Ovarian Fibroma

Introduction

• Description: The most common benign ovarian tumor is the ovarian fibroma, which is composed of stromal cells (fibroblasts). Although benign, these tumors are sometimes associated with ascites and hydrothorax (Demons syndrome, Meigs syndrome, 1% of patients).

• Prevalence: 4% of all ovarian tumors, most common solid tumor.

• Predominant Age: Any; most common in perimenopausal and menopausal women; average age is 48 years; less than 10% are younger than 30 years.

• Genetics: No genetic pattern and no known association with BRCA germline mutations or a genetic predisposition to breast cancer, with the exception of Gorlin syndrome.

Etiology and Pathogenesis

• Causes: Unknown. Ascites and pleural effusion are thought to be related to vascular endothelial growth factor, which raises capillary permeability.

• Risk Factors: None known.

Signs and Symptoms

• Asymptomatic (may grow to a large size without detection)

• Adnexal mass (average size is 6 cm, and weight is as much as 50 lb)

• Ascites (40% if the tumor is >10 cm)

• Hydrothorax (Meigs syndrome, regresses after removal of the tumor)

• Estrogen secretion (when theca cells predominate)

• Bilateral masses in less than 10% of patients

Diagnostic Approach