Case Report - Fibrosarcoma of Ovary

Abstract

Fibrosarcoma of ovary, a tumour arising do novo or secondary to malignant transformation of benign fibromatous tumours, is an extremely rare malignant sex cord stromal tumour of ovary. As on today, the total number of reported cases throughout the world is not more than hundred, There is no clearcut diagnostic criteria, prognostic factor and treatment modalities. Usually it presents as unilateral solid tumour. It can occur at any age though postmenopausal diagnosis is more frequent. Majority of the patients present with vague abdominal pain and a lump in lower abdomen arising from ovary. Ultrasonographic findings usually reveals unilateral solid homogenous tumour in ovary with uneven echo enhancement and increased vascularity. Serum tumor markers and sex hormones such as CA-125 usually found within normal levels. Peroperative frozen section study often concludes into wrong diagnosis, postoperative histopathological diagnosis usually reveals spindle cells with high mitotic activity with  Background of fibrous tissue. Depending on mitotic activity, cellular atypia associated with haemorhage and necrosis, it is differentiated from benign fibroma with mitotic activity. Immunohistochemistry findings may be positive for vimentin, á-inhibin, SMA, estrogen receptor, progesterone receptor. Ki-67 positive rate is associated with degree of severity of malignancy i.e, grading and prognosis. Our case was having the above features and was confirmed postoperatively by histological and later by histochemistry with positive Vimentin and Ki-67. As there were not enough cases to conclude a final treatment protocol, so far treated cases revealed total cytoreductive surgery followed by postoperative chemotherapy has the better prognosis. A round, solid unilateral heterogenous ovarian tumor should be taken in differential diagnosis of ovarian fibrosarcoma. As this is an extremely rare tumour of the ovary, there is usually no rise of specific tumuor marker, no conclusive diagnostive criteria available at present, clinical studies involving multicentered approach associated with studies at molecular level is a prime requirement for the gynaecologist to diagnose and treat in a better way in future.

J Bangladesh Coll Phys Surg 2023; 41: 89-92