Ovarian endometrioid adenofibroma in a perimenopausal woman with intermittent vaginal bleeding: a case report

Ovarian endometrioid adenofibroma (EA) is an exceptionally rare benign epithelial tumor of the ovary with nonspecific clinical and imaging manifestations, and its diagnosis relies mainly on pathological examination. This case describes a 55-year-old perimenopausal woman with a 1-year history of intermittent vaginal bleeding and a progressively enlarging right adnexal mass. Imaging revealed a solid mass in the right adnexal region with minimal blood flow signal. Serum tumor markers were within normal ranges, and the sex hormone profile showed no evidence of estrogen excess. Serial ultrasonography showed no interval increase in endometrial thickness; therefore, a causal relationship between the ovarian tumor and the abnormal bleeding could not be established. The patient underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. Postoperative uterine pathology demonstrated proliferative endometrium and endometrial polyps, providing a plausible uterine explanation for the bleeding. Histopathological examination of the ovarian lesion confirmed benign endometrioid adenofibroma with focal epithelial crowding but without cytological atypia, increased mitotic activity, or destructive stromal invasion. The postoperative course was uneventful, and no abnormal findings were detected during the 11-month follow-up. EA lacks specific clinical manifestations, and definitive diagnosis depends on histopathological and immunohistochemical evaluation. Management is primarily surgical, but the extent of surgery should be individualized according to patient age, menopausal status, fertility considerations, and preoperative suspicion of malignancy. Although the prognosis of benign EA is generally favorable, careful follow-up may be considered in cases with atypical histological features. This case highlights the diagnostic challenge of ovarian EA and emphasizes its consideration in the differential diagnosis of solid adnexal masses in peri- and postmenopausal women, particularly when imaging findings raise concern for malignancy.