The clinical characteristics and surgical management experience of ovarian fibroma/fibrothecoma in premenopausal women

This study aims to analyze the clinical characteristics and discuss appropriate surgical strategy of ovarian fibroma/fibrothecoma in premenopausal women. A review of the patients' medical records was undertaken at Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, from January 2015 to December 2023. Altogether, 286 cases were identified. The mean age was 47.73 years (14-89 years) and premenopausal women accounted for 51.40% (147/286). The proportion of patients appeared similar across all age decades from 21 to 70. Of these patients, 204 (71.33%) underwent surgeries due to the presence of a pelvic mass with a mean diameter of 6.25 cm (1.2-37 cm). The tumor size in premenopausal women (n = 81) was significantly smaller than that in postmenopausal women (n = 123; 4.78 cm vs 7.21 cm). Of these 81 premenopausal patients, 66 (81.48%) women underwent laparoscopy and 15 (18.52%) underwent laparotomy. The tumor size in the laparotomy group was significantly larger than that in the laparoscopy group (7.89 cm vs 4.08 cm). Tumorectomy and unilateral salpingo-oophorectomy served as the main surgical approaches in the laparoscopy and laparotomy group, respectively. Besides, 82 patients were diagnosed incidentally with a mean age of 36.82 years and an average diameter of 0.76 cm (0.2-2.3 cm), among which 66 (80.49%) were premenopausal and 85.37% lesions were on the ovarian surface. All premenopausal patients were alive with no recurrence after surgery. Ovarian fibroma/fibrothecoma may occur at an earlier age than conventionally estimated. Laparoscopic tumorectomy remains the preferred surgery for patients at reproductive age. A thorough and meticulous intraoperative examination is essential to identify and remove the early-stage lesion on the ovarian surface.