Ovarian fibroma disease

　　First, etiology

　　The etiology of ovarian fibroma disease is not yet clear.

　　Second, pathogenesis

　　1, Gross morphology

　　About 6/7 are unilateral, the ovary can be partially or completely involved, the involved ovary is enlarged, with a diameter of 6-12 cm, an average of 8 cm, with a white, smooth or nodular surface, lobulated, with a solid section, hard texture, most are white, a few are gray or yellow, about 1/3 can see small cysts, with the largest cyst diameter up to 2.5 cm.

　　2, Tissue morphology

　　Sarcomatous fibroblasts proliferate at the lesion site and produce varying degrees of collagen fibers, surrounding the normal ovarian structure, including all stages of follicles and corpus luteum. The small cysts seen with the naked eye are residual cystic follicles within the lesion. Flavonized stromal cells are occasionally seen in the proliferating fibroblasts or normal ovarian stroma. In a few cases, granulosa cell nests or hollow tubular structures similar to supportive cells appear in the fibrous hyperplasia foci, and half of the cases are accompanied by focal stromal edema.

　　There have been reports of a case of death due to right pulmonary artery embolism, bilateral peripheral pulmonary multiple emboli, and right lower lobe segmental infarction caused by concurrent intraperitoneal disseminated fibroma disease.

　　About half of the patients with ovarian fibroma have infertility, the rest have only 1 to 2 pregnancies, and more than half have abnormal menstruation, including irregular vaginal bleeding, menorrhagia, or amenorrhea. A few cases are accompanied by masculinization and hirsutism. If the tumor pedicle twists, it can cause abdominal pain. Gynecological examination can palpate unilateral or bilateral adnexal masses.

　　Ovarian fibroma disease is a relatively rare disease occurring in young women, and the etiology of ovarian fibroma disease is not yet clear. Therefore, early diagnosis, early treatment, and good follow-up work should be done.

　　1. Signs

　　The tumors are mostly unilateral, with bilateral cases accounting for 4% to 10%. They are round, kidney-shaped, or lobulated nodular. The surface is smooth, the capsule is intact, solid, and hard. The cut surface is solid, with a woven structure that is clearly visible, grayish or pinkish white, occasionally with hemorrhage or cystic change.

　　2. Microscopic examination

　　The tumor cells are long and spindle-shaped, with little cytoplasm and no lipid droplets. The cells are closely arranged, showing a woven or wavy pattern. Collagen fibers are abundant, and can be accompanied by extensive hyaline change. The tumor cells do not have atypical shapes or nuclear division figures.

　　3. Other examinations

　　Ultrasound, CT, laparoscopic examination

　　1. Pay attention to light diet, and it is better to choose easily digestible and absorbable foods such as vegetable congee and noodle soup.

　　2. Eat more fresh fruits and vegetables to ensure the intake of vitamins.

　　3. Provide liquid or semi-liquid foods such as various congee, rice soup, etc.

　　1. Treatment

　　Young et al. reported 14 cases, of which 2 underwent total hysterectomy and bilateral salpingo-oophorectomy, and the rest underwent unilateral salpingectomy or ovarian wedge resection. One case underwent left salpingectomy during the first operation, and the right ovary was found to be enlarged without treatment. The menstrual cycle remained irregular after surgery. After 3 years, progressive lower abdominal pain led to a second operation, where the right ovary was found to be enlarged to 6 cm, and a total hysterectomy and right salpingo-oophorectomy were performed. Postoperative examination showed right ovarian fibroma. Young followed up 10 cases, and postoperative menstrual irregularity, virilization signs, and hirsutism could be restored. Two cases of amenorrhea were reported, one of which achieved pregnancy and normal delivery. One case of hirsutism also achieved pregnancy. Since this condition often occurs in young women, conservative surgery, such as unilateral salpingectomy or ovarian wedge resection, can be considered. If ovarian wedge resection is performed, frozen section examination should be performed during surgery to exclude malignant lesions.

　　2. Prognosis

　　The development of this condition is slow, and the prognosis is good.