Department of Obstetrics and Gynecology, Kosin University Gospel Hospital, Busan, South Korea.
Department of Obstetrics and Gynecology, Pusan National University School of Medicine, Busan, South Korea; Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, South Korea.
Taiwan J Obstet Gynecol. 2024 Sep;63(5):722-730. doi: 10.1016/j.tjog.2024.04.016.
Mitotically active cellular fibroma (MACF) of the ovary, characterized by relatively high mitotic activity without severe atypia, was first described in the WHO classification in 2014. However, due to its rarity, the clinicopathological characteristics of ovarian MACF have not been established. This study was performed to describe the clinical, radiological, and pathological features of MACF by analyzing 11 cases of ovarian MACF.
Between 2015 and 2022, 11 patients with ovarian MACFs underwent surgical treatment at our institution. Clinicopathologic data of the patients were retrospectively reviewed from their medical records.
Median patient age was 53.7 years (range 21-77 years), and median tumor diameter was 7.8 cm (range 4.3-14.0 cm). Preoperative CA125 was elevated in 4 cases. Four of the eleven patients had abdominal pain, and two presented with vulvar pain or a palpable abdominal mass, respectively. Preoperative radiological impressions included fibroma, fibrothecoma, stromal tumor, and cystadenocarcinoma. A laparoscopic approach was adopted in 7 cases (64%). Intraoperative frozen section was performed in 5 patients, and all demonstrated the presence of a benign, fibromatous stromal tumor. Three patients underwent fertility-sparing surgery, including laparoscopic ovarian cystectomy and unilateral salpingo-oophorectomy. Median follow-up was 37.7 months (range 2-84 months), and no patient experienced disease relapse or died of their disease.
This study shows that ovarian MACF has a benign clinical course. Fertility-sparing surgery provides a safe therapeutic option for MACF, which can be managed safely by laparoscopy. Imaging findings and final pathological diagnosis were not well matched. Intraoperative frozen section is important for determining surgical extent in mitotically active cellular fibroma of the ovary.
有丝分裂活跃性细胞纤维瘤（MACF）的卵巢，其特点是相对较高的有丝分裂活性而无严重异型性，于 2014 年在世界卫生组织分类中首次描述。然而，由于其罕见性，卵巢 MACF 的临床病理特征尚未确定。本研究通过分析 11 例卵巢 MACF，描述其临床、影像学和病理学特征。
2015 年至 2022 年，本机构对 11 例卵巢 MACF 患者行手术治疗。回顾性分析患者病历资料。
患者中位年龄为 53.7 岁（范围 21-77 岁），肿瘤直径中位数为 7.8cm（范围 4.3-14.0cm）。4 例患者术前 CA125 升高。11 例患者中 4 例有腹痛，2 例分别表现为外阴痛或可触及的腹部肿块。术前影像学印象包括纤维瘤、纤维卵泡膜细胞瘤、间质瘤和囊腺癌。7 例（64%）采用腹腔镜方法。5 例患者行术中冰冻切片检查，均显示良性纤维瘤样基质肿瘤。3 例患者行保留生育力手术，包括腹腔镜卵巢囊肿切除术和单侧输卵管卵巢切除术。中位随访时间为 37.7 个月（范围 2-84 个月），无患者疾病复发或死于疾病。
本研究表明卵巢 MACF 具有良性临床过程。保留生育力手术为 MACF 提供了一种安全的治疗选择，可通过腹腔镜安全管理。影像学表现与最终病理诊断不匹配。术中冰冻切片对确定卵巢有丝分裂活跃性细胞纤维瘤的手术范围非常重要。
