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HOST: Estrogen production and the presence of low vaginal PH Abnormal activity of Hh signaling pathway (Hh)

Female G3P2012 77 y.o. HFD of HPN on maternal side

Triggering of SMO mutation/ oncogene

AGENT: Idiopathic/unknown Malfunctioning of the FOX L2 gene (Fork head box protein) ENVIRONMENT:

Loss of function of Patched/ Protein patched homolog/ tumor suppressor

Decrease protooncogene/ tumor suppressor function

Abnormal cell growth within the ovarian tissue

Triggering of adult stem cells (tumorigenic)

Increasing age

Accumulation of byproducts of bodys metabolism

Stress and stimulation within the pelvic cavity stimulates the fibroma

Proliferation of abnormal fibrous cell tissues in the ovaries

Slowing and decrease efficiency of DNA repair system

Increase production and stores of free radicals

Defective DNA repair system

Activation of the bodys DNA repair system

Ineffective inhibition of CA predisposing mutagens

Mutagen insensitivity to damage removal and reversal repair system

Permanent cell mutation


Recognition of immune system towards mutated cells Immunoditing Increase in WBC

Inflammation process

Natural killer cells, killer T cells, dendritic cells and macrophages move towards the tumor site Production of Chemokines CXCL10, CXCL9 and CXCL 11

Synthesization of IFN gamma by NKC and NKTC

Recruitment of more immune cells

Inhibit formation of new blood vessels Induces growth of death Increase tumor cell ovarian fibroma Increase antibody production

Circulation Ingestion of debris by dendritic cells and move towards draining lymphnodes

Destruction of mutated cells within the circulation

Tumor specific dendritic cells trigger differentiation of Th1 cells Development of CD8 + T cells

CD4 and CD8 + T cells & cytolytic T cells destroy the tumor cells remaining at the site

Surviving tumor cells become resistant to the immune response

Growth of immune system resistant tumor cells continue

Free radical mutagens influence on the tumor acting as a promoter

Increase metabolic demand of ovarian fibroma


Vaginal spotting

Compression of nearby tissues and organs

Thickening/ proliferation of the inner uterine lining

Abdominal discomfort

Irritation of peritoneal surface

Increase vascularization of the uterine lining


Stimulation of production peritoneal fluid

Shedding the of the endometrium

Exploratory laparotomy; total abdominal hysterectomy with bilateral salpingo-oophorectomy

Vaginal bleeding/ post menstrual bleeding