Rapid growth of mitotically active cellular fibroma of the ovary: a case report and review of the literature

Abstract

BackgroundMitotically active cellular fibroma (MACF) of the ovary, characterized by relatively high mitotic activity without severe atypia, represents a relatively new disease entity. MACF is categorized as a benign ovarian tumor. However, due to a limited number of case reports, its clinical and pathological features and optimum management remains largely undetermined. Herein, we report on a rare case of MACF that grew rapidly in size and was diagnosed on detailed pathological examination.Case presentationA 44-year-old Japanese woman, who detected a myoma-like lesion 1-year earlier, was referred to our hospital when the follow-up examination demonstrated that the mass had increased in size. Magnetic resonance imaging revealed a T1 isointense and T2 hyperintense tumor (11 cm in diameter) in the right pelvic cavity. Laparoscopy confirmed the presence of a right ovarian tumor and laparoscopic right adnexectomy was performed. The tumor cells consisted of dense cellular proliferations of spindle fibroblast-like cells without significant cytological atypia. The mitotic activity index was estimated at >15 mitotic figures per 10 high-power fields. Reticulin staining and FOXL2 mutation analysis excluded the possibility of an adult granulosa cell tumor, and the patient was diagnosed with a MACF of the ovary.ConclusionsTo the best of our knowledge, we are the first to report on a case of rapid growth of a MACF of the ovary during follow-up. When an increase in the size of a solid ovarian mass is detected, a MACF should be considered as a differential diagnosis.

Case Report: A Case of Mitotically Active Cellular Fibroma of the Ovary Misdiagnosed Preoperatively as Pedunculated Subserosal Uterine Leimyoma

“…Pelvic MRI is of limited utility in the diagnosis of cellular fibromas. In a study by Târcoveanu et al, MRI was suggestive for the diagnosis only in 3 of 10 cases of fibroma [12]. In our study, pelvic MRI showed a mass of 45 x 52 x 53 mm in size in close proximity with the right ovary, compatible with pedunculated subserosal uterine leiomyoma, leading to misdiagnosis.…”

Meigs’ syndrome mimicking heart failure with preserved ejection fraction: a case report

“…MACF of the ovary is a rare histopathologic entity; it is defined as a benign ovarian cellular fibrous tumor with high mitotic activity without severe atypia, has a different behavior from the distinct malignant behavior of ovarian fibrosarcoma, and is associated with a favorable outcome [12]. Owing to the high count of mitotic figures, MACF often provides diagnostic challenges in cases of pelvic mass with ascites, PE, and elevated tumor marker CA-125 levels.…”

A case report of primary ovarian fibrosarcoma

“…Benign fibromas are by far the commonest type of spindle cell ovarian neoplasm, and are characterized by mild nuclear atypia and 3 or fewer mitotic figures per 10 high power fields (HPFs) 3 . MACF has been more recently identified as a distinct entity 5 that resembles fibrosarcoma in its high degree of mitotic activity; however, MACFs lack significant cytological atypia 16 . MACF is considered benign and has a favorable prognosis.…”