Fibrothecoma/Fibroma of ovary-rare ovarian tumors with varied presentation and different modes of management: 14 years' experience from tertiary care hospitals.
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CONTEXT: Fibrothecomas are a rare group of tumors of stromal cell origin, accounting for approximately 5%-8% of all ovarian tumors. These tumors are frequently mistaken as malignant due to solid consistency, association with ascites, and pleural effusion leading to unnecessary radical surgery. Due to the relative rarity of these tumors, we want to highlight eleven cases of fibrothecoma/fibromas encountered in our experience with different clinical presentations in various age groups requiring different treatment strategies based on the clinical, radiological, cytological, histopathological, and immunochemical characteristics. AIMS: Our primary aim is to emphasize the diverse presentation of rare tumors, such as fibrothecoma/fibromas, and their management across different age groups. SETTINGS AND DESIGN: The present study was conducted over 14 years in the Department of Obstetrics and Gynecology and the Department of Pathology at Guru Gobind Singh Medical College and Hospital, Faridkot, as well as at All India Institute of Medical Sciences Bathinda. MATERIALS AND METHODS: Among 526 patients with ovarian masses who were surgically managed over 14 years at our institute, we identified only 11 cases that were diagnosed as fibrothecomas or fibromas based on histopathology. We studied the detailed clinical presentations, diagnostic modalities, and management of all these patients, who were all normal at a mean follow-up of 2 years and 5 months. RESULTS: Over 14 years, we evaluated 526 patients presenting with ovarian masses diagnosed through clinical examination, imaging techniques, fine-needle aspiration cytology (FNAC), histopathology, and immunohistochemistry. Only 11 cases (2.09%) were identified as fibroma or fibrosarcoma. Age of the patients ranged from 14 to 76 years, with a mean age of 44.22 years. Of the 11 cases, nine patients presented with an abdominopelvic mass. Ultrasonography and contrast-enhanced CT scans typically revealed solid masses accompanied by ascites. FNAC was effective in eight cases, identifying spindle cells upon microscopic examination. Final diagnoses were confirmed through histopathology, which classified two cases as fibroma and nine as fibrothecoma. Immunohistochemistry results showed vimentin positivity in nine cases. All patients remained healthy during a mean follow-up period of 2 years and 5 months. STATISTICAL ANALYSIS USED: Observational study. CONCLUSIONS: This article highlights a rare ovarian tumor with details of its different clinical presentations, radiological details, cytological findings, and histopathological and immunochemical findings. According to the patient's age, these can be treated using minimally invasive and fertility-sparing techniques.