae JW, et al. Laparoscopic surgical management and clinical characteristics of ovarian fibromas. JSLS 2011;15:16-20.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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