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Large twisted ovarian fibroma in menopausal women: a case report.

Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M - Pan Afr Med J (2015)

Bottom Line: Occasionally large fibromas may undergo torsion causing acute abdominal pain.The choice treatment is surgical removal with intraoperative frozensection.Immunohistochemicalanalysis is recommended to rule out the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology-Obstetric, University of Medicine Tangier, Military Training Hospital Med V, Rabat, Morocco.

ABSTRACT
Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

No MeSH data available.


Related in: MedlinePlus

Pelvic computed tomography revealing an enlarged ovary with iso-dense mass in the midline, measuring 122× 86cm with deviation of the uterus
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Figure 0001: Pelvic computed tomography revealing an enlarged ovary with iso-dense mass in the midline, measuring 122× 86cm with deviation of the uterus

Mentions: A 62-year-old post-menopausal, multiparous woman waspresented in emergency with nausea; vomiting and a 6-day history of worsening abdominal pain started in the right lower quadrant and subsequently spread to the whole abdomen. In her past medical history wereintermittent episodes of abdominal discomfort and a sensation of abdominal heaviness during the preceding months. Her vital signs were all within normal limits. Physical examination revealed a palpable abdominal mass in the lower abdomen with sensibility and involuntary guarding. Vaginal examination revealed a normal sized uterus and a large painful irregular mass of 10 cm size, firm in consistency. Pelvic ultrasonography showed a non-homogeneous mass (120 × 10 mm) in the upper and right latero uterinewithout any flow on color Doppler. Pelvic computed tomography revealed a right enlarged ovary with heterogeneous iso-dense mass in the midline, rotated toward the contralateral side of the pelvis measuring 122× 86cm with deviation of the uterus without lymphadenopathy or pelvic effusion (Figure 1, Figure 2). Anexploratory laparotomy had showed a black bluish encapsulated mass arising from the twisted right adnexa, measuring 140x100x60 mm with irregular surface and hemorrhagicreshuffle, attached to the right ovary with a thrice twisted pedicle (Figure 3, Figure 4, Figure 5). Both the uterus and left adnexa appeared normal. A total hysterectomy and bilateral salpingo-ooferectomy were performed. According to pathological and immunohistochimical findings, the diagnosis of ovarian fibroma with extensive ischemic necrosis was confirmed (Figure 6, Figure 7).


Large twisted ovarian fibroma in menopausal women: a case report.

Boujoual M, Hakimi I, Kouach J, Oukabli M, Moussaoui DR, Dehayni M - Pan Afr Med J (2015)

Pelvic computed tomography revealing an enlarged ovary with iso-dense mass in the midline, measuring 122× 86cm with deviation of the uterus
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4491469&req=5

Figure 0001: Pelvic computed tomography revealing an enlarged ovary with iso-dense mass in the midline, measuring 122× 86cm with deviation of the uterus
Mentions: A 62-year-old post-menopausal, multiparous woman waspresented in emergency with nausea; vomiting and a 6-day history of worsening abdominal pain started in the right lower quadrant and subsequently spread to the whole abdomen. In her past medical history wereintermittent episodes of abdominal discomfort and a sensation of abdominal heaviness during the preceding months. Her vital signs were all within normal limits. Physical examination revealed a palpable abdominal mass in the lower abdomen with sensibility and involuntary guarding. Vaginal examination revealed a normal sized uterus and a large painful irregular mass of 10 cm size, firm in consistency. Pelvic ultrasonography showed a non-homogeneous mass (120 × 10 mm) in the upper and right latero uterinewithout any flow on color Doppler. Pelvic computed tomography revealed a right enlarged ovary with heterogeneous iso-dense mass in the midline, rotated toward the contralateral side of the pelvis measuring 122× 86cm with deviation of the uterus without lymphadenopathy or pelvic effusion (Figure 1, Figure 2). Anexploratory laparotomy had showed a black bluish encapsulated mass arising from the twisted right adnexa, measuring 140x100x60 mm with irregular surface and hemorrhagicreshuffle, attached to the right ovary with a thrice twisted pedicle (Figure 3, Figure 4, Figure 5). Both the uterus and left adnexa appeared normal. A total hysterectomy and bilateral salpingo-ooferectomy were performed. According to pathological and immunohistochimical findings, the diagnosis of ovarian fibroma with extensive ischemic necrosis was confirmed (Figure 6, Figure 7).

Bottom Line: Occasionally large fibromas may undergo torsion causing acute abdominal pain.The choice treatment is surgical removal with intraoperative frozensection.Immunohistochemicalanalysis is recommended to rule out the differential diagnosis.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology-Obstetric, University of Medicine Tangier, Military Training Hospital Med V, Rabat, Morocco.

ABSTRACT
Ovarian fibroma is the most common benign solid tumors of the ovary, commonly misdiagnosed as uterine fibromaor as malignant ovarian tumors. It occurs generally in older perimenopausal and postmenopausal women. Occasionally large fibromas may undergo torsion causing acute abdominal pain. Doppler Ultrasonographyimaging is the choice study. CT and MRI are often needed for further characterization and differentiation from other solid ovarian masses. The choice treatment is surgical removal with intraoperative frozensection. Immunohistochemicalanalysis is recommended to rule out the differential diagnosis. Here we present a case of a postmenopausal woman with a large twisted ovarian fibroma reflecting diagnostic and management difficulties including potential misdiagnosis of the tumor as a malignant ovarian neoplasm that may influence the surgical approach.

No MeSH data available.


Related in: MedlinePlus