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Microscopic photograph showing sheets of malignant squamous cells with pleomorphism and atypical mitotic figure (H&E stain, ×40)
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Key Clinical Message
Clinicians, pathologists, and radiologists should be aware of rare malignant ovarian tumors arising in mature cystic teratoma (MCT). Suspicion should be raised if the patient is elderly, the tumor is huge, and the tumor has large solid foci. However, malignant transformations in MCTs in younger women have been reported.
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Objective
Mature cystic teratoma is a common benign ovarian tumor. But extragonadal teratomas are very rare. They mainly occur in the midline structure of the body. Uterine teratomas are extremely rare with only few reports. The diagnosis was mainly based on the operative findings. We report a case of uterine mature teratoma in a 37 year-old woman...
Background: Ovarian cancers represent the 6th most common cancer among females and are the most common cause of death from gynaecological cancers in the world. The aim is to do clinicopathologic study of ovarian tumours along with evaluation of the expression of estrogen receptor (ER) and human epidermal growth factor receptor (HER2/neu).Methods: A...
Background
Single-port robot-assisted laparoscopic surgery (S-RALS) is rarely applied in pediatric surgery. There is still no study on the application of S-RALS for resection of pediatric benign ovarian tumors. The current study aimed to investigate the safety and feasibility of S-RALS for resection of pediatric benign ovarian tumors using the da V...
Background
Different diseases affect both mechanical and chemical features of the involved tissue, enhancing the symptoms.
Methods
In this study, using atomic force microscopy, we mechanically characterized human ovarian tissues with four distinct pathological conditions: mucinous, serous, and mature teratoma tumors, and non-tumorous endometriosis...
Teratoma is a tumor consisting of several types of tissues derived from one, two or three germ leaves, the presence of which is not peculiar to those organs and anatomical areas of the body in which the tumor develops. According to the WHO classification definition, immature teratomas are those containing embryonic tissues along with definitive, ma...
Citations
... The majority of individuals diagnosed with mature teratomas typically do not exhibit any symptoms, but they may experience pain and a sensation of abdominal occupancy as a result of the mass effect (2) . he preoperative identification of malignancy poses significant challenges due to the generic nature of symptoms and indications, as well as the limited predictive capabilities of tumour markers and imaging modalities (3) . With regards to clinical manifestations, it is common for tumours in their early stages to be incidentally found during a physical examination or through postoperative pathology analysis. ...
Introduction: Mature cystic teratomas are part of a subclass of ovarian germ-cell tumour believed to arise from the primordial germ cells. Ovarian germ-cell tumours account for around 20–25% of ovarian neoplasms and 5% of ovarian cancers. A secondary malignant transformation of the various tissue components of mature cystic teratoma can occur, typically in postmenopausal women. More than 80% of malignant transformations are squamous-cell carcinomas arising from the ectoderm; the rest are carcinoid tumours or adenocarcinomas. Methods and Methodology, Case Report: A 40-year-old postmenopausal patient came with lower abdominal pain past 2 months. The patient was submitted to a gynecological examination and to transvaginal ultrasound, which confirmed the presence of right adnexal mass measuring 11×8x 2 cm; the mass proved to have cystic features in association with intracystic fat, raising the suspicion of an ovarian teratoma. In addition, areas of acoustic shadowing were discovered, raising the suspicion of a Rokitansky nodule exhibiting solid components such as hair and teeth. Pelvic CT scan demonstrated right adnexal dermoid cyst causing mild hydroureteronephrosis. A total hysterectomy with bilateral adnexectomy was performed, and the specimen was submitted for histopathological examination. Histopathological examination revealed Mature Cystic Teratoma with Squamous Cell Carcinoma. Discussion: Ovarian teratoma develops from germ cells and might present different cellular types originating from one or more of the germ layers, represented by endoderm, ectoderm and mesoderm. Of this malignant transformation is about 1- 2 %. Malignant transformation of ovarian teratoma can arise from any type of germ cell that is present at the level of these tumors; therefore, adenocarcinomas, squamous cell carcinomas, sarcomas, melanomas, adenosquamous carcinomas or even carcinoid tumors might occur. Of this squamous cell carcinoma is common. Conclusion: Although ovarian teratomas are frequently encountered, a small proportion of them will develop further complications, such as infection or malignancy. In cases in which malignant transformation occurs, squamous cell carcinoma is the most commonly encountered type of malignancy. Novelty: Malignant transformation of mature cystic ovarian teratoma is a scarce eventuality, only rare cases being reported so far. Furthermore, the development of this transformation in the setting of an abscessed tumor is even scarcer
... Unilateral oophorectomy is performed in a nulliparous or young woman where fertility is an issue with stage IA disease. In postmenopausal women, the treatment of choice would be a total abdominal hysterectomy with bilateral oophorectomy [10]. No consensus or standard guidelines are available regarding the optimum outcome of post-operative adjuvant management of SCC arising from MCT because of a relatively little known entity and limited studies. ...
Malignant transformation of mature cystic teratoma (MCT) is a well-known but uncommon phenomenon seen mostly in postmenopause women. We report a case of a 65-year-old postmenopausal woman with a malignant transformation of MCT and with a low-grade squamous intraepithelial lesion in her cervix. She was treated surgically by total abdominal hysterectomy with bilateral salpingo-oophorectomy with a preoperative diagnosis of right ovarian teratoma. Her postoperative period was uneventful. On follow-up, the histopathology report revealed a right ovarian dermoid cyst with well-differentiated squamous cell carcinoma; there was no evidence of malignancy elsewhere, including the cervix. Ascitic fluid was also free of malignant cells, and the disease was at stage Ia. The patient did not receive any adjuvant chemotherapy and was followed up with clinical examination postoperatively for 1 year, and there was no evidence of any relapse clinically. Preoperative diagnosis of malignant transformation of squamous cell carcinoma (SCC) is difficult, as there is no specific screening marker and no consensus or standard guidelines available regarding the optimum management of this relatively poorly known entity. Here we emphasize the need for a high index of suspicion of malignant transformation with the presence of factors such as elderly age, the huge size of the tumor, and large solid components in the tumor. Considering the scarcity of case reports and studies about SCC arising from MCT, every experience with malignant transformation of MCT should be reported for a better understanding of the disease presentation and management.
... Secondary transformation of an MCT occurs when the ectodermal germ layer of a cystic teratoma undergoes metaplasia. 80 % of ovarian SCC's are from these transformations (Maharjan, 2019;Hackethal et al., 2008). Another common transformation occurs within an endometrioma, which is the posited mechanism in this patient. ...
... Most patients who received specified chemotherapy were treated with platinum-based regimens. Those with stage IA disease, such as our patient, were dead of disease at 6 months (without any adjuvant chemotherapy) (McCullough et al., 1946), and alive without disease progression at 6 months (Maharjan, 2019). ...
•This 71 year old patient was diagnosed with mixed squamous and clear cell ovarian adenocarcinoma.•Patient was surgically staged with guidance from frozen section.•Patient received adjuvant treatment with carboplatin and paclitaxel for 6 cycles.
... 9 Tumour size may range from 10-40 cm. 3,10,11 Management of SCC of the ovary is similar to that of other epithelial carcinoma. Hysterectomy, bilateral salpingooophorectomy, comprehensive surgical staging with peritoneal washing cytology, omentectomy, peritoneal biopsy and pelvic plus para-aortic lymphadenectomy, form the cornerstone of surgical management. ...
Squamous cell carcinoma of the ovary arising in a mature cystic teratoma in a 28-year-old female: a case report and review of literature,
... 1 Malignant transformation of MCTO was noted in only 1.4%. 2 Squamous cell carcinoma (SCC) constitutes 0.3% of malignant transformation 3 which accounts for 80% of malignant transformation in MCTO. 4 SCC arising in MCTO is commonly observed in postmenopausal women. 5 The other histological types include adenocarcinoma, small cell carcinoma, sarcoma, malignant melanoma and mixed type. 6 The clinical presentation of SCC transformation in MCTO is not specific. ...
... Some cases are diagnosed during cesarean section and laparotomy for ectopic pregnancy. 2,3,5,17,18 There is no specific symptoms and signs for early-stage malignant transformation. Advanced stages might have constitutional symptoms like weight loss, loss of appetite, early satiety and cachexia. ...
Malignant transformation in a mature cystic teratoma of the ovary is a rare complication. Herein, we report a case of a 62-year-old woman who was diagnosed with squamous cell carcinoma in a mature cystic teratoma of the ovary in the histopathology examination. This case report highlights the importance of suspecting malignant transformation in an elderly woman with a large mature cystic teratoma of the ovary with a thickened wall so that proper surgical and adjuvant treatments are planned.
... Over 80% of these tumors, which accounts for 20 to 25% of all the ovarian tumors, occur mainly during the reproductive years and may occur in 10 to 2,3 20% of women during their lifetime . Malignant transformation in these tumors is rare, squamous cell carcinoma (SCC) is the frequent malignancy arising from the ectodermal component of MCT followed 4,5,6 by adenocarcinomas . ...
... In different publications the frequency of the malignant change in 1,2,3,4,7,8 MCT varies from 1 to 2% irrespective of the age of the patient . Kim et al conducted a study on 560 patients who underwent surgery for a mature cystic teratoma at their hospital and concluded the rate of 2 transformation to be 0.6% , similarly Comerci et al in 1994 conducted a study on 517 cases and concluded the incidence of malignancy in 6 MCT to as low as 0.17% . ...
... SCC arising in MCTs has been observed in a relatively older patient population although it has 8 been reported in patients as young as 19 years old . The median age at 9 diagnosis of malignant transformation of MCT is 54-61.5 years 6,7 compared to 37.5 years in MCT , similar ndings were present in our cases. ...
Ovarian mature cystic teratomas are the commonest germ cell tumors of the ovary. Malignant transformation in them is a rare event and is difcult to diagnose preoperatively. Clinicians, pathologists and radiologists should always suspect this if the patient is elderly or when the cyst is large or in presence of a solid foci. Here, we discuss two cases of squamous cell carcinoma arising from a mature cystic teratoma
... Mature cystic teratoma originates from primordial germ cells and histologically includes at least two of the three germ layers ( ectoderm, endoderm and mesoderm) [5,6]. It is the most common tumor (60%) among benign tumors [5]. ...
... Mature cystic teratoma originates from primordial germ cells and histologically includes at least two of the three germ layers ( ectoderm, endoderm and mesoderm) [5,6]. It is the most common tumor (60%) among benign tumors [5]. Since, MCTs tend to arise at an early age, it is undoubtedly also encountered during pregnancy [7]. ...
Objectives: Mature cystic teratomas (MCT) originate from three germ layers: ectoderm, mesoderm and endoderm. The predictive significance of tumor markers in mature cystic teratomas is still unclear. In this study, we aimed to evaluate the predictive value of tumor markers in ovarian MCTs and histopathological contents of tumor. Materials and Methods: The data of 106 patients who were operated for ovarian MCT between 2015 and 2020 were analyzed retrospectively. In addition, slides in the pathology archive were re-examined under a microscope to evaluate their histopathological contents. Results: The average age of the patients was 35.7; 26.7 in the cystectomy group and 42.1 in the oophorectomy group (p = 0.000). The ratio of tumor markers exceeding the cut off value for carbohydrate antigen (CA 19-9), lactate dehydrogenase (LDH), cancer antigen (CA 125), carcinoma antigen (CA 15-3), carcinoembryonic antigen (CEA) were 45.2%; 47.7%; 8.15%; 12.3%; 6.9%, respectively. Histopathological examination of MCTs revealed 99.1% ectoderm, 45.3% mesodermal, 39.6% endodermal origin. Conclusion: Mature cystic teratoma is a benign tumor of the reproductive age that contains three germ layers in various proportions. LDH and CA 19-9 can be a helpful tool in predicting mature cystic teratomas.
... Preoperative diagnosis of malignancy is very difficult because symptoms and signs are nonspecific, and neither tumor markers nor imaging techniques can predict the specific diagnosis [3]. Regarding clinical manifestations, tumors in early stages are usually detected accidentally during a physical examination or after postoperative pathological analysis, while a palpable mass, bloating, and abdominal pain usually occur in more advanced stages. ...
Germ cell tumors represent 20-25% of ovarian tumors, and 95% of them are benign. The most frequent type is the mature benign teratoma (dermoid cysts). The proportion of cases in which malignancy occurs is 0.17-2%. Seventy-five percent to 90% of malignancies are squamous cell carcinomas (SCC).
We present a case of squamous cell carcinoma originating from a mature cystic teratoma that was diagnosed after intraoperative pathology study in a 64-year-old woman who consulted for an adnexal tumor causing abdominal pain. Laparoscopic surgery was scheduled, describing an enlarged right ovary (13 cm) which was included in the ipsilateral broad ligament and adhered to the posterior aspect of the uterus in its distal third as well as the rectum. It was converted to laparotomy and we performed a hysterectomy + double anexectomy + omentectomy + resection of sigma with end-to-end anastomosis after intraoperative pathological study reported for malignancy compatible with squamous cell carcinoma. It was labeled as FIGO III stage. Chemotherapy was decided as adjuvant therapy with carboplatin + paclitaxel (Carbo-Taxol) scheme.
We review the existing literature to provide evidence on a rare pathology with important repercussions for our patients.
... Mature cystic teratomas are the germ cell tumor deriving from primordial germ cells and composes of tissues arising from endoderm, mesoderm, and ectoderm in terms of histology [1]. Malignant elements or the secondary benign tumors in MCTs can also be seen [1,2]. ...
... Mature cystic teratomas are the germ cell tumor deriving from primordial germ cells and composes of tissues arising from endoderm, mesoderm, and ectoderm in terms of histology [1]. Malignant elements or the secondary benign tumors in MCTs can also be seen [1,2]. However, the incidence of their co-exist in MCTs is extremely rare. ...
Background:
Mature cystic teratoma (MCT) with meningioma of the ovary is a very rare benign tumor. There is only 3 reports of this disease until June 2019. The aim of the present study was to describe a ovarian mature cystic teratoma containing meningioma and nests of neuroblasts in a 15-year-old girl.
Methods:
The method used in the present study consists of description of the clinical history, image lab features, and pathological result.
Results:
The patient complained of a 2-month history of irregular vaginal bleeding. Abdominal computed tomography (CT) showed a large oval cystic-solid mass with septations and fat density shadow, in abdomen pelvic cavity. The cystic part was the main component in the mass. The tumoral solid parts and its internal division could be seen intensified from slight to moderate on contrast-enhanced CT images compared with those on precontrast images, and the solid parts showed heterogeneous enhancement. Neighbouring intestinal tract and the uterus displaced by compression. The pathological examination confirmed the diagnosis.
Conclusions:
The clinical feature of ovarian mature cystic teratoma with meningioma includes a lack of specificity. Only meticulous recording of the gross features, histopathological examination including immunohistochemistry and supportive clinical and radiological findings to arrive at a correct diagnosis in case of unconventional tumours. If necessary, preoperative puncture can be performed.
... However, both epidermoid and dermoid splenic cysts alike may display mucous cells along their lining [6,16]. Dermoid cysts can also present with varied contents such as hair shafts and pulp-like material further distinguishing them from splenic epidermoid cysts [16,17]. While the origin of epidermoid splenic cysts is still under investigation, previous case reports and research all agree that epidermoid splenic cysts are congenital, primary, nontraumatic, benign cysts [1][2][3][4]. ...
Epidermoid splenic cysts are rare lesions in the spleen. These cysts are characterized by a stratified squamous epithelial lining, internal septations, and calcification. Congenital in origin, epidermoid splenic cysts are postulated to arise from misfolding and mesothelial cell incorporation into the splenic parenchyma. This report presents a unique case of an 18-year-old woman with an epidermoid splenic cyst in a congenital wandering spleen. Computed tomography and transabdominal ultrasound imaging along with immunochemistry staining confirmed the diagnosis. To the authors’ knowledge, this is the first reported case of an epidermoid cyst in a wandering spleen.
