Fibroma (Ovarian), Thecoma, and Fibrothecoma

Published on 10/03/2015 by admin

Filed under Obstetrics & Gynecology

Last modified 22/04/2025

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Fibroma (Ovarian), Thecoma, and Fibrothecoma

Synonyms/Description

Thecoma, fibroma, and fibrothecoma are all tumors belonging to the thecoma-fibroma group of stromal tumors (per the World Health Organization classification of ovarian sex cord–stromal tumors).

Etiology

Thecoma-fibroma tumors are a closely related group of benign tumors that arise from ovarian stroma and are often difficult for the imager and even pathologist to distinguish. The fibroma contains spindle cells, and is the most common type of sex cord-stromal tumor, accounting for 6% of all ovarian tumors. They are usually asymptomatic although they can be large.
The thecoma arises from theca (stroma) cells and can produce estrogen, much like the granulosa cell tumors, thus sometimes presenting with abnormal uterine bleeding. Many of these tumors are a mixture of cell types and are called fibrothecoma.

Ultrasound Findings

Fibromas/thecomas are typically solid, rounded, or oval ovarian lesions and may attain a large size (fibroma) and have low to moderate vascularity. Sonographically, fibromas tend to cast an intense acoustic shadow, making it difficult to see beyond the anterior surface of the tumor. They can also be solid but “stripy,” with linear streaks appearing vertically within the lesion. Vascularity is typically low by color Doppler, but occasional lesions may be more vascular, such as cellular fibromas. There can be small cystic areas within the solid mass; however, large cystic components are extremely rare.

Differential Diagnosis

These solid tumors cast intense acoustic shadows either as stripes or simply a global shadow from the entire lesion. A pedunculated fibroid is the most likely differential diagnosis to mimic this appearance. The finding of a normal ovary separate from the solid tumor can help to make that differentiation. Other solid ovarian tumors such as teratomas, dysgerminomas, and some solid malignancies are unlikely to cast a shadow and tend to be more vascular throughout the lesion than the fibroma/thecoma.

Clinical Aspects and Recommendations

Larger lesions are sometimes associated with ascites and rarely even hydrothorax. Meigs’ syndrome (ascites and hydrothorax) occurs in 10% of all cases and 40% of the time when the tumor exceeds 10 cm in diameter.
Similar to myomas they can sometimes have increased mitotic figures per 10 high-powered fields. True ovarian fibrothecomas, however, are extremely rare. Treatment generally consists of salpingo-oophorectomy. Occasionally, because thecomas can produce estrogen and present with postmenopausal bleeding, endometrial sampling is indicated.

Figures

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Figure F2-1 Small fibroma indicated by the calipers. The lesion is almost invisible due to the intense acoustic shadow cast by the front of the mass.

 

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Figure F2-2 Fibroma—typically oval, completely solid but smooth mass.

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Figure F2-3 Fibrothecoma with and without Doppler flow showing a typical solid mass with internal shadowing and limited vascularity.

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Figure F2-4 Fibroma with more vascularity than usually seen.

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Figure F2-5 Large fibroma with limited Doppler color flow and linear vertical shadows down the middle of the mass, typical of fibromas.

 

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Figure F2-6 Fibroma presenting as a large solid ovarian mass in a pregnant woman. Note the multiple vertical linear stripes and poor vascularity of this mass.

 

Suggested Reading

Chechia A., Attia L., Temime R.B., Makhlouf T., Koubaa A. Incidence, clinical analysis, and management of ovarian fibromas and fibrothecomas. Am J Obstet Gynecol. 2008;199  473.e1-4.

Conte M., Guariglia L., Benedetti Panici P., Scambia G., Rabitti C., Capelli A., Mancuso S. Ovarian fibrothecoma: sonographic and histologic findings. Gynecol Obstet Invest. 1991;32:51–54.

Paladini D., Testa A., Van Holsbeke C., Mancari R., Timmerman D., Valentin L. Imaging in gynecological disease (5): clinical and ultrasound characteristics in fibroma and fibrothecoma of the ovary. Ultrasound Obstet Gynecol. 2009;34:188–195.

Yaghoobian J., Pinck R.L. Ultrasound findings in thecoma of the ovary. J Clin Ultrasound. 1983;11:91–93.

Yen P., Khong K., Lamba R., Corwin M.T., Gerscovich E.O. Ovarian fibromas and fibrothecomas. J Ultrasound Med. 2013;32:13–18.

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