Ovarian serous eystadenofibroma: Towards a preoperative diagnosis

Background: Ovarian cystadenofibromas are rare benign ovarian neoplasms which contain epithelial and fibrous stromal components which give rise to complex cystic and solid areas which will be visualized sonographically as malignant tumours. The management of cystadenofibroma of ovary is complete surgical removal of the tumour. The prognosis is generally excellent with prompt and appropriate treatment as there is a very low risk of recurrence.

Case Presentation: A 45-year-old woman presented to the gynaecology clinic complaining of irregular menstrual bleeding, secondary dysmenorrhea and left sided lower abdominal pain of one month duration. On bimanual examination a cystic, nontender, left adnexal mass was found. Imaging revealed a complex cystic mass in left ovary (10 x 9.6 x 8 cm). There was a thin film of pelvic free fluid adjacent to the inferior margin of the lesion. Few non-specific subcentrimetric para aortic, left iliac lymph nodes were seen. CA-125 level was 179 U/ml.

A staging laparotomy was performed and included total abdominal hysterectomy, bilateral salphyngoophorectomy and infracolic omentectomy. Bilateral multilocular ovarian cysts (left cyst – 10 x 8cm and right cyst – 3 x 4cm) were present. Histology revealed bilateral serous cystadenofibromas. No atypical or malignant cells were observed in peritoneal washings.

Conclusion: Ovarian cystadenofibromas appear malignant on imaging and macroscopy. Frozen sections does not appear to be reliable indicator and only MRI appears to be dependable in predicting the diagnosis of a cystadenofibroma prior to histological confirmation.