Serous ovarian cystadenofibroma and review of the literature: Report of a case.

A 58-year-old multiparous patient consulted for pelvic pain for which an MRI was prescribed, objecting to the presence of a mass of ovarian origin. The patient had been menopausal since the age of 51 and was not taking hormone replacement therapy. She had comorbid hypertension for 6 years under treatment. The preoperative ultrasound showed a leftolidocystic mass of ovarian appearance, finely echogenic, site of endocystic vegetations, measuring 8.48 mm × 7.30 mm long axis. With the presence of a sparse effusion, the mass was nonvascular on Doppler, the contralateral vein was unremarkable ( Figs. 1-2 ). Preoperative pelvic MRI confirmed the hypothesis of a unilateral primary tumor without visible lymphadenopathy in contact with the iliac and lumbo-aortic vessels. Pelvic MRI described a well-limited left latero-uterine mass measuring 82 × 55 × 60 mm, solid-cystic, with the presence of endocystic vegetation, enhanced after injection of gadolinium, and an effusion layer at the level of the sac of Douglas ( Fig. 3 ). Laparoscopic examination revealed a firm left solid-ovarian mass with a cystic component. The right dinghy was normal in appearance and without adhesions. A small amount of effusion was visualized. In the abdominal region, no signs of dissemination were observed. In view of this appearance, which seemed to allow an exhaustive resection of the lesions, and considering the very probable diagnosis of ovarian cancer, a laparoconversion was undertaken. It allowed to perform a non-conservative extrafacial hysterectomy, a submesocolic stomentectomy, multiple peritoneal biopsies. The latter were performed without the need for an extemporaneous examination because of all the arguments in favor of malignancy, which wrongly led to the fear of a diagnosis of cancer. Pathological examination led to the diagnosis of unilateral simple serous cystadenofibroma. Examination of the remaining specimens for pathology was free of tumor or tumor cells. Fig. 1-2 Leftsolido-cysticovarian mass, not vascularized on Doppler. Fig. 1-2 Fig. 3 Leftsolido-cysticovarian mass on pelvic MRI, measuring 8 cm. Fig. 3 Leftsolido-cysticovarian mass, not vascularized on Doppler. Leftsolido-cysticovarian mass on pelvic MRI, measuring 8 cm.

Younes bencherifi: writing the paper. WATIK Fedoua: Corresponding author writing the paper. Layafi yasmin: writing the paper. Benhassou mostapha: correction of the paper. Ennachet mohammed: correction of the paper. El karroumi mohammed :correction of the paper.

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.

I declare on my honour that this work has been exempted from ethical approval by my institution, as the dissemination of research results does not allow specific individuals to be identified.

We have no sources of funding.

The exact incidence of ovarian stages of fibroids is poorly determined. However, it seems to be higher than historically accepted [ 1 , 3 ]. Thus, Fatum et al. found this entity in nearly 8 % of the 302 cystectomies or adnexectomies performed between 1995 and 2000 [ 4 ]. The stages of ovarian fibroids are most often serous, as in our patient, but they may also be endometrioid, clear cell or mucinous [ 2 , 5 ]. They frequently occur in women between 40 and 50 years of age, but can also affect younger women, especially if they have been exposed to disthylbene in the uterus [ 6 ]. These tumors are most often asymptomatic. When they are large, they are likely to cause pelvic pain, disturbances in rectal emptying, increased abdominal girth or dysuria [ 3 , [6] , [7] , [8] , [9] ]. They sometimes manifest as metrorrhagia or feminization, which is thought to be secondary to the hyperestrogenism induced by the tumor [ 8 , 10 ]. The mechanism underlying this hyperestrogenism is considered to be hypersecretion of the hormone by the tumor itself. In our observation, there was reason to fear the hypothesis of cancer before the operation, both on the pelvic imaging data and on the history. Ovarian fibroid stages may have several macroscopic features usually associated with ovarian cancer (thickening of the adenoids, septa, and wall, suspicious presence of intracystic fluid, anarchy of the vascularization of the ovarian cortex). It is therefore important for surgeons not to ignore the deceptively worrying morphological appearance of these ultimately benign tumors. In this context, it is therefore important to recall the interest of an extemporaneous examination of an ovarian tumor suspected of being malignant. This request should be made if the tumor presents worrying macroscopic characteristics (adenoids, thick septa, suspicious intracystic fluid) and if the results of this examination are likely to modify the operative strategy. If this request for an extemporaneous examination is anticipated before the operation, the patient must be informed of the modifications that its conclusions are likely to have on the operative strategy (laparoconversion, bilateral hysterosalpingo-oophorectomy, lomboaortic and pelvic lymphadenectomies). In cases where the extemporaneous examination shows a marginal tumor of the ovary, maintaining the laparoscopic approach to complete the staging procedures seems sufficient. However, in cases where extemporaneous examination is not feasible or uncertain, the laparoscopic appearance described in this article should prompt the surgeon to defer extensive first-line surgical treatment.

Not applicable.

Watik Fedoua.

In conclusion, half of ovarian cystadenofibromas were purely cystic and the other half were complex cystic with one or more solid components on imaging; thus, half of ovarian cystadenofibromas had morphologic imaging features of malignancy on CT or MR images. On histology, solid components in the cystic tumors were correlated with fibrous stromas that occasionally made a false positive result for malignancy on imaging.

Ovarian stadenofibroma is a relatively rare benign tumor [ 1 ] arising from the ovarian lineages and stroma. This tumor can be solid, cystic, or semisolid, depending on the fraction of epithelium and stroma it contains and the secretory activity of the epithelium that composes it. Ovarian cystadenofibromas may present as malignant tumors, posing the problem of adapting surgical treatment. We present a case of cystadenofibroma in a 58-year-old female patient with no particular pathological history. All our work was reported according to the SCARE criteria and guidelines [ 11 ].

The authors declare that they have no conflict of interest.