Abstract
BACKGROUND: Ovarian thecoma-fibroma group (OTFG) is an unusual type of ovarian cancer with three histopathologic subtypes, but their features on ultrasonography are still poorly understood. This study evaluated the features of different histopathological subtypes of OTFG on conventional ultrasonography and contrast-enhanced ultrasonography (CEUS). METHODS: This retrospective study enrolled sixty-nine women with pathologically confirmed OTFG who underwent preoperative CEUS. The characteristics of OTFG on conventional ultrasonography and CEUS, clinical manifestations, and laboratory findings were compared among subtypes. RESULTS: Fourteen patients were diagnosed with fibroma, fifty-one with thecofibroma, and four with thecoma. Although 69% of patients were post-menopausal, thecoma patients were significantly younger than those in other two groups. Laboratory examination revealed 21.7% (15/69) of patients had high carbohydrate antigen 125 (CA-125) level. On conventional ultrasonography, 72.5% (50/69) masses showed solid type, 24.6% (17/69) showed mixed cystic-solid type, and only 2.9% (2/69) showed cystic type. On CEUS, 50% (2/4) of thecoma lesions were rapid enhancement, 58.8% (30/51) of thecofibroma lesions and 78.6% (11/14) of fibroma lesions showed slow enhancement, 75% (3/4) of thecoma lesions showed isoenhancement during the descent process, and only 13.75% (7/51) of thecofibroma lesions and 7.1% (1/14) of fibroma lesions showed isoenhancement during the descent. they varied significantly among different histopathological subtypes. CONCLUSIONS: The majority of OTFG is solid-like on conventional ultrasonography. Menopause is an important factor related to the subtype of OTFG. In postmenopausal patients with solid adnexal masses, slow hypoenhancement on CEUS is an important feature of fibroma. In premenopausal patients with solid or mixed cystic-solid adnexal masses, thecoma may be considered when rapid hyperenhancement, and isoenhancement or hypoenhancement during descent are observed on CEUS. CLINICAL TRIAL NUMBER: Not applicable.