A rare case of fibro-thecoma mimicking ovarian malignancy: Diagnostic challenges and surgical management

A 78-year-old woman presented with chronic pelvic pain, abdominal distension, and a mobile mass suggestive of ovarian malignancy. Imaging studies, including MRI, revealed a malignant-appearing ovarian mass with abundant ascites, and serum CA125 levels were significantly elevated. During surgery, a total hysterectomy with bilateral anexectomy was performed due to the tumor’s malignant features. Postoperative histopathology identified the mass as a fibro-thecoma, a rare benign ovarian tumor often misdiagnosed as malignant. The surgical intervention was curative, and no adjuvant therapy was required. This case underscores the diagnostic challenges associated with fibro-thecoma, emphasizing the importance of preoperative evaluation, intraoperative assessment, and the role of radical surgery in achieving optimal outcomes. It also highlights the need for distinguishing Demons-Meigs syndrome from advanced ovarian malignancies. • Case Overview: A 78-year-old woman presented with chronic pelvic pain, abdominal distension, and a mobile mass suggestive of ovarian malignancy. Imaging studies revealed a malignant-appearing ovarian mass with ascites and elevated serum CA125 levels. • Diagnostic Challenges: The patient’s symptoms, imaging findings, and elevated CA125 levels led to a preliminary diagnosis of ovarian malignancy. The case highlights the difficulty in distinguishing fibro-thecomas from malignant tumors, especially in elderly women. • Demons-Meigs Syndrome: The fibro-thecoma was associated with ascites and pleural effusion, known as Demons-Meigs syndrome. This rare condition can mimic advanced ovarian cancer but resolves following tumor resection. • Postoperative Outcome: The surgery was curative, and no adjuvant therapy was needed. The ascites and pleural effusion resolved after tumor resection, further confirming the benign nature of the tumor. • Conclusion: Radical surgery remains the treatment of choice for fibro-thecomas when malignancy cannot be ruled out. Awareness of Demons-Meigs syndrome is essential to avoid overtreatment and ensure appropriate management of rare ovarian conditions.