Robotic surgery for calcified bilateral ovarian fibroma: a Case Report

Background: Ovarian fibroma is a benign sex cord-stromal tumor that accounts for 1%-4% of all ovarian neoplasms. It commonly affects women over the age of 40 and is rarely bilateral or calcified. Due to overlapping clinical and radiological features, it is frequently misdiagnosed as uterine fibroids or malignant ovarian tumors. This case report presents an unusual occurrence of bilateral, calcified ovarian fibroma in a young female patient undergoing fertility evaluation, which was successfully managed with robotic ovarian-preserving surgery. Case Presentation: A 32-year-old woman with secondary infertility was referred to the gynecology department following the incidental detection of bilateral ovarian cysts during an infertility workup. Initial clinical and laboratory evaluations, including CA-125 and transvaginal ultrasound, were conducted. Imaging revealed bilateral calcified adnexal masses suggestive of ovarian fibroma. A robotic bilateral ovarian cystectomy was planned and performed. Histopathological examination of the excised masses was conducted postoperatively. Results: Intraoperatively, multiple solid fibrous masses were observed involving both ovaries and fallopian tubes. A total of 11 fibromas were successfully removed using robotic assistance while preserving the ovarian tissue. Due to the high degree of calcification, tissue extraction was performed via mini-laparotomy. Histopathological analysis confirmed the diagnosis of bilateral calcified ovarian fibroma with no malignant features. The patient's postoperative recovery was uneventful. Four months after surgery, she underwent an unsuccessful intrauterine insemination and was scheduled for in vitro fertilization but was subsequently lost to follow-up. Conclusion: This case highlights the diagnostic challenges associated with ovarian fibroma, particularly in young women with infertility and asymptomatic presentation. It emphasizes the importance of selecting appropriate imaging modalities and considering fertility-preserving surgical approaches, such as robotic cystectomy, in reproductive-aged patients.