Fibrothecal tumors of the ovary: a case report

Ovarian fibrothecal tumors are rare, benign neoplasms accounting for 1-4.7% of organic ovarian tumors, predominantly affecting postmenopausal women. This report highlights the diagnostic challenge and intraoperative management of a voluminous ovarian fibrothecal tumor presenting with atypical, purely mechanical symptoms.

A 67-year-old female presented with a 5-month history of progressive pelvic pain without endocrine manifestations. Clinical examination revealed a lateralized, mobile hypogastric mass exceeding 10 cm. Abdominopelvic computed tomography (CT) and pelvic magnetic resonance imaging (MRI) characterized a large, solid pelvic mass. A median laparotomy with bilateral Salpingo-oophorectomy was performed. Intraoperative frozen section analysis suggested a fibrothecoma, which was definitively confirmed by standard histopathological examination. The patient had an uneventful postoperative recovery.

Unlike classic literature reports that frequently associate fibrothecomas with estrogenic symptoms or Meigs' syndrome, this case was distinguished by isolated mass effect. The voluminous size (>10 cm) of the solid mass raised preoperative suspicion for malignancy, demonstrating that imaging alone is insufficient for definitive characterization. This case emphasizes the critical role of intraoperative frozen section in the surgical decision-making process.

Ovarian fibrothecoma can present atypically without hormonal symptoms. Intraoperative frozen section is paramount in managing large ovarian masses, as it allows surgeons to immediately confirm benignancy, tailor the surgical extent, and avoid unnecessary radical procedures in postmenopausal women.