Fibromas occur at all ages but are most frequently seen in middle-aged women.
Fibromas are generally asymptomatic and are often detected at palpation during a routine gynecologic examination. Tumors can reach a large size at presentation.
It is composed of spindle cells forming variable amounts of collagen. Sectioning of a fibroma typically reveals a chalky-white surface that has a whorled appearance, similar to that of a uterine fibroid. Areas of edema, occasionally with cyst formation, are also relatively common.
- Meigs syndrome: consists of ovarian fibroma with ascites and a pleural effusion
- fibromas are seen in 75% of patients with nevoid basal cell carcinoma syndrome
On ultrasound, fibromas most commonly manifest as solid, hypoechoic masses with ultrasound beam attenuation. As such, they may appear similar to a pedunculated subserosal uterine fibroid.
However, the sonographic appearance can be variable, and some tumors can rarely have cystic components.
Fibromas usually manifest as diffuse, slightly hypoattenuating masses with poor, very slow contrast enhancement. Calcification and bilaterality are both uncommon.
Signal characteristics include:
- T1: fibromas usually demonstrate homogeneous low signal intensity
- fibromas appear as well-circumscribed masses with low signal intensity
- may contain scattered hyperintense areas representing edema or cystic degeneration
- a band of T2 hypointensity separating the tumor from the uterus on all imaging planes is also considered a characteristic feature
- T1 C+ (Gd): usually shows heterogeneous enhancement
Treatment and prognosis
Ovarian fibromas are almost always benign .
General imaging differential considerations include:
- large pedunculated subserosal uterine leiomyoma
- thecoma and fibrothecoma
- tend to have brighter signal on T2 given edema and cystic degeneration
- contrast-enhancement may be observed given the vascularization of the theca cells
- Neoplasien des Ovars
- ovarian cystadenofibroma
- ovarian fibrothecoma
- subseröses Uterusmyom
- ovarian fibromatosis
- Adenofibrom des Ovars