A rare case of fibro-thecoma mimicking ovarian malignancy: Diagnostic challenges and surgical management

A 78-year-old woman presented with chronic pelvic pain, abdominal distension, and a mobile mass suggestive of ovarian malignancy. Imaging studies, including MRI, revealed a malignant-appearing ovarian mass with abundant ascites, and serum CA125 levels were significantly elevated. During surgery, a total hysterectomy with bilateral anexectomy was performed due to the tumor’s malignant features. Postoperative histopathology identified the mass as a fibro-thecoma, a rare benign ovarian tumor often misdiagnosed as malignant. The surgical intervention was curative, and no adjuvant therapy was required. This case underscores the diagnostic challenges associated with fibro-thecoma, emphasizing the importance of preoperative evaluation, intraoperative assessment, and the role of radical surgery in achieving optimal outcomes. It also highlights the need for distinguishing Demons-Meigs syndrome from advanced ovarian malignancies.