Ovarian fibrosarcomas

Ovarian fibrosarcomas originating from the ovarian stroma are rare but aggressive tumors, associated with an extremely poor prognosis. Ovarian fibrosarcomas are commonly large, unilateral, highly vascular tumors with evidence of inside hemorrhage and necrosis 1-3). There have been sporadic reports in the literature regarding ovarian fibrosarcomas, the gathering of which is useful for treatment and patient follow up. A 49-year-old patient with an ovarian fibrosarcoma was evaluated by diagnosis, treatment and follow up. A 49-year-old woman with gravida 5, parity 3 was admitted to our clinic with abdominal pain and mass. She was in her perimenopausal period and her menstrual cycles were irregular. Vaginal and abdominal examinations confirmed the presence of a semisolid mass, reaching up to the umbilicus and filling the pelvic cavity totally. Abdominal ultrasonography demonstrated a 112 × 99 × 94 mm in diameter, calcificated, capsulated, semisolid and irregular mass in the left ovarian region. The serum level of CA125 was 300 IU/ml. The serum levels of CA15.3 and CA19.9 were normal. During the laparotomy, a 12 × 10 × 10 cm in diameter, irregular, semisolid, and hemorrhagic cystic mass was found in the left ovarian region. On the ileum, a metastatic lesion with a 4-cm diameter was revealed. Although there were no palpable lymph nodes, metastatic lesions smaller than 2 cm were found on the peritoneum. Total abdominal hysterectomy, left ovarian mass extirpation, right salphingooferectomy, ileac resection and reanastomosis, total omentectomy and cytoreduction were performed. The pathologic diagnosis of the mass and ileal metastases was an ovarian fibrosarcoma 1-3). In the microscopic examination, more than four mitotic figures in 10 high-power fields were demonstrated. Van Giesan, PTAH and TRPL stainings and Vimentin, Desmin and S-100 immunostainings were performed to demonstrate the mesenchymal tissue and the diagnosis of a fibrosarcoma. Desmin immunostaining was performed to exclude leiyomyosarcoma. KÍ-67 and PCNA immunostaining were used for the differential diagnosis of cell rich fibromas and fibrosarcomas. The tumor was labelled as stage III C. The patient was given eight cycles of systemic chemotherapy with Cisplatin 75 mg/m2 and Paclitaxel (Taxol) 175 mg/m2 once and at 3-weekly intervals. After the fifth cycle, serum CA125 levels decreased to the normal range. In total, eight cycles of Cisplatin and Paclitaxel therapy were given. After the chemotherapy, tumoral invasion was not found in the abdominal or cranial computed tomography control. After 36 months of the initial diagnosis, a recurrence in the pelvis and lower abdomen of liver metastases were found. A second operation was not performed. The patient died 42 months after the initial diagnosis from hepatic-renal disorders and liver metastases. An atypic fibroblast with a fusiform and hyperchromatic nucleus (HE. X40). An atypic fibroblast with a fusiform and hyperchromatic nucleus (HE. X20). An atypic fibroblast with a fusiform and hyperchromatic nucleus (HE. X10). This case report describes an ovarian fibrosarcoma, an unusual type of tumor, but the commonest type of ovary sarcoma. Fibrosarcomas are highly malignant potential neoplasms. Histologically, the neoplasms were densely cellular, with the spindle-shaped cells being arranged in a herringbone or storiform pattern: the tumor cells had indistinct borders, eosinophilic cytoplasm, and hyperchromatic nuclei with prominent nucleoli. There was a moderate to marked degree of pleomorphism, and the number of mitotic figures ranged from four to 25/10 high-power fields 1-4). In this case, more than four mitotic figures/10 high-power fields were demonstrated in the mass. Van Giesan, PTAH and TRPL stainings and Vimentin, Desmin and S-100 immunostainings were performed to demonstrate the mesenchymal tissue and the diagnosis of a fibrosarcoma. KÍ-67 and PCNA immunostaining were used for the differential diagnosis of cell rich fibromas and fibrosarcomas. Macroscopically, fibrosarcomas range in size from 7 to 22 cm in the greatest diameter, with a mean value of 12.3 cm. Fibrosarcomas are solid tumors with lobulated, soft, white-gray color, fleshy appearances and wide areas of necrosis and hemorrhage (2, 5). In this case, the mass was nearly 12 × 10 × 10 cm in diameter, semisolid with hemorhagic cysts and an irregular contour in the left ovary. A patient's age with ovarian fibrosarcomas ranges from 42 to 73 years with an average of 58 years. The principal presenting complaints are pelvic pain, abdominal enlargement or awareness of an abdominal mass (2, 3, 5). Our patient was aged 49 years and presented symptoms with abdominal pain and awareness of a mass. Ovarian fibrosarcomas have been considered to be lethal neoplasms. Fibrosarcomas are associated with an extremely poor prognosis, but fortunately cases are extremely rare. Treatment consists of surgery with staging and debulking, chemotherapy and radiotherapy. The small number of cases limits our knowledge about effective therapies (6). In this case, in spite of the advanced stage, radical surgery and chemotherapy consisting of Paclitaxel and Cisplatin resulted in a complete initial response and 41 months of survival. Despite the advanced stage of the ovarian fibrosarcoma, a highly aggressive tumor, in our patient, radical surgery and chemotherapy resulted in a better prognosis and a resultant longer survival rate. We believe that by gathering data of sporadic cases, future treatment and patient follow up will be more effective.