Ovarian fibroma in a 14-month-old girl: A case report

Ovarian fibromas are rare in children, and cellular fibromas with mitotic activity are exceptionally uncommon, with fewer than ten pediatric cases reported. Their preoperative differentiation from malignant tumors is challenging. We report a 14-month-old girl who was hospitalized for malarial fevers in addition to an abdominal mass. She had a prior two-month history of painless abdominal distention with a palpable, non-tender lower abdominal mass. The patient had mild anemia (hemoglobin of 11.2 g/dl). Tumor markers were unavailable. Ultrasound demonstrated an 8 × 5 cm solid pelvic mass. The mass was well circumscribed with a homogeneous echotexture. Laparotomy revealed no evidence of metastatic disease, and the contralateral ovary was normal. A solid tumor of the right ovary without visible normal ovarian stroma was identified. The highly vascular tumor capsule was adherent to the right fallopian tube, which was carefully separated and preserved. The bisected tumor was notable for pale tan homogeneous tissue within the tumor capsule. Histopathology demonstrated a cellular fibroma with focal necrosis and rare mitoses. The patient was tolerating a regular diet and ambulating well within 24 hours postoperatively. Her one-week follow-up visit confirmed no complications. The family was instructed to follow up annually, with plans for serial abdominal ultrasounds and chest radiographs. As benign ovarian tumors such as cellular fibroma can occur in females as young as one year of age, in the absence of a definitive preoperative diagnosis of malignancy surgeons should prioritize fertility preservation over radical salpingo-oophorectomy.