Rapid growth of mitotically active cellular fibroma of the ovary: a case report and review of the literature
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CASE REPORT
Open Access
Rapid growth of mitotically active cellular fibroma of the ovary: a case report and review of the literature Katsuya Matsuda1*, Seiko Tateishi2, Yuko Akazawa3, Akira Kinoshita4, Shiko Yoshida2, Sachiko Morisaki2, Ai Fukushima2, Takahiro Matsuwaki2, Koh-Ichiro Yoshiura3 and Masahiro Nakashima1
Abstract Background: Mitotically 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 presentation: A 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. Conclusions: To 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. Keywords: Case report, Mitotically active cellular fibroma, Preoperative diagnosis, Rapid growth, FOXL2 analysis
Background Ovarian fibrous tumors were previously classified as benign fibromas or malignant fibrosarcomas, according to the World Health Organization’s classification of tumors of the breast & Female Genital Origans [1]. Ovarian cellular fibromas were defined as having a mitotic figure of G (p.C134W) point mutation that is observed in the majority of AGCT patients [18, 19]. The FOXL2 mutation was detected in the AGCT case used as a positive control, but was absent from our case and the negative control (Fig. 6). Because necrosis and hemorrhage were not detected macro- or microscopically, a fibrosarcoma was ruled out. After performing the differential diagnoses outlined above, a final diagnosis of MACF was confirmed. Having obtained written informed consent, we evaluated the patient’s risk of recurrence. Based on our recommendation and the preference of the patient, we performed radical surgery (simple hysterectomy, left adnexectomy and omentectomy). The patient is undergoing regular follow-up. Recurrence of the tumor has no
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