Answer for BIR CoW 06 Dec 2020
OVARIAN FIBROMA
Findings
T2 hypointense lesion with T2 hyperintense foci , likely cystic degeneration noted in right adnexal region abutting the right lateral wall of uterus. It appeared hypointense in TIWI with restricted diffusion or gradient blooming . These features were suggestive of Ovarian Fibroma . The Tumor markers were normal, Excision of the lesion was done and the final diagnosis by HPE was Ovarian fibroma
Discussion
Thecoma -Fibroma Tumor Spectrum includes thecomas, fibrothecomas, and fibromas Thecomas consist of lipid-laden stromal cells analogous to those seen with ovarian follicles. Fibroma is the most common sex cord tumor and can occur in both premenopausal and postmenopausal women. Large tumors can be associated with Meigs syndrome, which is characterized by ascites and right-sided pleural effusion. Classically, FIBROMAS are Completely solid, homogeneously T2 and T1 hypointense (due to their high collagen content), exhibit homogenous low-level enhancement less than that of the myometrium, and do not restrict diffusion. A lesion arising from the ovary with these features may be confidently diagnosed as fibroma or fibrothecoma It is common for tumors to have areas resembling both thecoma and fibroma, and many are classified as fibrothecoma. Primary differential diagnosis consideration is Broad ligament or pedunculated fibroids (leiomyomas), and fibromas are often misdiagnosed as fibroids on imaging. Inability to identify a normal ovary ipsilateral to a fibrous mass, although not excluding the diagnosis of a fibroid, should promote consideration of fibroma or fibrothecoma. Enhancement characteristics should also be assessed, because fibromas and fibrothecomas are hypoenhancing relative to normal myometrium and most fibroids
Findings
T2 hypointense lesion with T2 hyperintense foci , likely cystic degeneration noted in right adnexal region abutting the right lateral wall of uterus. It appeared hypointense in TIWI with restricted diffusion or gradient blooming . These features were suggestive of Ovarian Fibroma . The Tumor markers were normal, Excision of the lesion was done and the final diagnosis by HPE was Ovarian fibroma
Discussion
Thecoma -Fibroma Tumor Spectrum includes thecomas, fibrothecomas, and fibromas Thecomas consist of lipid-laden stromal cells analogous to those seen with ovarian follicles. Fibroma is the most common sex cord tumor and can occur in both premenopausal and postmenopausal women. Large tumors can be associated with Meigs syndrome, which is characterized by ascites and right-sided pleural effusion. Classically, FIBROMAS are Completely solid, homogeneously T2 and T1 hypointense (due to their high collagen content), exhibit homogenous low-level enhancement less than that of the myometrium, and do not restrict diffusion. A lesion arising from the ovary with these features may be confidently diagnosed as fibroma or fibrothecoma It is common for tumors to have areas resembling both thecoma and fibroma, and many are classified as fibrothecoma. Primary differential diagnosis consideration is Broad ligament or pedunculated fibroids (leiomyomas), and fibromas are often misdiagnosed as fibroids on imaging. Inability to identify a normal ovary ipsilateral to a fibrous mass, although not excluding the diagnosis of a fibroid, should promote consideration of fibroma or fibrothecoma. Enhancement characteristics should also be assessed, because fibromas and fibrothecomas are hypoenhancing relative to normal myometrium and most fibroids
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
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Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!