PMC8382553_01
Physical and imaging test findings before operation. (a) Her abdomen was markedly distended, making it difficult for her stand by herself. (b, c, d) Findings of enhanced-computed tomography. (b) Majority of the mass was homogenous with a density of subcutaneous fat and no obvious hypervascular lesions. (c) The right gonadal artery and vein flow into the tumor. (d) The pleural effusion was detected in right thoracic predominance.
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Her vital signs were stable; however, her abdomen was markedly distended from the cardiac fossa to the lower abdomen, making it difficult for her to stand by herself (Figure 1(a)). Contrast-enhanced computed tomography showed that the tumor occupied the whole abdominal cavity (38 cm x 40 cm x 48 cm), and both kidneys were being pressed significantly dorsally (Figure 1(b)). There were no hypervascular lesions, and the right ovarian artery and vein flowed into the tumor (Figure 1(c)). No obvious venous thrombosis was detected; however, pleural effusion was detected in the right thoracic region (Figure 1(d)).
Intraoperative findings in the laparotomy. (a) The surgery was performed in the left lateral recumbency position. (b) Most of the tumor was removed from the body without any adhesions between the tumor and the abdominal wall. (c) The right ovarian artery was found to be flowing into the tumor.
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During the laparotomy, the patient was placed in the left lateral decubitus position to maintain hemodynamic stability and because the tumor was assumed to be of right ovarian origin (Figure 2(a)). With the help of general surgeons, we confirmed that there were no adhesions between the tumor and the abdominal wall, and the surface of the tumor was smooth (Figure 2(b)). We confirmed that the right ovarian artery and vein truly flowed into the tumor (Figure 2(c)).
Postoperative findings and pathological findings. (a) Chest X-ray on the fourth postoperative day showed marked decrease of pleural effusion. (b) Macroscopic finding of the tumor. It was nearly white, and there were no obvious necrotic lesions. (c, d) Microscopic findings. The tumor was composed of thin spindle cells in a whorled arrangement, and nuclear atypia and mitosis were not observed. (c) x40 magnification: black bar is 1 mm. (d) x100 magnification: black bar is 200 mum.
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A chest radiograph on the fourth postoperative day showed a marked decrease in the right pleural effusion (Figure 3(a)). A pathological examination showed that the tumor was macroscopically nearly white, but there were no obvious necrotic lesions (Figure 3(b)). Microscopically, the tumor was composed of thin spindle cells in a whorled arrangement, but nuclear atypia and mitosis were not observed, and the fibroma diagnosis was confirmed (Figures 3(c) and 3(d)).