A case report of ovarian pseudotumor: a very rare histopathological finding

Authors: Batool Samara 1, Suha Shriam 1, Aseel Al-Balas 1, Reham Isied 1, Ismaiel Abu  Mahfouz 2 , Suha Ali 1

                                                1- The Specialty Hospital  2- Al-Balqa Applied University

Introduction

•        Inflammatory pseudotumor (IPT) is a term used to describe a benign, rare chronic inflammatory process that most frequently affects the lungs and orbits but can occur in almost any place in the body such as the pelvis

•        The origin of IPT is not known, however, various mechanisms have been suggested including immune-autoimmune, trauma and surgical inflammation. Inflammatory pseudotumors may develop as a result of an infection. And have been linked to different pathogen in different body sites. Furthermore, It may resemble low-grade fibrosarcoma with Inflammatory cells.

•        The diagnosis of IPT is difficult, usually by exclusion, and usually made on histopathological investigation

•        For the majority of IPT, complete surgical resection is the preferred treatment.

The case

•        A 39-year-old healthy, virgin woman who had no previous surgical operations presented to the gynaecology outpatient clinic for routine check. During the course of the consultation, she described mild lower abdominal pain, therefore a trans-abdominal scan showed a right ovarian complex mass measuring 6X6.5 cm. Thereafter, a pelvic magnetic resonance imaging was requested and confirmed the findings, in addition to the presence of small amount of free fluid in the pelvis. The following markers were requested; B-HCG, CEA, LDH, CA-125, and the results were normal.

•        In light of the complex nature of the cyst, and after counselling,  a low transverse laparotomy followed by aspiration of the peritoneal fluid, right ovarian cystectomy, left ovarian and omental biopsies.

•        Histopathology result of the right ovarian cyst was described as an inflammatory pseudotumor (IPT). Additionally, the results of the peritoneal fluid cytology, left ovarian and omental biopsies were normal. The woman had a smooth postoperative course.

Discussion

•        Inflammatory pseudotumor (IPT) is a benign rare chronic inflammatory process that is destructive to normal tissues of the involved organs, and rarely diagnosed in the reproductive system.

•        While the  disease might be asymptomatic, it may present with symptoms related to mass effect or with non-specific symptoms and  signs of inflammation

•        There are no specific characteristic features on imaging study.

•        The diagnosis of IPT is based on histopathological findings of chronic inflammatory cell infiltrate. In our case, the histopathology showed infiltrative mononuclear chronic inflammatory cells with histiocytes and multinucleated giant cells, necrosis, myxoid degeneration, fibrinoid material, and hyalinized fibrosis.

Conclusion

Inflammatory pseudotumor can arise from the ovary, with no pathognomonic features on imaging studies  and need surgery for both diagnosis and management .