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Journal of Clinical and Diagnostic... Mar 2014Sclerosing Peritonitis (SP) is characterized by fibrous thickening and adhesions of the peritoneum and it is encountered frequently in association with peritoneal...
Sclerosing Peritonitis (SP) is characterized by fibrous thickening and adhesions of the peritoneum and it is encountered frequently in association with peritoneal dialysis, practolol and anticonvulsant therapy. Rarely does it present as a gynaecological complication, most commonly in conjunction with luteinized thecoma of ovary. Very rarely has sclerosing peritonitis been reported to occur with ovarian cystic teratoma and a luteinized variant of adult granulosa cell tumour, among which only one case has been reported in the English literature. An 18-year-female presented with a history of lower abdominal pain, of one month's duration. At surgery, an ovarian mass was noted, along with adhesion of bowel loops which were enclosed within a diffusely thickened peritoneal membrane, forming a cocoon. Adhesions were seen in bilateral paracolic gutter and infracolic omentum, which were suggestive of metastatic deposits. Histopathology of ovarian lesion was interpreted as a juvenile granulosa cell tumour. The peritoneal process revealed sclerosing peritonitis. We emphasize this rare association of sclerosing peritonitis with juvenile granulosa cell tumour and that the peritoneal process of sclerosing peritonitis in a juvenile granulosa cell tumour should not lead to over staging of an ovarian tumour.
PubMed: 24783102
DOI: 10.7860/JCDR/2014/6825.4131 -
The Malaysian Journal of Pathology Apr 2014Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumour that has mixed features of both fibroma and thecoma. The...
Ovarian fibrothecoma is a relatively new term that is used to describe an ovarian sex cord stromal tumour that has mixed features of both fibroma and thecoma. The prevalence of ovarian fibrothecoma tumours is very rare and is reported to be about 1.2% of all ovarian tumours. We report a case of a 32-year-old woman who presented with acute menorrhagia with no previous medical, surgical or gynecological history. She was amenorrhic for four years after the insertion of a levonorgestrelreleasing intrauterine system (LNG-IUS) for contraception. The efficacy and location of LNG-IUS was reflected due to the sudden onset of menorrhagia. On pelvic examination and ultrasound the LNG-IUS could not be visualized and a uterine fibroid was noted. A diagnostic laparoscopy was done to identify the LNG-IUS, which revealed an incidental large ovarian mass on the left ovary. CA-125 level was elevated to 45 kU/L (Normal range <35 kU/L). Total abdominal hysterectomy, left salpingo-oopherectomy and cystectomy were performed. On histopathology, the mass was proven to be an ovarian fibrothecoma. No signs of malignancy were noted on peritoneal fluid cytology. The LNG-IUS was found inside the uterus. Our case is reported on the basis of the rare incidence of ovarian fibrothecoma and the possible effect it may have on the efficacy of LNG-IUS causing menorrhagia.
Topics: Acute Disease; Adult; Female; Humans; Leiomyoma; Menorrhagia; Ovarian Neoplasms; Thecoma
PubMed: 24763236
DOI: No ID Found -
Advanced Biomedical Research 2014Leiomyoma is benign mesenchymal tumor, that frequently occur in uterus but it rarely happens in ovary. Ovarian leiomyomas are seen concomitantly with uterine leiomyoma...
Leiomyoma is benign mesenchymal tumor, that frequently occur in uterus but it rarely happens in ovary. Ovarian leiomyomas are seen concomitantly with uterine leiomyoma in about 78% of cases. They often discover incidentally but their most clinical manifestations are abdominal pain and palpable mass. Herein, we reported a large ovarian leiomyoma in a 22-year-old woman with abdominal pain and palpable mass at lower abdominal region. Computed tomography scan revealed large adnexal mass. Microscopic appearance was typical for leiomyoma but because its rarity in ovary the immunohistochemical staining was done. Major differential diagnostic considerations for this tumor in ovary are fibroma/thecoma, sclerosing stromal tumor, and leiomyosarcoma. The immunohistochemical staining with desmin, inhibin, and α-smooth muscle actin are helpful to rule out this differential diagnosis.
PubMed: 24761396
DOI: 10.4103/2277-9175.128001 -
Journal of Reproduction & Infertility Jan 2014Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is...
BACKGROUND
Ovarian fibroma is the most common benign solid tumor of the ovary, which is often difficult to diagnose preoperatively. The choice treatment for ovarian fibroma is surgical removal, but discussions for the operative approach, laparoscopic or open, in the literature seem to be scant.
CASE PRESENTATION
We presented a unique clinical experience of laparoscopic approach to a case of 15 cm unilateral ovarian fibroma in a 24 year old patient, with a successful and complete resection of the tumor beside ovarian tissue preservation in December 2012 in Rasoul-e-Akram hospital, Tehran, Iran.
CONCLUSION
In conclusion, we should not forget the role of laparoscopy as a diagnostic procedure even in suspicious cases of ovarian fibroma with solid tumor, ascites, and pleural effusion.
PubMed: 24696796
DOI: No ID Found -
The British Journal of Radiology Jun 2014To study MRI diagnosis of ovarian fibrothecomas.
OBJECTIVE
To study MRI diagnosis of ovarian fibrothecomas.
METHODS
MRI appearances of 27 ovarian fibrothecomas 26 female patients confirmed by surgical pathology were retrospectively reviewed and correlated with clinical and histological findings.
RESULTS
Most patients were post-menopausal females 73.1% (19/26) of cases. 38.5% (10/26) of patients showed an elevated serum carbohydrate antigen 125 (CA-125) level (>35 U ml(-1)). On MR T2 weighted imaging, 3 distinct features were revealed. (1) Homogeneous hypointense masses in 25.9% (7/27) cases. (2) Heterogeneous tumours with mostly isointense and few patchy hyperintense areas in 51.9% (14/27) cases. (3) Heterogeneous tumours with predominantly hyperintense and few isointense parts in 22.2% (6/27) cases. On T1 weighted imaging, all the fibrothecomas turned out to be homogeneous masses except six cystic degeneration cases. After contrast, 70.4% (19/27) tumours showed homogeneous mild enhancement in all phases. Beyond the tumours, endometrial abnormality and uterus enlargement were found in 38.5% (10/26) and 15.4% (4/26) patients, respectively. Ascites were seen in 53.8% (14/26) patients. There was a statistically significant difference among the 3 T2 weighted image features (F = 7.024; p = 0.003) in terms of the size of fibrothecomas. The cystic tumours also had the tendency to show the ascite condition (p = 0.002) as well as elevated serum CA-125 levels (p = 0.014). Vimentin was positively stained in 10 (76.9%) of 13 cases who underwent the immunohistochemical analysis.
CONCLUSION
MRI has the superiority to show the distinct appearances of tumours as well as their functional features according to oestrogenic effect.
ADVANCES IN KNOWLEDGE
This study describes the unique features of fibrothecomas on MRI on a relatively large series of patients with tumours and the indirect oestrogenic effect findings.
Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Estrogens; Female; Humans; Magnetic Resonance Imaging; Middle Aged; Ovarian Neoplasms; Retrospective Studies; Thecoma
PubMed: 24670054
DOI: 10.1259/bjr.20130634 -
BMC Endocrine Disorders Feb 2014Steroid cell tumors of ovary account for less than 0.1% of all ovarian tumors and these tumours may present at any age in association with interesting presentations...
BACKGROUND
Steroid cell tumors of ovary account for less than 0.1% of all ovarian tumors and these tumours may present at any age in association with interesting presentations related to hormonal activities. The subtype, not otherwise specified (NOS), is associated with androgenic changes in 56-77% and Cushing syndrome in 6-10%. Due to the rarity of available data regarding these tumors, little is known about their malignant potential and metastatic behaviour. We hereby report an unusual metastasis of steroid cell ovarian neoplasm presented with both Cushing syndrome and hyperandrogenemia.
CASE PRESENTATION
A 31-year-old woman, who had a past medical history of ovarian tumor resection (left ovarian thecoma was initially diagnosed at that time), presented with hirsutism, hypertension and menstrual disorder. Also, laboratory work-up revealed hypercortisolism and androgen excess. Computerized tomography (CT) of the abdomen showed abdominal paraaortic masses, multiple intrahepatic nodules and retroperitoneal lymph nodes enlargement. Positron emission tomography/computed tomography (PET/CT) scan demonstrated metastatic lesions. Her ovarian tumor sections were re-examined and pathology result was corrected to steroid cell tumor (NOS) associated with active cell growth and necrosis. Subsequent excision of metastatic lesions yielded clinical improvement promptly and metastasis of steroid cell tumor was confirmed by postoperative pathological studies. However, one year after the surgical management of metastasis, recurrence happened while radiotherapy was ineffective. The patient finally died of tumor metastatic recurrence.
CONCLUSION
This case reports a rare coexistence of Cushing syndrome and hyperandrogenemia which occurs based on metastasis of steroid cell ovarian neoplasm. It presents a real diagnostic challenge to both clinicians and pathologists. Therefore, it is very important to establish a final diagnosis by pathological studies along with clinical manifestations and imaging findings. Besides, it is necessary to improve follow-up of patients with this kind of tumors.
PubMed: 24506845
DOI: 10.1186/1472-6823-14-12 -
Caspian Journal of Internal Medicine 2014CA125 levels in Meig's syndrome can increase or be normal which an unusual laboratory condition is. In this paper, we present a case of Meigs' syndrome associated with...
BACKGROUND
CA125 levels in Meig's syndrome can increase or be normal which an unusual laboratory condition is. In this paper, we present a case of Meigs' syndrome associated with increased CA125 level due to ovarian fibroma / thecoma.
CASE PRESENTATION
A 50-year old Iranian woman presented with fever, abdominal pain and distention and in imaging assessment, a 90×109 mm heterogeneous pelvic mass with free abdominopelvic fluid was reported. Pleural effusion was detected in CXR. Aspiration of ascetic fluid showed no evidence of malignancy. CA125 level was greater than 600 IU/mL. The patient went under laparotomy in which a 120×100 mm mass was detected in her left adnexa attached to colon, bowels and bottom of pelvis. Histology reported ovarian fibro/ thecoma. The mass was resected and after that, the symptoms disappeared and CA125 level reached to 15 IU/mL. The patient had no problem after 18 months of follow up.
CONCLUSION
Meigs' syndrome should be considered at the differential diagnosis for a patient with pelvic mass, pleural effusion and ascites with normal cytology, increased CA125 levels.
PubMed: 24490014
DOI: No ID Found -
International Journal of Clinical and... 2014In this article, we described an ovarian sclerosing stromal tumor (SST) in a young woman with ectopic pregnancy. It is important to distinguish SST from fibroma,...
In this article, we described an ovarian sclerosing stromal tumor (SST) in a young woman with ectopic pregnancy. It is important to distinguish SST from fibroma, thecoma, and lipoid cell tumors clinically and histologically. Several unique histologic features including pseudolobulation, sclerosis and prominent vascularity are clearly reflected at histopathological findings. The SST cells were immunopositive for CD34, Desmin and SMA, and negative for factor VIII-related antigen, CD31, S-100, ER and PR. The patient's postoperative recovery was smooth and she was discharged after 21 days.
Topics: Adult; Female; Humans; Ovarian Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Pregnancy, Tubal; Sex Cord-Gonadal Stromal Tumors
PubMed: 24427372
DOI: No ID Found -
Journal of Ovarian Research Dec 2013Ovarian sex cord stromal tumors are rare neoplasms as compared to epithelial tumors. No large study has been done in Pakistan to find out the frequencies of various sex...
BACKGROUND
Ovarian sex cord stromal tumors are rare neoplasms as compared to epithelial tumors. No large study has been done in Pakistan to find out the frequencies of various sex cord stromal tumors and their clinicopathological behavior in our region. The purpose of our study was to determine the various histological patterns and clinical features of ovarian sex cord stromal tumors along with follow-up in our set-up.
METHODS
It is a retrospective observational study. The study was conducted in section of Histopathology, Aga Khan University Hospital, Karachi, Pakistan. All reported cases of sex cord stromal tumors of ovary during 1992 to 2012 were retrieved. The retrieved slides were reviewed and patient demographics, clinical and pathological features were noted on proforma. SPSS Statistics Version 19 was used for all analyses. Data is expressed as absolute values and percentage or as mean ± standard deviation (SD).
RESULTS
A total of 480 cases of sex cord stromal tumors were retrieved. The median age was 45 years. Bilaterality was observed in 4 cases. Of the different subtypes of sex-cord stromal tumors, most common was adult granulosa cell tumor 211(43.9%). 24 Juvenile granulosa cell tumors were retrieved (5%). Other types were fibromas 98 (20.4%) fibrothecomas 47(9.8%), thecomas 26(5.4%), sertoli-leydig cell tumors 34(7%), sclerosing stromal tumors 26 (5.4%), steroid cell tumors (10) and 4 cases of sex cord tumor with annular tubules. Of various immunohistochemical stains applied, Inhibin was frequently positive in all subtypes and focal cytokeratins were also seen commonly. Follow up information was available in 305 cases and out of these only 16 (5%) developed recurrence or metastasis.
CONCLUSIONS
Sex cord stromal tumors are uncommon ovarian tumors in Pakistani population, with wide age range and diverse histological types having good prognosis. Immunohistochemical markers overlap with epithelial tumors so there is need to distinguish these two.
PubMed: 24304499
DOI: 10.1186/1757-2215-6-87 -
Journal of Ovarian Research Aug 2013To investigate the value of diffusion-weighted imaging (DWI) at 3.0 T (3T), and especially the apparent diffusion coefficient (ADC), in discriminating ovarian thecoma...
BACKGROUND
To investigate the value of diffusion-weighted imaging (DWI) at 3.0 T (3T), and especially the apparent diffusion coefficient (ADC), in discriminating ovarian thecoma from other adnexal solid masses.
METHODS
Eighteen thecomas or fibrothecomas, 14 ligamentous leiomyomas, and 24 other ovarian solid tumors underwent prospective DWI magnetic resonance imaging (MRI) in addition to routine MRI on a 3T MRI machine. The baseline characteristics, components, and conventional MRI and DWI-MRI signals for the thecomas were recorded. The ADC values (ADCs) were measured for each group and compared.
RESULTS
The thecomas often appeared as homogeneous isointensity (17/18) on T1-weighted images (T1WI; 11/18) or T2WI (11/18) on DWI-MRI, with minor (9/18) or mild (6/18) enhancement. The mean ADC value for thecoma (1.20 ± 0.45 × 10-3 mm2/s) was almost equal to that of the other solid ovarian masses (1.26 ± 0.51 × 10-3 mm2/s), but lower than that for leiomyoma (1.48 ± 0.42 × 10-3 mm2/s), although not significantly so. There was a significant difference (p = 0.043) in the ADCs of the benign ovarian solid masses (1.16 ± 0.47 × 10-3 mm2/s) and leiomyomas (1.48 ± 0.42 × 10-3 mm2/s).
CONCLUSIONS
There is no significant difference in ADC between thecoma and other adnexal solid masses, but the ADCs of thecomas are lower than those of leiomyomas.
PubMed: 23962187
DOI: 10.1186/1757-2215-6-58