Mitotically active cellular fibroma of the ovary diagnosis and treatment

Mitotically active cellular fibroma (MACF) of the ovary is a relatively newly recognized histological disease entity which explains its scarce reporting in literature and unknown prognosis [1]. In this tumor type, high mitotic activity is noticed without severe atypia. These tumors are categorized as benign ovarian tumors with late recurrence, if any. However, we herein report an unusual case of an ovarian mitotically active atypical fibrous tumor case which presented as recurrence within six months of being operated thereby raising suspicion of an element of malignancy. On presentation, the patient suffered from abdominal pain and abdomino-pelvic mass. After imaging confirmed an ovarian neoplastic lesion patient underwent bilateral salpingo-oophorectomy and hysterectomy. Histopathology defined the lesion as “ovarian mitotically active atypical fibrous tumor”.

Six months later, abdominal pain recurred for which imagining was done and confirmed a newly developed well defined irregular complex solid cystic mass causing intestinal obstruction giving an impression of a malignant neoplasm, probably ovarian carcinoma. However, histopathology for the new lesion remained the same as was for the previous mass, i.e. mitotically active ovarian fibroma, but with lung and mesenteric lymph nodes metastases. Patient couldn’t be operated on due to her co-morbid conditions, and the mass was vascular. She was given supportive care with consideration to start hormonal therapy and during this period died due to sepsis.

This case highlights the importance of having a high suspicion of the possibility of malignancy when mitotically active cellular fibroma manifests as a recurrence of mass as this tumor may tend to have an uncertain malignant potential. Thereby, stressing the importance of long term follow up even after the primary tumor is surgically treated without any surgical difficulty or tumor rupture [2]. Such tumors need to be followed and reported more often to help understanding the way they behave and their management.