Ovarian fibroma torsion mimicking solid malignant tumors of the ovary: A case report and mini‑review of the literature

The present study describes a rare case of torsion of an ovarian fibroma in a woman of reproductive age, where a severe diagnostic dilemma arose in differentiating it from a solid ovarian cancer. A 48-year-old female patient presented to the hospital with a 1-week history of low-grade fever and mild, continuous abdominal pain, accompanied by nausea and a mild sensation of abdominal bloating. The pain, which was not associated with signs of peritoneal irritation, was more pronounced in the right iliac fossa. The levels of inflammatory and tumor markers were found to be slightly elevated. A computed tomography scan and magnetic resonance imaging of the right adnexal region revealed a large heterogeneous mass with cystic-necrotic areas inside, free fluid collection in the pelvis, and multiple slightly enlarged para-aortic and iliac lymph nodes. These imaging findings, combined with the lack of clinical and laboratory improvement following treatment with antibiotics, led to the decision to proceed with a laparotomy, without having ruled out the diagnosis of solid ovarian cancer. Intraoperatively, the torsion of an ovarian fibroma was identified. A total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. An immunohistochemical examination confirmed the diagnosis of ovarian fibroma. Following an uneventful post-operative course, the patient was discharged from the clinic on the 4th day post-operatively. The present case report highlights an unusual clinical manifestation of ovarian fibroma torsion, which entailed milder symptom intensity and characteristics resembling ovarian malignancy instead. The aim of the present study was to report this uncommon manifestation, explore its differential diagnosis from malignancy and provide a brief review of the current diagnostic and treatment algorithms for clinicians faced with similar cases in their practice. In this manner, it is hoped that the present study may contribute to the improvement of the diagnostic accuracy and treatment efficacy for similar cases.