The case of ovarian serous cystadenofibroma confused with postmenopausal malign adnexial mass

Introduction and Objective

Ovarian cystadenofibroma is quite rare benign ovarian tumor including both epithelial and fibrous stromal contents and seen between 25 and 65 years old. Ultrasonographic appearance of cystadenofibroma is frequently a cystic adnexial mass with solid content, and it is generally confused with malign ovarian tumor. In our study, we operated our case with the pre-diagnosis of postmenopausal malign adnexial mass by radiological imaging, and we found serous cystadenofibroma by intraoperative pathological diagnosis. In the patients operated due to the pre-diagnosis of malign adnexial mass, cystadenofibroma should also be considered as a differential diagnosis even it is rare.

Case(s)

Our case referred to our clinic with the complaint of inguinal pains. Seventy-five-year-old multipara patient who was in menopause for 25 years have had no gynecologic disease so far. In the ultrasonography performed, a total of 15 cm cystic mass including bilobular solid papillary areas were found within right adnexal area. Ca 125 value of the patient lies within normal ranges. In the MRI examination, right adnexial mass was observed causing suspicion for solid cystic malignity which is hypointense in T1 and hyperintense in T2. When serous papillary cyst adenofibroma was found after the intraoperative pathology, total hysterectomy and bilateral salpingo-oophorectomy were carried out, and the patient was discharged with healthy posteoperative condition.

Discussion and Conclusion

Ovarian cystadenofibroma is a rare benign tumor with epithelial and fibrous contents. Its incidence rate is 1.7% in all benign ovarian tumors. These tumors are cystic masses with solid or papillary components and therefore, they can be evaluated as malign masses in preoperative ultrasonographic or MR imaging. In our patient, both ultrasonographic and MR pre-diagnoses were against malign adnexial mass. Cystadenofibromas are grossly similar to malign tumor during operation and therefore, intraoperative pathological diagnosis by frozen should be established to get the proper diagnosis. Although our patient was in postmenopausal period, these cysts may be seen during reproductive period, and radical surgical intervention may be planned due to preoperative malign appearance. Serous papillary cystadenofibroma which is benign ovarian cystic tumor rarely seen in cases with clinically negative tumor markers should be remembered although preoperative imaging findings supports malignity in the differential diagnosis of malign adnexial masses.

Keywords

Adnexial mass, cystadenofibroma, ovary.