OVARIAN FIBROMA: A CASE REPORT

Ovarian fibroma is a pathological variant of ovarian fibrothecomas. They are very rare tumors, mostly seen following menopause. Their diagnosis may be enabled by clinical symptoms and ultrasonography, then supplemented by magnetic resonance imaging. The histological study confirms the diagnosis and surgical resection is the preferred management strategy for these tumors. Here, we describe a case of a unilateral ovarian fibroma in a 19 years old patient.


…………………………………………………………………………………………………….... Introduction:-
Fibromas are the most common tumors of the female genital tract, specifically, the uterus. They affect 20 to 25% of reproductive women. The ectopic location, whose pathophysiology is not well clarified, is rare. The ovarian location of the fibroma is very rare and mostly seen following menopause. When associated with peritoneal effusion on clinical examination and radiological investigations in addition to the elevation of CA125 marker, it could be a sign of the malignant ovarian tumors. Histopathology establishes the diagnosis and the Treatment is surgical.

Presentation of case:
S.I. is a 19 years old patient who has never been pregnant anddoes not have a remarkable medical history. She has presented with an increase of abdominal volume without associated symptoms.Particularly, pelvic pain, or compression signs. The Abdominal examination revealed a well limited and mobile hard mass ranging from the hypogastric region to the xiphoid appendix. The Gynaecological examination was not performed (the patient stated that she is a virgin) and the mass was separated from the uterus on rectal examination. The Abdominal ultrasonography revealed a normal-sized uterus with regular outlines.The interface line can be seen entirely, the myometrial wall is homogeneous, a heterogeneous echogenic extra and right latero-uterine tissue mass of 20x15cm without signs in colour Doppler, the left ovary is normal-sized, and a low abundant effusion in the Douglas cul-de-sac.
The Abdominal pelvic magnetic resonance imaging (MRI) revealed a hugeovoid well-defined abdominal pelvic mass, characterized by a T2 heterogeneous hyperintense signal and T1 intermediate signal, which was early enhanced, intense and heterogeneous after the injection of gadolinium, it had no septum, measured 155x103mm in cross-section and 165mm in height, and developed in the right ovary independently of the uterus, the left ovary is normal, the MRI also showed a liquid effusion blade in the Douglascul-de-sac (figure1,2). CA125 was negative.
The patient underwent a laparotomy, whichrevealedat exploration: a low abundant peritoneal effusion aspirated for cytological study, a solid smooth-walled cystic mass measuring 17x15x10 cm at the expense of the right ovary, the ISSN: 2320-5407 Int. J. Adv. Res. 8(06), 1380-1383 1381 left adnexa wasof normal aspect, and the uterus of normal size. The rest of the abdominal pelvic cavity was within normal limits. A right adnexectomy was performed followed by an extemporaneous examination showing a fusocellular proliferation which benign or malignant nature required an immunohistochemical study. Multiple biopsies were taken afterwards. The definitive anatomopathological and immunohistochemical result revealed a fibroma of the right ovary. The biopsy of the left ovary, the rest of the peritoneal and epiploon biopsies,as well as the cytology of the peritoneal effusion were normal. The postoperative course was uneventful. The patient is well and asymptomatic three months after surgery.   Ovarian fibroids are mostly associated with a good prognosis, and their treatment is based on surgical removal of the tumor. The diagnosis is established by histopathology [6, 7].

Conclusion:-
Ovarian fibromas are rare tumors. They mainly affect postmenopausal or peri-menopausal women. Clinical examination and imaging investigation generally enable the diagnosis, and histological examination allows its confirmationafter surgical removal.