Hemorrhagic Torsion of a Left Ovarian Fibroma

Pamela L Mok, MD
Madeleine D Kraus, MD
Clare MC Tempany, MD

May 31, 1994

Presentation

Imaging Findings

Axial enhanced pelvic CT and MR images show a 13 x 10 x 11.5 cm omplex pelvic mass (CT with arrows)(MR with arrows) with mixed fluid and enhancing solid components. The mass is predominantly of decreased T1 and T2 signal intensity on the MRI, although there are areas of intermediate T1 and increased T2 signal with fluid levels seen anteriorly, possibly representing cystic degeneration. A well-defined 2.5 cm round enhancing nodule (arrow) is noted within the mass superiorly as well. No normal uterus or ovary is identified. There is fluid within the descending colon proximal to the mass as well as in the rectum (arrows). The mass abuts and may involve portions of the sigmoid colon, small bowel, and bladder, but no enlarged pelvic lymph nodes are identified. The liver is normal, and there is no free fluid in the upper abdomen or pleural space.

Differential Diagnosis

Diagnosis

Discussion

Ovarian fibromas are benign neoplasms which arise from the connective tissue stroma of the ovary and constitute 4% of all ovarian neoplasms. They are typically homogeneous, well-encapsulated masses which enhance mildly and are of decreased signal intensity on both T1 and T2 weighted images. The complication of torsion in this case, however, resulted in hemorrhage and necrosis of the fibroma. Between 10 and 20% of all ovarian tumors are complicated by torsion.

Ovarian fibromas are unilateral in 90% of cases, and if multiple, Gorlin's syndrome (Basal cell nevus syndrome) should be considered. Another association with ovarian fibromas, ascites, and pleural effusion or hydrothorax exists, and is called Meigs-Salmon syndrome.

Pathology

Ovarian fibromas are uncommon tumors of the ovary, and are benign. They are solid and have a firm, white fascicular appearance on cut surface. Microscopically, the tumor is composed of fibroblasts and thick bands of collagen; small pockets of rounded cells with cleared ytoplasm (theca cells) may be present. The differential diagnosis includes ovarian fibromatosis, metastatic carcinoma with marked desmoplastic response ("Krukenberg tumor"), and fibrosarcoma.

References

2. Cotran R, Kumar V, Robbins S, editors. Robbins pathologic basis for disease. 4th ed. Philadelphia: Saunders, 1989:1151 - 1156.

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