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Thecoma is a rare type of ovarian sex cord-stromal tumor, accounting for about 0.5% to 1.0% of ovarian tumors. This tumor mainly occurs in women before and after menopause and is relatively rare before puberty. Thecoma generally consists of benign solid or cystic masses and can be accompanied by ascites, abnormal hormone levels, and elevated CA125. Most of these tumors have a good prognosis. In this case study, we report on a 16-year-old girl who presented with bloating and a huge abdominal mass. A full-body computed tomography (CT) showed a huge cystic mass in the pelvic and abdominal cavities indicative of malignancy. The abdominal ultrasound (US) showed a huge solid hypoechoic mass reaching up to the lower abdomen and pelvic cavities. The tumor markers and estradiol were within the normal range. The tumor was surgically removed, and the histopathological examination revealed a solid thecoma measuring about 26 cm × 20 cm × 12 cm. Although thecomas mostly occur in perimenopausal and postmenopausal women, the findings of this case study suggest that thecomas should not be ruled out in adolescents presenting with a large pelvic mass. Abdominal US could be used to facilitate the differentiation between fluid-filled and solid masses, which can be difficult to distinguish on a CT scan.

Background Ovarian thecoma-fibroma group (OTFG) is an unusual type of ovarian cancer with three histopathologic subtypes, but their features on ultrasonography are still poorly understood. This study evaluated the features of different histopathological subtypes of OTFG on conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). Methods This retrospective study enrolled sixty-nine women with pathologically confirmed OTFG who underwent preoperative CEUS. The characteristics of OTFG on conventional ultrasonography and CEUS, clinical manifestations, and laboratory findings were compared among subtypes. Results Fourteen patients were diagnosed with fibroma, fifty-one with thecofibroma, and four with thecoma. Although 69% of patients were post-menopausal, thecoma patients were significantly younger than those in other two groups. Laboratory examination revealed 21.7% (15/69) of patients had high carbohydrate antigen 125 (CA-125) level. On conventional ultrasonography, 72.5% (50/69) masses showed solid type, 24.6% (17/69) showed mixed cystic-solid type, and only 2.9% (2/69) showed cystic type. On CEUS, 50% (2/4) of thecoma lesions were rapid enhancement, 58.8% (30/51) of thecofibroma lesions and 78.6% (11/14) of fibroma lesions showed slow enhancement, 75% (3/4) of thecoma lesions showed isoenhancement during the descent process, and only 13.75% (7/51) of thecofibroma lesions and 7.1% (1/14) of fibroma lesions showed isoenhancement during the descent. they varied significantly among different histopathological subtypes. Conclusions The majority of OTFG is solid-like on conventional ultrasonography. Menopause is an important factor related to the subtype of OTFG. In postmenopausal patients with solid adnexal masses, slow hypoenhancement on CEUS is an important feature of fibroma. In premenopausal patients with solid or mixed cystic-solid adnexal masses, thecoma may be considered when rapid hyperenhancement, and isoenhancement or hypoenhancement during descent are observed on CEUS. Clinical trial number Not applicable.

Background Ovarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. The objective of the study was to demonstrate clinical and sonographic features of OTFG and compare with surgical histopathology. Methods A total of 61 patients with surgically proven OTFG were enrolled in this retrospective study to demonstrate its clinical and sonographic features and to compare with pathological findings. Gray scale and color Doppler sonography were performed presurgically with either transabdominal or transvaginal approach to image pelvic structures and lesions. The clinical findings and sonographic appearances were compared with the types of the OTFG tumors based on the histopathological diagnosis. Results The mean patient age was 53.57 (range, 26–86) years. There were 63.93% (39/61) patients in postmenopausal and 63.93% (39/61) patients with no clinical symptoms. Ultrasound findings of OTFG revealed as solid tumors with a typical feature of well-demarcated hypoechoic masses in 70.49% (43/61), among which 74.41% (32/43) tumors were smaller than 5 cm in diameter. There were 17 mixed echogenic masses with calcification, hemorrhage, or cyst, among which 70.59% (12/17) lesions were larger than 5 cm in diameter. Acoustic attenuation of the tumor was presented in 44.26% (27/61) of the cases. Doppler flow signals within the tumors were found in 20 cases (32.79%), in which 80% (16/20) had minimal or moderate flow signals. Ascites was detected in 32.79% (20/61) of the cases, Megi’s syndrome was found in 1 case. Final pathology revealed 41 (67.21%) thecoma-fibromas, 15 (24.59%) fibromas, 4 (6.56%) thecomas and 1 (1.64%) fibrosarcoma. There were 58 patients underwent cancer antigen 125 (CA125) test, and 20.69% (12/58) showed an elevated level. The diameter of tumors was found to be significantly correlated with CA125 level ( p  < 0.01) and the amount of ascites fluid ( p  < 0.05). Conclusions The typical sonographic features of OTFG include adnexal hypoechoic masses with clear border and acoustic attenuation as well as minimal Doppler flow signals. All the aforementioned features could make ultrasound imaging as a assistent tool improve the preoperative diagnostic accuracy.

Objective To evaluate the diagnostic utility of conventional magnetic resonance imaging (MRI)-based characteristics and a texture analysis (TA) for discriminating between ovarian thecoma-fibroma groups (OTFGs) and ovarian granulosa cell tumors (OGCTs). Methods This retrospective multicenter study enrolled 52 patients with 32 OGCTs and 21 OTFGs, which were dissected and pathologically diagnosed between January 2008 and December 2019. MRI-based features (MBFs) and texture features (TFs) were evaluated and compared between OTFGs and OGCTs. A least absolute shrinkage and selection operator (LASSO) regression analysis was performed to select features and construct the discriminating model. ROC analyses were conducted on MBFs, TFs, and their combination to discriminate between the two diseases. Results We selected 3 features with the highest absolute value of the LASSO regression coefficient for each model: the apparent diffusion coefficient (ADC), peripheral cystic area, and contrast enhancement in the venous phase (VCE) for the MRI-based model; the 10th percentile, difference variance, and maximal correlation coefficient for the TA-based model; and ADC, VCE, and the difference variance for the combination model. The areas under the curves of the constructed models were 0.938, 0.817, and 0.941, respectively. The diagnostic performance of the MRI-based and combination models was similar ( p  = 0.38), but significantly better than that of the TA-based model ( p  < 0.05). Conclusions The conventional MRI-based analysis has potential as a method to differentiate OTFGs from OGCTs. TA did not appear to be of any additional benefit. Further studies are needed on the use of these methods for a preoperative differential diagnosis of these two diseases.

Even if the benign nature of a mass is stated with a high level of diagnostic confidence or if several reassuring ultrasound features are present, the risk of malignancy exceeds the 0·3% risk of morcellating an unsuspected uterine sarcoma reported by the FDA. Characteristic present Characteristic absent Postmenopausal 9/123 (7%) 4/58 (7%) Increased CA125 (>=35 U/mL) 5/33 (15%) 4/86 (5%) Largest diameter of lesion (>=55 mm)* 8/92 (9%) 5/89 (6%) Lesion volume (>=58·4 mL)* 7/91 (8%) 6/90 (7%) Pain during examination[dagger] 2/29 (7%) 11/152 (7%) Bilateral lesions 2/16 (13%) 11/165(7%) Irregular walls 1/8 (13%) 12/173 (7%) Acoustic shadows 4/105 (4%) 9/76 (12%) Ascites 2/11 (18%) 11/170 (7%) Free fluid in the Pouch of Douglas 5/69 (7%) 8/112 (7%) Colour score 3-4 (moderate to abundant vascularisation) 3/49 (6%) 10/132 (8%) Typical appearance (colour score 1 or 2 plus acoustic shadows plus regular walls) 2/78 (3%) 11/103 (11%) Table 1 Number of malignant cases depending on the presence or absence of certain ultrasound features and clinical characteristics in solid tumours judged to be fibro(theco)mas

The aim of this study was to investigate characteristic CT manifestations of the group of ovarian thecoma–fibroma. 24 patients (26 lesions) presenting with the ovarian thecoma–fibroma were analyzed retrospectively, and the diagnosis were confirmed by pathology after surgery. Our findings included: 22 patients were unilateral, while 2 were bilateral; 12 lesions were located in the right side of ovary, while 14 lesions were in the left side. Of the 26 lesions, there were ovarian thecoma (16 lesions), fibrothecoma (6 lesions), and fibroma (4 lesions). The largest diameters of tumor ranged from 37 to 231 mm with the mean value of 100 ± 44.29 mm. 14 patients were accompanied by ascites. All the tumors had well-defined borders. The shape of  22 lesions appeared round or oval, and 4 lesions were irregular. The tumors were solid in 19 lesions, cystic in 2 lesions, and mixed in 5 lesions. Most of the tumors were of heterogeneous density. There were no (20 lesions) or slight enhancement (6 lesions) after injection of the contrast medium. CT values of plain scan, arterial phase and venous among three groups had no significant difference. The enhancement were in the range of 0–5 HU in 10 lesions, and 6–17 HU in 16 lesions. In conclusion, the characteristic CT manifestations of the group of ovarian thecoma–fibroma were: often unilateral solid mass with the shape of oval and well defined border; no enhancement or slight enhancement; accompanied by small amount of ascites.

Several studies have noted benign thecoma-fibroma tumors with positive F-18 fluorodeoxyglucose (FDG) accumulation mimicking malignant ovarian tumors following F-18 FDG positron emission tomography (PET). The present study analyzed four cases with false-positive F-18 FDG PET/computed tomography (CT) diagnoses of thecoma-fibroma tumors as malignant tumors due to F-18 FDG accumulation, compared with eight cases of FDG-positive ovarian cancers and two cases of FDG-negative fibromas. Hypoxia inducible factor (HIF)-1α expression was examined in the six thecoma-fibroma tumors using reverse transcription-polymerase chain reaction (RT-PCR). The four F-18 FDG-positive cases exhibited higher cellularity, maximum standard uptake and signal intensity on T2-weighted imaging, and gadolinium (Gd) enhancement using magnetic resonance imaging than the two FDG-negative fibroma cases. In the F-18 FDG-positive thecoma-fibroma group, Ki-67 expression was low and LAT1 expression was not identified, ruling out the diagnosis and potential for malignancy. However, considerable glucose transporter 1, HIF-1α, and vascular endothelial growth factor expression was observed. HIF-1α expression was elevated in all four false-positive cases by RT-PCR. From these results, it was hypothesized that hypoxia due to elevated cellularity may stimulate HIF-1α expression and be associated with F-18 FDG accumulation in F-18-positive thecoma-fibroma tumors.

ObjectiveThe aim of this study was to identify the sonographic features of solid ovarian masses and to determine whether they may be managed conservatively.Study designSixty-three patients from September 1999 to September 2008 with solid adnexal masses demonstrating acoustic attenuation, absent Doppler vascularity and minimal or no cystic component were retrospectively reviewed. 20 patients without pathologic results or follow-up studies were excluded. The remaining 43 patients had follow-up imaging studies and/or surgical treatment. The median age of the study group was 52 years (range 16–80 years).ResultsTwenty-nine patients with solid adnexal masses were managed non-surgically. Their age range was 26–80 years (median 56). The size of the masses ranged from 0.7 to 8.3 cm (median 2.2). The follow-up time ranged from 3 to 76 months (median 30). 19 masses (65.5%) showed no change on the follow-up exam. Two masses showed an increase in size (6.9%), and eight masses (27.6%) showed a decrease in size or complete resolution. All these masses had well-circumscribed margins, were homogeneous, with increased attenuation, and had minimal or no vascular flow or cystic component. Normal ovarian tissue was detected in the margins of 24 of the masses (85.7%). These patients exhibited no subsequent evidence of malignancy, such as development of metastases, local invasion, or ascites. 14 patients with solid adnexal masses underwent surgical treatment. Their age range was 16–72 years (median 40). The size of the excised masses ranged from 1.8 to 12.3 cm (median 3.2 cm). Normal ovarian tissue was sonographically demonstrated in ten of these masses (71.4%). All 14 patients (100%) had benign results at pathology. Four patients showed no ovarian neoplasm. Ten patients had benign ovarian neoplasms, including four fibromas, three fibrothecomas, one Brenner tumor, one granulosa cell tumor, and one mature teratoma.ConclusionWe present a retrospective study of both surgical and nonsurgical management of solid ovarian masses. None of the sonographically diagnosed benign-appearing solid adnexal masses were subsequently proved to be malignant either at pathology or by clinical course, suggesting that ultrasound can accurately predict benignity in these masses and that conservative management is an option in these patients.

Background To investigate the value of diffusion-weighted imaging (DWI) at 3.0 T (3T), and especially the apparent diffusion coefficient (ADC), in discriminating ovarian thecoma from other adnexal solid masses. Methods Eighteen thecomas or fibrothecomas, 14 ligamentous leiomyomas, and 24 other ovarian solid tumors underwent prospective DWI magnetic resonance imaging (MRI) in addition to routine MRI on a 3T MRI machine. The baseline characteristics, components, and conventional MRI and DWI-MRI signals for the thecomas were recorded. The ADC values (ADCs) were measured for each group and compared. Results The thecomas often appeared as homogeneous isointensity (17/18) on T1-weighted images (T 1 WI; 11/18) or T 2 WI (11/18) on DWI-MRI, with minor (9/18) or mild (6/18) enhancement. The mean ADC value for thecoma (1.20 ± 0.45 × 10 −3 mm 2 /s) was almost equal to that of the other solid ovarian masses (1.26 ± 0.51 × 10 −3 mm 2 /s), but lower than that for leiomyoma (1.48 ± 0.42 × 10 −3 mm 2 /s), although not significantly so. There was a significant difference ( p  = 0.043) in the ADCs of the benign ovarian solid masses (1.16 ± 0.47 × 10 −3 mm 2 /s) and leiomyomas (1.48 ± 0.42 × 10 −3 mm 2 /s). Conclusions There is no significant difference in ADC between thecoma and other adnexal solid masses, but the ADCs of thecomas are lower than those of leiomyomas.