FIBROTECOMA AND STROMAL THECOMATOSIS OF THE OVARIES IN CLINICAL PRACTICE

The purpose of this study is to study fibrothecoma and stromal ovarian tecomatosis in clinical practice.We investigated the management of patient B., 50 years old, who was hospitalized for surgical treatment in the gynecology department of the V.D.Seredavin State Medical University with a directional diagnosis: "Cyst of the left ovary. Non-insulin-dependent diabetes mellitus without complications. Hypertension 2 st. Risk 3".Ovarian fibrothecomas are rare benign tumors that occur in menopausal women. The main symptoms may be pelvic pain and abnormal uterine bleeding caused by hyperestrogenism. Fibrothecomas are accompanied by a clinic of hyperestrogenism due to the following mechanisms. The source of fibrothecoma is ovarian theca cells that produce androgens, mainly testosterone and androstenedione, which subsequently turn into estrogens in the granulosa layer of the ovaries under the influence of aromatases. Due to hyperestrogenism, hyperplastic processes in the endometrium and abnormal uterine bleeding may occur. In this clinical case, the patient was diagnosed with fibrothecoma of the left ovary. In the right ovary, stromal tecomatosis was diagnosed, which is a pathology of the ovarian stroma in the form of its proliferation. This pathology also occurs during peri and postmenopause and is characterized by increased androgen synthesis and increased peripheral estrogen production. It is manifested clinically by virilic symptoms such as oligo and amenorrhea, infertility, hirsutism, changes in voice tone, metabolic syndrome with its inherent manifestations such as hypertension, obesity, diabetes mellitus. In this clinical case, there was a very rare combination of two variants of benign hormonally active non-epithelial ovarian formations (fibrothecomas with predominantly estrogenic activity and stromal tecomatosis, which more often has moderate androgenic activity. Therefore, this patient had slightly pronounced clinical manifestations of pathologies, expressed in the absence of menstrual disorders and reproductive history, non-insulin-dependent diabetes mellitus without complications, well-controlled hypertension. The lack of clear clinical manifestations of the pathology did not allow a preliminary diagnosis to be made at the diagnostic preinvasive stage, but the correct histological diagnosis of the pathology, including cyto– biopsy, allowed choosing the right amount of surgery and patient management tactics.