Nuclear Atypia Is a Necessary Factor for Diagnosis of Primary Ovarian Fibrosarcoma: A Case Report and Literature Review

Gynecol Obstet Invest. 2020;85(5):437-445. doi: 10.1159/000510875. Epub 2020 Oct 2.

Abstract

Introduction: Primary ovarian fibrosarcoma is a rare malignant tumor with few case reports. The current opinion in diagnosis preferring mitotic activity was questioned as there is a large amount of heterogeneity in prognosis between cases. We report a case of primary ovarian fibrosarcoma, and a literature review was performed according to the latest diagnostic trends. This is the first study to review the prognostic factors of primary ovarian fibrosarcoma according to the latest trend in diagnosis.

Case presentation: A 50-year-old woman with primary ovarian fibrosarcoma is reported. The patient was admitted to the hospital due to increasing abdominal girth. Physical examination and CT scan showed a giant mass from the suprapubic area to the xiphoid region which filled her entire abdominopelvic cavity. Frozen sections were performed during an operation to resect, and the pathology report indicated a high degree of malignancy. Because of the degree of malignancy, a bilateral salpingo-oophorectomy and omentectomy were performed. Histopathological examination and immunohistochemical staining confirmed the diagnosis of primary ovarian fibrosarcoma. During the operation, the tumor ruptured, which placed the patient in a FIGO stage IC1. After surgery, the patient received 6 courses of combination chemotherapy, consisting of etoposide, bleomycin, and cisplatin. The patient has been free from disease without evidence of recurrence at 5 months after the initial diagnosis.

Conclusions: Herein we report a case of primary ovarian fibrosarcoma and reviewed all published cases in English. Following the latest trend of diagnosis, multiple prognostic factors were used to determine survival prognosis. These included nuclear atypia, FIGO stage, mitotic counts, treatment methods, and tumor size. Only nuclear atypia was found to be associated with patient prognosis (p < 0.05). FIGO stage (p = 0.383), mitotic count per 10 hpfs (p = 0.155), treatment methods (p = 0.185), and tumor size (p = 0.972) were not found to be associated with survival prognosis. Nuclear atypia was an important factor in prognosis of patients. Using surgery with adjuvant medical treatment was inconclusive regarding patient survival.

Keywords: Mitotic activity; Nuclear atypia; Primary ovarian fibrosarcoma; Prognosis.

Publication types

  • Case Reports
  • Review

MeSH terms

  • Cell Nucleus / pathology*
  • Chemotherapy, Adjuvant
  • Female
  • Fibrosarcoma / diagnosis*
  • Fibrosarcoma / pathology*
  • Fibrosarcoma / surgery
  • Humans
  • Middle Aged
  • Neoplasm Recurrence, Local
  • Ovarian Neoplasms / diagnosis*
  • Ovarian Neoplasms / pathology*
  • Ovarian Neoplasms / surgery
  • Prognosis
  • Salpingo-oophorectomy