OP17.09: Sonographic features of primary ovarian fibrosarcoma. A report of two cases

Primary ovarian fibrosarcoma is one of the rarest ovarian tumors. It is an aggressive malignant condition and there are no clinical guidelines for the management of patients. In the published reports, these ovarian malignancies present a great heterogeneity of clinical and pathological features, and no specific sonographic features have been reported. We present two cases of primary ovarian fibrosarcoma referred to our tertiary center in Rome. These two cases are unique in several aspects: i) both patients did not complain of any particular symptom and the diagnosis was made at a routine ultrasound scan; in the vast majority of previously reported cases, the patients were symptomatic, with abdominal and pelvic pain or progressive abdominal enlargement ii) the malignant nature of the ovarian tumor was suspected at the preoperative sonographic examination: in both cases a monolateral inhomogeneous roundish solid ovarian mass, with irregular borders and the largest diameter of 110 and 80 mm, respectively, was diagnosed. A small amount of free fluid in the pouch of Douglas was detected in both cases. At color Doppler examination, a main vessel penetrating into the mass (“lead vessel”) was observed in one case (color score = 3), whereas only a few vascular spots were detected (color score = 2) in the other case. In both cases an aggressive strategy was applied, and after radical surgery, the patients underwent six courses of adjuvant chemotherapy with Adriamicin and Ifosfamide. Both patients are now free of disease and the survival period of 50 months, for the first patient, is one of the longest reported in the literature. In both cases the ovarian fibrosarcomas showed an inhomogeneous solid morphology with irregular borders. These sonographic features, together with the absence of regular stripes, allowed us to exclude the hypothesis of ovarian fibromas. However, no specific sonographic features to discriminate fibrosarcomas from ovarian carcinomas, were identified.