Ovarian Fibroma Ossification: A Common Tumor with an Uncommon Feature


  • Apessou Dimitra Department of Obstetrics & Gynecology, Konstantopouleio General Hospital of Nea Ionia, Athens, 14233, Greece
  • Papamargaritis Eythimios Department of Obstetrics & Gynecology, Konstantopouleio General Hospital of Nea Ionia, Athens, 14233, Greece
  • Vasileiadou Dimitra Department of Pathology, Konstantopouleio General Hospital of Nea Ionia, Athens, 14233, Greece
  • Sofoudis Chrisostomos Department of Obstetrics & Gynecology, Konstantopouleio General Hospital of Nea Ionia, Athens, 14233, Greece




Ovarian fibroma, Ossification, Thecoma.


Ovarian thecoma-fibroma groups (OTFG) are uncommon sex cord-stromal neoplasms. Most of them are benign, and often found in postmenopausal patients. Thecomas are less common than granulosa cell tumors, but they have similar appearances. They are solid fibromatous lesions that show varying degrees of yellow or orange coloration. According to current bibliography, cases of ovarian fibromas with further ossification, are extremely rare entities. Objective of our study, consists of presentation of such rare case, properly diagnosed and treated followed by depiction of its pathogenic mechanisms.


Dolan, M.S., C. Hill, and F.A. Valea, Benign Gynecologic Lesions, in Comprehensive Gynecology, R.A. Lobo, et al., Editors. 2016, Elsevier Health Sciences.

Landim, F.M., et al., Vaginal osseous metaplasia. Arch Gynecol Obstet, 2009. 279(3): p. 381-4. https://doi.org/10.1007/s00404-008-0706-4

Miliaras, D., M. Ketikidou, and S. Pervana, Osseous metaplasia in ovarian tumours: a case with serous cystadenoma. J Clin Pathol, 2007. 60(5): p. 582-3.

Misselevich, I. and J.H. Boss, Metaplastic bone in a mucinous cystadenoma of the ovary. Pathol Res Pract, 2000. 196(12): p. 847-8. https://doi.org/10.1016/s0344-0338(00)80086-2

Shipton, E.A. and S.D. Meares, Heterotopic Bone Formation in the Ovary. Aust N Z J Obstet Gynaecol, 1965. 5(2): p. 100-2. https://doi.org/10.1111/j.1479-828x.1965.tb00298.x

Zahn, C.M. and B.S. Kendall, Heterotopic bone in the ovary associated with a mucinous cystadenoma. Mil Med, 2001. 166(10): p. 915-7. https://doi.org/10.1093/milmed/166.10.915

Barua, R. and L.W. Cox, Occurrence of bone in serous cystadenocarcinoma of the ovary. Aust N Z J Obstet Gynaecol, 1982. 22(3): p. 183-6. https://doi.org/10.1111/j.1479-828x.1982.tb01440.x

Bosscher, J., et al., Osseous metaplasia in ovarian papillary serous cystadenocarcinoma. Gynecol Oncol, 1990. 39(2): p. 228-31. https://doi.org/10.1016/0090-8258(90)90439-r

Mukonoweshuro, P. and A. Oriowolo, Stromal osseous metaplasia in a low-grade ovarian adenocarcinoma. Gynecol Oncol, 2005. 99(1): p. 222-4. https://doi.org/10.1016/j.ygyno.2005.05.040

Gabrilovich, S., et al., Ovarian Endometrioma with Osseous Metaplasia: A Case Report and Review of the Literature. Journal of Gynecologic Surgery, 2019. 35(4): p. 246-252. https://doi.org/10.1089/gyn.2019.0007

Mooney, E.E., K.P. Vaidya, and F.A. Tavassoli, Ossifying well-differentiated Sertoli-Leydig cell tumor of the ovary. Ann Diagn Pathol, 2000. 4(1): p. 34-8. https://doi.org/10.1016/s1092-9134(00)90008-x

Godbole, P., A. Outram, and N. Sebire, Osseous metaplasia in a benign ovarian cyst in association with cloacal anomaly. J Clin Pathol, 2005. 58(3): p. 334-5.

Badawy, S.Z., et al., Supernumerary ovary with an endometrioma and osseous metaplasia: a case report. Am J Obstet Gynecol, 1995. 173(5): p. 1623-4. https://doi.org/10.1016/0002-9378(95)90661-4

Rosa e Silva, J.C., et al., Isolated osseous ovarian metaplasia: case report. Eur J Gynaecol Oncol, 2010. 31(4): p. 469-70.

Morizane, M., et al., Ossifying luteinized thecoma of the ovary. Arch Gynecol Obstet, 2003. 267(3): p. 167-9. https://doi.org/10.1007/s00404-001-0282-3

Pervatikar, S.K., R. Rao, and U.S. Dinesh, Ossifying luteinized thecoma of the ovary with endometrial adenocarcinoma. Indian J Pathol Microbiol, 2009. 52(2): p. 222-4. https://doi.org/10.4103/0377-4929.48925

Young, R.H., P.B. Clement, and R.E. Scully, Calcified thecomas in young women. A report of four cases. Int J Gynecol Pathol, 1988. 7(4): p. 343-50. https://doi.org/10.1097/00004347-198812000-00005

Cochrane, J.B., A case of calcified ovarian fibroma in a young adolescent. J Obstet Gynaecol Br Emp, 1950. 57(5): p. 801-2.

Lu, J.C., [Complete calcification of ovarian fibroma: a case report]. Zhonghua Fang She Xue Za Zhi, 1960. 8: p. 59.

Terada, S., et al., Parovarian fibroma with heterotopic bone formation of probable wolffian origin. Gynecol Oncol, 1993. 50(1): p. 115-8. https://doi.org/10.1006/gyno.1993.1174

Chen, C.P., et al., Bilateral calcified ovarian fibromas in a patient with Sotos syndrome. Fertil Steril, 2002. 77(6): p. 1285-7. https://doi.org/10.1016/s0015-0282(02)03118-7

Akbulut, M., et al., A probable secondary infertility due to osseous metaplasia of the endometrium. Arch Gynecol Obstet, 2008. 277(6): p. 563-5. https://doi.org/10.1007/s00404-007-0515-1

Bahçeci, M. and L.C. Demirel, Osseous metaplasia of the endometrium: a rare cause of infertility and its hysteroscopic management. Hum Reprod, 1996. 11(11): p. 2537-9.

Lainas, T., et al., Osseous metaplasia: case report and review. Fertil Steril, 2004. 82(5): p. 1433-5. https://doi.org/10.1016/j.fertnstert.2004.04.055

Manzur, Y.A. and C.S. Varela,

[Bony metaplasia of the endometrium. Report of two cases]. Rev Med Chil, 2010. 138(8): p. 1004-7.

Bhatia, N.N. and M.G. Hoshiko, Uterine osseous metaplasia. Obstet Gynecol, 1982. 60(2): p. 256-9.

Polat, I., et al., Osseous metaplasia of the cervix and endometrium: a case of secondary infertility. Fertil Steril, 2011. 95(7): p. 2434.e1-4. https://doi.org/10.1016/j.fertnstert.2011.02.001

Campo, S., et al., Simultaneous ovarian and endometrial osseous metaplasia: a case report. J Reprod Med, 2007. 52(3): p. 241-2.

Kumar, R., et al., An Unusual Case of Extensive Osseous Metaplasia in Fibroma of Ovary. Int J Surg Pathol, 2018. 26(8): p. 733-734. https://doi.org/10.1177/1066896918766239