Mitotically active cellular fibroma of the ovary diagnosis and treatment

Mitotically active cellular fibroma (MACF) of the ovary is a relatively newly recognized histological disease entity which explains its scarce reporting in literature and unknown prognosis [1]. In this tumor type, high mitotic activity is noticed without severe atypia. These tumors are categorized as benign ovarian tumors with late recurrence, if any. However, we herein report an unusual case of an ovarian mitotically active atypical fibrous tumor case which presented as recurrence within six months of being operated thereby raising suspicion of an element of malignancy. On presentation, the patient suffered from abdominal pain and abdomino-pelvic mass. After imaging confirmed an ovarian neoplastic lesion patient underwent bilateral salpingo-oophorectomy and hysterectomy. Histopathology defined the lesion as “ovarian mitotically active atypical fibrous tumor”. Six months later, abdominal pain recurred for which imagining was done and confirmed a newly developed well defined irregular complex solid cystic mass causing intestinal obstruction giving an impression of a malignant neoplasm, probably ovarian carcinoma. However, histopathology for the new lesion remained the same as was for the previous mass, i.e. mitotically active ovarian fibroma, but with lung and mesenteric lymph nodes metastases. Patient couldn’t be operated on due to her co-morbid conditions, and the mass was vascular. She was given supportive care with consideration to start hormonal therapy and during this period died due to sepsis. This case highlights the importance of having a high suspicion of the possibility of malignancy when mitotically active cellular fibroma manifests as a recurrence of mass as this tumor may tend to have an uncertain malignant potential. Thereby, stressing the importance of long term follow up even after the primary tumor is surgically treated without any surgical difficulty or tumor rupture [2]. Such tumors need to be followed and reported more often to help understanding the way they behave and their management.

Recurrence of Mitotically Active Cellular Fibroma of the Ovary

Background. 10% of ovarian fibromatous tumours typically exhibit increased cellularity, mitotic activity, and less frequently nuclear atypia. Therefore, the classification within the group of fibromatous tumours may represent some difficulties, thus, one or several of these features should appear.Case. We introduce the clinical and pathologic features based on one case of recurrence of a mitotically active cellular ovarian fibroma (MACF) in the pararectal fossa. This recurrence took place six years after primary surgery. Macroscopically, the tumour was firm, fibrous, well delimited, yellow-white without gross necrosis. On microscopic examination, it was composed of a densely cellular proliferation of fibrolastic-like cells with bland nuclear features and arranged in a fascicular pattern. There was no sign of significant atypia or necrosis.Conclusion. Recently, this case is the first report of a recurrence of MACF, following primary surgery with no tumoral rupture or surgical difficulty. The clinical outcome of ovarian cellular fibromas (CFs) and MACFs is typically uneventful. This case, however, strongly suggests maintaining a long-term clinical follow-up even though the principal tumour was surgically treated without tumour rupture or in the absence of adherence or any surgical difficulty.