Management of Ovarian Cystadenofibroma
Ovarian cystadenofibromas are benign epithelial tumors that should be surgically excised when discovered, particularly because they frequently mimic malignancy on imaging and cannot be reliably distinguished from malignant lesions preoperatively.
Diagnostic Challenges
Cystadenofibromas present a significant diagnostic dilemma because they commonly appear suspicious for malignancy on both ultrasound and CT imaging 1, 2, 3. The fibrous stromal component creates complex-appearing masses with solid components that radiologically resemble malignant ovarian tumors 3. MRI may provide additional characterization, showing low signal intensity on T2-weighted images due to the fibrous component, which can help suggest the benign nature preoperatively 3.
Surgical Management Approach
When Malignancy Cannot Be Excluded
- Surgical excision is indicated when imaging cannot definitively exclude malignancy 4, 1, 2
- The surgical approach should be performed by surgeons with extensive experience in gynecological procedures 4
- Intraoperative frozen section analysis is critical to determine the extent of surgery needed 1, 5
Surgical Technique Considerations
- For premenopausal women and fertility preservation: If frozen section confirms benign pathology, perform conservative surgery with tumor excision or unilateral oophorectomy/adnexectomy only 1, 5
- For postmenopausal women: Standard surgical approach with removal of affected adnexa is appropriate 6
- Laparoscopy may be considered if the lesion appears clearly benign and is of manageable size, though laparotomy is often chosen given the difficulty distinguishing from malignancy preoperatively 1
Critical Pitfalls to Avoid
Avoid extensive staging procedures (lymphadenectomy, omentectomy) unless frozen section confirms malignancy, as these can lead to serious complications including bowel obstruction and perforation in what ultimately proves to be benign disease 2. One case report documented a patient who developed early postoperative small bowel obstruction requiring re-exploration after unnecessary extensive surgery for a benign cystadenofibroma 2.
Special Considerations
- Scattered peritoneal lesions may occur with benign cystadenofibromas, mimicking malignant dissemination 5. Intraoperative frozen section is essential to avoid overtreatment in these cases, particularly in young women where fertility preservation is paramount 5
- Fine-needle aspiration is contraindicated for solid or mixed ovarian masses 6
- These tumors are typically asymptomatic but can cause complications including bowel obstruction when large 1, 2
Postoperative Management
Once histopathology confirms benign cystadenofibroma, no adjuvant therapy or extensive follow-up is required beyond routine gynecological care 1, 5.