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. 2025 May 20;25(1):175.
doi: 10.1186/s12880-025-01693-2.

Findings on conventional ultrasonography and contrast-enhanced ultrasonography in different histopathological subtypes of ovarian thecoma-fibroma group

Yuemingming Jiang  1 , Yanhua Ding  2 , Minhua Guo  1 , Yue Yu  3 , Hongpeng Duan  1 , Shengmin Zhang  4
Affiliations

Findings on conventional ultrasonography and contrast-enhanced ultrasonography in different histopathological subtypes of ovarian thecoma-fibroma group

Yuemingming Jiang et al. BMC Med Imaging. .

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.

Keywords: Contrast-enhanced ultrasonography; Fibroma; Ovarian thecoma-fibroma group; Thecoma.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Ningbo University First Hospital ([2024]181RS, on September 3, 2024). The study was conducted according to the Declaration of Helsinki, and written informed consent was obtained from each patient. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
A woman with a pathologically proven thecoma. (A) Transvaginal gray-scale ultrasonography showed a 4.5 cm solid mass (+, measurement cursors). (B) Contrast-enhanced ultrasonography showed the mass (M) at the right of uterus (UT). CEUS showed hyperenhancement at the peak intensity. (C) Pathology (hematoxylin eosin, ×20). CEUS, contrast-enhanced ultrasonography
Fig. 2
Fig. 2
A woman with a pathologically proven thecofibroma. (A) Transvaginal gray-scale ultrasonography showed a 5.3 cm solid mass, and color Doppler ultrasonography revealed the color flow within the mass. (B) Contrast-enhanced ultrasound showed the mass (M) at the right of uterus (UT). CEUS showed hypoenhancement during descent. (C) Pathology (hematoxylin eosin, ×20). CEUS, contrast-enhanced ultrasonography
Fig. 3
Fig. 3
A woman with a pathologically proven fibroma. (A) Transabdomal gray-scale ultrasonography showed a 6 cm solid mass (M), at the right of uterus (UT) with posterior echo shadow. (B) CEUS showed sparse hypoenhancement (feature of CEUS). (C) Pathology (hematoxylin eosin, ×20). CEUS, contrast-enhanced ultrasonography
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