Ovarian Fibromatosis in Puberty: A Long-Term Battle

Abstract

Ovarian fibromatosis (OF) is a rare, benign condition that often mimics malignancy, leading to unnecessary oophorectomies. We report the case of a 12-year-old girl presenting with acute right lower abdominal pain and vomiting, with a history of intermittent abdominal pain since age seven. Imaging revealed an enlarged, avascular right adnexa with a solid lesion. Despite normal adrenal imaging, her hyperandrogenism raised concerns for an underlying endocrine pathology. Multidisciplinary team discussions led to surgical exploration, revealing ovarian torsion with an abnormal ovary, necessitating oophorectomy. Histopathology confirmed OF. Postoperatively, her androgen levels normalized; however, prolonged androgen exposure resulted in persistent hyperandrogenic features. This case highlights the diagnostic challenge of OF, emphasizing its link to massive ovarian oedema and disrupted steroidogenesis. Recognizing OF preoperatively is critical to prevent overtreatment. A conservative approach with ovarian biopsy should be considered to avoid unnecessary oophorectomy in young patients.

Keywords: hormones in gynecology; ovary; pediatrics; puberty; puberty onset; torsion.

Figure 1. Transabdominal ultrasound scan showing adnexal mass

Figure 2. Pelvic MRI showing adnexal mass in sagittal section

Figure 3. Pelvic MRI showing adnexal mass in axial (transverse) section

Figure 4. Intraoperative findings showing enlarged and abnormal ovary