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Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature

  • Authors:
    • Efthymia Thanasa
    • Anna Thanasa
    • Emmanouil Xydias
    • Ioannis-Rafail Antoniou
    • Apostolos Ziogas
    • Ioannis Thanasas
  • View Affiliations / Copyright

    Affiliations: Department of Health Sciences, Medical School, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece, Department of Obstetrics and Gynecology, EmbryoClinic IVF, 55133 Thessaloniki, Greece, Department of Obstetrics and Gynecology, General Hospital of Trikala, 42100 Trikala, Greece, Department of Medicine, University of Thessaly, School of Health Sciences, 41334 Larissa, Greece
    Copyright: © Thanasa et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY 4.0].
  • Article Number: 81
    |
    Published online on: October 29, 2025
       https://doi.org/10.3892/mi.2025.280
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Abstract

The present study describes a rare case of torsion of an ovarian fibroma in a woman of reproductive age, where a severe diagnostic dilemma arose in differentiating it from a solid ovarian cancer. A 48‑year‑old female patient presented to the hospital with a 1‑week history of low‑grade fever and mild, continuous abdominal pain, accompanied by nausea and a mild sensation of abdominal bloating. The pain, which was not associated with signs of peritoneal irritation, was more pronounced in the right iliac fossa. The levels of inflammatory and tumor markers were found to be slightly elevated. A computed tomography scan and magnetic resonance imaging of the right adnexal region revealed a large heterogeneous mass with cystic‑necrotic areas inside, free fluid collection in the pelvis, and multiple slightly enlarged para‑aortic and iliac lymph nodes. These imaging findings, combined with the lack of clinical and laboratory improvement following treatment with antibiotics, led to the decision to proceed with a laparotomy, without having ruled out the diagnosis of solid ovarian cancer. Intraoperatively, the torsion of an ovarian fibroma was identified. A total abdominal hysterectomy with bilateral salpingo‑oophorectomy was performed. An immunohistochemical examination confirmed the diagnosis of ovarian fibroma. Following an uneventful post‑operative course, the patient was discharged from the clinic on the 4th day post‑operatively. The present case report highlights an unusual clinical manifestation of ovarian fibroma torsion, which entailed milder symptom intensity and characteristics resembling ovarian malignancy instead. The aim of the present study was to report this uncommon manifestation, explore its differential diagnosis from malignancy and provide a brief review of the current diagnostic and treatment algorithms for clinicians faced with similar cases in their practice. In this manner, it is hoped that the present study may contribute to the improvement of the diagnostic accuracy and treatment efficacy for similar cases.
View Figures

Figure 1

Magnetic resonance imaging of a
twisted large ovarian fibroma: A large heterogeneous lesion (red
arrows) is clearly visible in the region of the right adnexa, with
cystic and necrotic areas present within.

Figure 2

Intraoperative imaging of the ovarian
fibroma with torsion.

Figure 3

Surgical specimen of the twisted
ovarian fibroma.

Figure 4

Histological image of ovarian fibroma
torsion: Vascular congestion, hemorrhagic infiltration and ischemic
necrosis of the ovarian tumor support the diagnosis of torsion of
the corresponding adnexa (magnification, x100).

Figure 5

Immunohistochemical images of twisted
ovarian fibroma: (A) Reticulin positivity (magnification, x100),
(B) WT1 positivity (magnification, x400), (C) inhibin focal
positivity (magnification, x400), (D) calretinin negativity
(magnification, x40).
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Spandidos Publications style
Thanasa E, Thanasa A, Xydias E, Antoniou I, Ziogas A and Thanasas I: Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature. Med Int 5: 81, 2025.
APA
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., & Thanasas, I. (2025). Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature. Medicine International, 5, 81. https://doi.org/10.3892/mi.2025.280
MLA
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., Thanasas, I."Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature". Medicine International 5.6 (2025): 81.
Chicago
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., Thanasas, I."Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature". Medicine International 5, no. 6 (2025): 81. https://doi.org/10.3892/mi.2025.280
Copy and paste a formatted citation
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Spandidos Publications style
Thanasa E, Thanasa A, Xydias E, Antoniou I, Ziogas A and Thanasas I: Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature. Med Int 5: 81, 2025.
APA
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., & Thanasas, I. (2025). Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature. Medicine International, 5, 81. https://doi.org/10.3892/mi.2025.280
MLA
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., Thanasas, I."Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature". Medicine International 5.6 (2025): 81.
Chicago
Thanasa, E., Thanasa, A., Xydias, E., Antoniou, I., Ziogas, A., Thanasas, I."Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature". Medicine International 5, no. 6 (2025): 81. https://doi.org/10.3892/mi.2025.280
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