Serous Cystadenoma and Fibrothecoma: A Rare Combination in Collision Tumor of Ovary with Pseudo-Meigs Syndrome

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Collision tumors are best considered as separate primary neo-plasms. These tumors have been reported in various organs, such as the esophagus, stomach, liver, thyroid gland, ovary, and lung, but they are extremely rare in the ovaries. 1 The majority of these tumors are a collision between carcinomas and sarcomas or lymphomas, and rarely between two types of carcinoma. 2 The most common histological combination of collision tumor in the ovary is the coexistence of teratoma with mucinous tumors (mucinous cystadenoma or carcinoma). 1 Here we report a very unusual combination of fibrothecoma and serous cystade-noma in the left ovary of an elderly woman who presented with an abdominal lump and ascites. A 63-year-old, parous, menopausal woman was admitted with complaints of abdominal distention for 3 months and difficulty in passing urine for 1 month. Physical examination revealed an abdominal lump and ultrasonography revealed a large cystic mass. A computed tomography (CT) scan revealed a large cystic lesion (22.7×15×20 cm) occupying the pelvis and abdomen , with a well delineated solid area (9×5 cm) within it. Minimal ascites were noted (Fig. 1A, B). No other significant findings , including pleural or pericardial effusion, were noted. Malignant neoplasm of the ovary was suspected. Cytology of ascitic fluid showed a few reactive mesothelial cells. Malignant cells were not seen. Carcinoma antigen 125 (CA-125) levels were mildly elevated (0.42 IU/mL). A specimen from radical hysterectomy, including a left ovarian cystic mass, was received for histopathological examination. On cutting, the left ovarian cyst leaked blood-tinged, serous fluid. The cut surface showed a large, uniloculated, thin walled cyst (20×18 cm) with a smooth surface and congested vessels. At one end of the cyst, we observed a well-demarcated, solid, homogeneous, yellow-white mass (8×6 cm) (Fig. 1C, arrows). A few areas of cystic changes were seen. Compressed ovarian tissue at the periphery and fallopian tube could be identified. Histopathological examination of the solid area in the left ovarian mass showed a tumor composed of fascicles of loosely arranged spindle cells with variable cellularity and a variable amount of intervening collagen. The cells had oval to elongate nuclei with a moderate amount of pale to vacuolated cytoplasm (Fig. 2A, B). Nuclear atypia, …