Cystadenofibroma and contralateral collision lesions: A unique ovarian case report

Ovarian cystadenofibromas are rare benign tumors, accounting for only 1.7% of benign ovarian neoplasms. Even rarer are ovarian collision tumors, with the coexistence of collision tumors and other benign ovarian neoplasms being exceptionally uncommon. This report presents a unique case of serous cystadenofibroma in one ovary, accompanied by collision features involving serous and mucinous cysts in the contralateral ovary.

A 41-year-old woman presented with lower abdominal pain and swelling persisting for 2-3 months. Clinical evaluation of the abdomen revealed a mobile, non-tender, cystic mass resembling a 26-28-week gravid uterus, with no free fluid. Local and per speculum examinations showed a healthy vulva, cervix, and vagina, with a Pap smear negative for intraepithelial lesions or malignancy. A bimanual examination identified a mobile, multiparous uterus and a large (~15 × 12 cm), predominantly cystic lesion originating from the right adnexa and extending anteriorly and superiorly to the uterus. MRI findings confirmed these observations. Given the endometrial biopsy indicating endometrial intraepithelial neoplasia, the patient underwent an exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological analysis revealed serous cystadenofibroma in the right ovary and multiple serous and mucinous cysts in the left ovary, consistent with collision features. Additionally, the uterine endometrium showed hyperplasia without atypia.

This case underscores the rare coexistence of a benign surface epithelial-stromal tumor in one ovary and collision features in the other. It emphasizes the importance of comprehensive evaluation, precise diagnosis, and timely surgical management to ensure optimal patient outcomes.