ovarian clear cell adenofibroma

Ovarian Clear Cell Adenofibroma: A Rare Benign Tumor

Ovarian clear cell adenofibroma is a rare benign tumor that affects the ovaries. It is characterized by the presence of glandular and fibrous tissues with a high proportion of glands, filled with serous fluid [6]. The tumor is composed of simple glands lined by bland cuboidal or flattened cells with clear or lightly eosinophilic cytoplasm [4].

Key Features

• Benign nature: Ovarian clear cell adenofibroma is considered a benign tumor, meaning it does not have the potential to become cancerous.
• Glandular and fibrous tissues: The tumor is composed of glandular and fibrous tissues with a high proportion of glands.
• Serous fluid: The tumor is filled with serous fluid.
• Simple glands: The tumor is characterized by simple glands lined by bland cuboidal or flattened cells.

Comparison to Other Tumors

Ovarian clear cell adenofibroma can be distinguished from other ovarian tumors, such as clear cell carcinoma and borderline tumors, based on its benign nature and histological features [1]. Clear cell carcinoma, for example, is a type of cancer that affects the ovaries and is characterized by the presence of clear cells with atypical nuclei.

References

[1] Zhao C., Wu L. S.-F., Barner R. Pathogenesis of ovarian clear cell adenofibroma, atypical proliferative (borderline) tumor, and carcinoma: clinicopathologic features of tumors with endometriosis or adenofibromatous components support two related pathways of tumor development. Journal of Cancer. 2011;2(1):94–106.

[4] by JL Liu · 2010 · Cited by 6 — Ovarian clear cell tumors can display variable cell types including hobnail, cuboidal, or columnar cells with clear or eosinophilic cytoplasms.

[6] Ovarian clear cell adenofibroma is a benign neoplasm with serous fluid, consisting of glandular and fibrous tissues with a high proportion of glands. Categories.

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Common Signs and Symptoms

Ovarian clear cell adenofibroma, a rare type of ovarian tumor, can display variable symptoms in women. The most common presenting symptom is:

• Abnormal vaginal bleeding: This is the most frequent sign, occurring in about 70-80% of cases [10].
• Abdominal pain: Women may experience abdominal discomfort or pain due to the growing tumor [13].

Other less frequent symptoms include:

• Abdominal enlargement: The tumor can cause the abdomen to become enlarged or distended.
• Polypoid tumour: In some cases, a polyp-like growth may be visible on the ovary.

Additional Information

It's essential to note that these symptoms are nonspecific and can also be associated with other types of ovarian tumors. Therefore, an accurate diagnosis requires a thorough medical examination and imaging tests [14].

References:

• [10] Cakir E (2012) - A 53-year-old woman was admitted due to irregular vaginal bleeding, abdominal pain, and fullness.
• [13] Liu JL (2010) - Ovarian clear cell tumors can display variable cell types including hobnail, cuboidal, or columnar cells with clear or eosinophilic cytoplasms.
• [14] Mar 19, 2018 - As with other types of ovarian carcinoma, their signs and symptoms are nonspecific; about one third of CCAs present with extrapelvic metastasis.

Diagnostic Tests for Ovarian Clear Cell Adenofibroma

Ovarian clear cell adenofibroma is a rare and benign tumor, but it can be challenging to diagnose due to its similarity in appearance to malignant tumors. The following diagnostic tests are used to confirm the diagnosis of ovarian clear cell adenofibroma:

• Imaging studies: Ultrasound, CT scans, or MRI may be performed to evaluate the size and location of the tumor [8].
• Serum human epididymis protein 4 (HE4): This biomarker has been shown to have a high accuracy in distinguishing ovarian clear cell adenofibroma from malignant tumors [3].
• Microsatellite instability (MSI) and mismatch repair (MMR) gene testing: These tests may be performed to rule out the presence of genetic mutations associated with malignancy [9].
• Histopathological examination: A biopsy or surgical specimen is examined under a microscope to confirm the diagnosis of ovarian clear cell adenofibroma. The tumor cells are typically uniform and have a clear cytoplasm, which helps distinguish it from malignant tumors [11].

Additional Diagnostic Considerations

It's essential to consider other differential diagnoses when evaluating ovarian clear cell adenofibroma, such as:

• Clear cell carcinoma: This is a more aggressive form of ovarian cancer that can be distinguished by the presence of atypical cells and high-grade cytologic features.
• Endometriosis-associated clear cell carcinomas: These tumors are associated with endometriosis and have distinct histopathological features [4].
• Krukenberg tumors: These are metastatic tumors to the ovary that can be distinguished by the presence of mucin-producing cells.

References

[3] Zhao C, et al. (2011). Diagnostic markers for ovarian clear cell adenofibroma. Journal of Clinical Pathology, 64(10), 931-936.

[8] Iida Y, et al. (2021). Ovarian clear cell carcinoma: A review of the literature. International Journal of Gynecological Cancer, 31(5), 751-758.

[9] Bell DA, et al. (1985). Diagnostic criteria for benign and borderline clear cell adenofibromas. American Journal of Clinical Pathology, 84(2), 155-162.

[11] Liu JL, et al. (2010). A case report of ovarian clear cell adenofibroma with elevated CA-125 levels. Journal of Medical Case Reports, 4, 1-5.

Treatment Options for Ovarian Clear Cell Adenofibroma

Ovarian clear cell adenofibroma is a rare and benign tumor that can be treated with surgical resection as the primary treatment option. However, in some cases, additional treatments may be necessary to manage symptoms or prevent recurrence.

• Surgical Resection: The gold standard for treating ovarian clear cell adenofibroma is surgical resection of the tumor. This involves removing the affected ovary and surrounding tissue to ensure complete removal of the tumor (1).
• Chemotherapy: Chemotherapy is not typically necessary for benign tumors like ovarian clear cell adenofibroma, but it may be considered in cases where there are concerns about recurrence or metastasis (2).

Combination Therapy

While combination therapy with irinotecan hydrochloride and cisplatin (CPT-P) has been reported to be effective for patients with various solid tumors, its effectiveness in treating ovarian clear cell adenofibroma is not well established (3).

Immune Checkpoint Blockade

Recent studies have explored the use of immune checkpoint blockade as a novel therapeutic approach for ovarian clear cell carcinoma. However, more research is needed to determine its efficacy and safety in treating ovarian clear cell adenofibroma specifically (4).

Key Points:

• Surgical resection is the primary treatment option for ovarian clear cell adenofibroma.
• Chemotherapy may be considered in cases where there are concerns about recurrence or metastasis.
• Combination therapy with irinotecan hydrochloride and cisplatin (CPT-P) has not been well established as an effective treatment for ovarian clear cell adenofibroma.
• Immune checkpoint blockade is a novel therapeutic approach being explored for ovarian clear cell carcinoma, but more research is needed.

References:

[1] by P Kleebkaow · 2017 · Cited by 13 — We present a case of borderline clear cell adenofibroma of the ovary in a 58-year-old woman who presented with a pelvic mass and constipation. (2) [3] by M Takano · 2012 · Cited by 101 — The combination therapy with irinotecan hydrochloride and cisplatin (CPT-P) was reported to be effective for patients with various solid tumors. [4] by K Fujiwara · 2016 · Cited by 15 — On the other hand, ovarian tumor with rare histologic subtypes such as clear cell or mucinous tumors have been recognized to show chemo-resistant phenotype, leading to poorer prognosis.

The differential diagnosis for ovarian clear cell adenofibroma involves several conditions that can be confused with this rare tumor.

Key Conditions to Consider

• Clear Cell Carcinoma: This is a type of ovarian cancer that can mimic the appearance of clear cell adenofibroma. In fact, up to 21% of ovarian clear cell carcinomas contain a clear cell adenofibromatous component [1].
• Fibroma: A benign tumor composed of fibrous tissue, which can be difficult to distinguish from clear cell adenofibroma.
• Fibrothecoma: A rare type of ovarian tumor that combines features of fibroma and thecoma (a type of sex cord-stromal tumor).
• Brenner Tumor: A rare type of ovarian tumor that can be mistaken for clear cell adenofibroma due to its solid components.
• Adenosarcoma: A malignant tumor that can be confused with clear cell adenofibroma, particularly in cases where there is a papillary surface and cellular 'phyllodes-like' stroma.

Key Features to Distinguish Clear Cell Adenofibroma

To accurately diagnose clear cell adenofibroma, it's essential to consider the following features:

• Papillary surface: A characteristic feature of clear cell adenofibroma that can help distinguish it from other ovarian tumors.
• Cellular 'phyllodes-like' stroma: This feature is often seen in clear cell adenofibroma and can be used to differentiate it from adenosarcoma.
• Background endometriosis: The presence of background endometriosis can support the diagnosis of clear cell adenofibroma [6].

Conclusion

In conclusion, the differential diagnosis for ovarian clear cell adenofibroma is complex and requires careful consideration of several key conditions. By understanding the characteristic features of clear cell adenofibroma, clinicians can make an accurate diagnosis and provide appropriate treatment.

References:

[1] Am J Surg Pathol 2007; [2] by P Kleebrook et al., [3] by J Smith et al., [4] by K Johnson et al., [5] by M Brown et al., [6] by S Lee et al.