Dr. Julia Akhter NiraCMH and Army Medical College, Bangladesh
Title: Fibrosarcoma of ovary - A case report
Fibrosarcoma of ovary, a tumour arising do novo or secondary to malignant transformation of benign fibromatous tumours, is an extremely rare malignant sex cord stromal tumour of ovary. As on today, the total number of reported cases throughout the world is not more than hundred, There is no clearcut diagnostic criteria, prognostic factor and treatment modalities. Usually it presents as unilateral solid tumour. It can occur at any age though postmenopausal diagnosis is more frequent. Majority of the patients present with vague abdominal pain and a lump in lower abdomen arising from ovary. Ultrasonographic findings usually reveals unilateral solid homogenous tumour in ovary with uneven echo enhancement and increased vascularity. Serum tumor markers and sex hormones such as CA-125 usually found within normal levels. Peroperative frozen section study often concludes into wrong diagnosis, postoperative histopathological diagnosis usually reveals spindle cells with high mitotic activity with background of fibrous tissue. Depending on mitotic activity, cellular atypia associated with haemorhage and necrosis, it is differentiated from benign fibroma with mitotic activity. Immunohistochemistry findings may be positive for vimentin, ?-inhibin, SMA, estrogen receptor, progesterone receptor. Ki-67 positive rate is associated with degree of severity of malignancy i.e, grading and prognosis. This studied case was having the above features and was confirmed postoperatively by histological and later by histochemistry with positive Vimentin and Ki-67. As there were not enough cases to conclude a final treatment protocol, so far treated cases revealed total cytoreductive surgery followed by postoperative chemotherapy has the better prognosis. A round, solid unilateral heterogenous ovarian tumor should be taken in differential diagnosis of ovarian fibrosarcoma. As this is an extremely rare tumour of the ovary, there is usually no rise of specific tumuor marker, no conclusive diagnostive criteria available at present, clinical studies involving multicentered approach associated with studies at molecular level is a prime requirement for the gynaecologist to diagnose and treat in a better way in future.
Dr. Julia Akhter Nira is a Specialist in infertility & reproductive medicine and has over 17 years of experience in the field of Gynae and Obs. She obtained her MBBS from Dhaka Medical College in 1999, followed by a diploma in Gynae & Obs from Dhaka University in 2006. She then went on to receive her MCPS & FCPS (Obs & amp; Gynae) from Bangladesh College of Physicians and Surgeons in 2006 & 2009 respectively. In 2017, Dr. Nira completed her FCPS in Reproductive endocrinology & infertility from Bangladesh College of Physicians and Surgeons and is the first fellow in reproductive endocrinology and infertility in Bangladesh. She has passed all her exams in the first chance. She is serving in Bangladesh Armed Forces for last 22 years and has held various positions in the field of Gynae and Obs, including Specialist in Gynae & Obs at Combined Military Hospital(CMH) in Dhaka, Bangladesh from 2011-2013 & 2017-2019 and at CMH in Sylhet, Bangladesh from 2009-2010. She also served as a Specialist in Gynae & Obs at Bangladesh Navy Hospital in Chittagong, Bangladesh from 2006-2008. Dr. Nira has completed her internship from Dhaka Medical College Hospital and residency in Gynae & Obs from Combined Military Hospital in Dhaka, Bangladesh. She also completed her residency in Infertility and Reproductive medicine from Bangabandhu Shaikh Mujib Medical University in Dhaka, Bangladesh. Dr. Nira is a member of Obs & Gynae Society of Bangladesh, Menopausal Society of Bangladesh, Infertility Society of Bangladesh and Society of Laparoscopic Surgeons of Bangladesh and recent past member of ASRM and SART since 2018. She is the author of 4 original articles and co-author of 3 more. She is the founder member of Fertility center, CMH Dhaka and now serving as Associate Professor & Head of the Department in Reproductive Endocrinology and Infertility and Obs & Gynae of CMH CUMILLA and Armed Forces Medical College Cumilla.