Pre-operative diagnosis of a primary uterine mature teratoma

ObjectiveMature 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 who was diagnosed before the operation. We also review the literature about this exceptional presentation.Case reportWe report a case of uterine teratoma that was initially diagnosed as a uterine tumor under ultrasound examination. But teratoma was highly suspected preoperatively by the abdominal CT scan. She underwent tumor excision via laparotomy. The operative finding and the histological examination confirms the diagnosis of primary uterine teratoma.ConclusionPreoperatively diagnosis of uterine teratoma was difficult. Although there are no gold standard to treat the uterine teratoma, the majority of the treatment choice is surgery. The prognosis of this unusual disease is relatively good in benign lesions.     

Follicular variant of papillary thyroid carcinoma arising from a dermoid cyst: A rare malignancy in young women and review of the literature

ObjectiveBenign or mature cystic teratomas, also known as dermoid cysts, are composed of mature tissues, which can contain elements of all three germ cell layers. Malignant transformation of a mature cystic teratoma is more common in postmenopausal women, however, it can also, rarely, be identified in younger women. We present a case of a 19-year-old woman with malignant transformation of an ovarian mature cystic teratoma.Case ReportOur case was a 19-year-old woman, who was diagnosed postoperatively with follicular variant of papillary thyroid carcinoma in a mature cystic teratoma. She underwent right cystectomy for adnexal mass. Postoperative metastatic workup revealed a non-metastatic disease and the patient did not undergo any further treatment. After 2 months, a near-total thyroidectomy was performed. Serum thyroglobulin levels were monitored on follow-up and the patient is asymptomatic.ConclusionMalignant transformation of a dermoid cyst is a rare ovarian neoplasm. We believe that unilateral oophorectomy or cystectomy is a reasonable treatment option for cases in which there is no evidence of capsular invasion, vascular invasion or gross metastasis, and preservation of fertility is desired. Total thyroidectomy was diagnosed in selected cases. Serial serum thyroglobulin should be used as a tumor marker for follow-up.     

Mature cystic teratoma of the uterosacral ligament successfully treated with laparoendoscopic single-site surgery

ObjectiveAlthough the majority of teratomas are encountered in the ovary, extragonadal mature cystic teratoma is an unusual disease entity, and the most common site is the omentum.Case ReportThe occurrence of this tumor on a uterosacral ligament is extremely rare with enigmatic etiology. To our knowledge, there have been only three cases reported to date that describe a mature cystic teratoma of the uterosacral ligament, and this is the first report of successful treatment of these rare tumors with laparoendoscopic single-site surgery (LESS).ConclusionIn the present study, we report a mature cystic teratoma of the uterosacral ligament successfully treated with LESS in a 34-year-old woman with a preoperative diagnosis of mature cystic teratoma of the left ovary.     

Virilizing Ovarian Dermoid Cyst with Leydig Cells

BackgroundThe clinical observation of virilization is a rare finding that has a number of possible explanations. Overall, ovarian tumors causing virilization are exceedingly rare and mostly occur in post-menopausal women. In fact, there are no reported cases of virilization from a testosterone-producing ovarian dermoid in the adolescent female age group. The most frequent germ cell tumor derived from the ovaries is the benign cystic teratoma (dermoid) which accounts for 25% of all ovarian neoplasms.¹ Teratomas consist of tissues that recapitulate the ectoderm, endoderm, and mesoderm. Usually the tumors are asymptomatic, but they occasionally can cause severe pain if there is torsion or if sebaceous material perforates the cyst wall, leading to reactive peritonitis.¹CaseA 12-year-old female was found to have a large 3 5× 19 × 12 cm ovarian mature cystic teratoma arising from her right ovary. The patient also displayed evidence of masculinization demonstrated by a deepening voice and clitoromegaly. The dermoid was producing large amounts of testosterone from a nest of Leydig cells found pathologically in the mass.ConclusionBenign cystic teratomas can produce active hormones, albeit rarely. This is a finding important to consider when ovarian cystectomy is performed for removal of a benign cystic teratoma.     

Asynchronous Bilateral Ovarian Torsion. A Case Report and Mini Review

BackgroundAdnexal torsion is a serious condition and delay in surgical intervention may result in loss of ovary. Children and adolescents who have suffered from uterine adnexal torsion may be at risk for asynchronous torsion of the contralateral adnexa.CaseWe report the case of asynchronous bilateral ovarian torsion in a 9-year-old girl, resulting in right and subsequently left salpingo-oophorectomy.ConclusionThe diagnosis of ovarian torsion often is delayed. When ovarian torsion is suspected, laparoscopy should be performed without delay, and conservative management should be strongly considered to prevent surgical castration. Oophoropexy of the ipsilateral and contralateral ovary should be considered to prevent a recurrent torsion.     

Malignant transformation of an ovarian mature cystic teratoma: computed tomography findings

Introduction The malignant transformation of an ovarian mature cystic teratoma is rare. We presented such a case of a 46-year-old woman with characteristic computed tomography (CT) findings.Case report The patient had suffered from fullness and tenderness of the lower abdomen for one year. A high serum CA-125 level was noted. Computed tomography images showed a left adnexal mass with fat, calcification and soft tissue components, and areas of invasion through the teratoma wall.Outcome The histologic diagnosis was compatible with a squamous cell carcinoma arising from a mature cystic teratoma of the ovary.     

Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma

Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1-2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63-year-old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.     

Familial occurrence of mature ovarian teratomas

It has been suggested that genetic predisposing factors play a role in the development of ovarian teratomas. Familial occurrence of these tumors would support this view. Reported herein are identical twins, both of whom had a right ovarian mature teratoma. In both cases the presenting symptoms were acute torsion. The diagnosis was confirmed at laparotomy and subsequent histopathologic examination. The origin of ovarian teratomas seems to be linked to the process of parthenogenesis. This process probably involves a germ cell after its first meiotic division.     

Postmenopausal hyperandrogenism caused by a benign cystic teratoma: a case report

BACKGROUND: Mature, benign cystic teratomas of the ovary are common in reproductive-age women, but they are very rarely associated with androgen production and subsequent development of hirsutism or virilization. We describe a case of postmenopausal hirsutism and hyperandrogenism caused by a mature cystic teratoma as well as the 7 previously reported cases. CASE: A 55-year-old, postmenopausal woman presented with hirsutism and unilateral lower extremity edema. Pelvic ultrasound showed a complex cystic mass in the left ovary measuring 6.0 x 7.0 x 10 cm, and laboratory evaluations revealed progressively increasing testosterone levels. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, with resection of a large, complex mass originating in the left ovary. The pathology department found 2 left, mature ovarian cystic teratomas containing a layer of Leydig cells. Postoperatively the patient experienced rapid normalization of the elevated testosterone level. CONCLUSION: Although rare, ovarian production of androgens resulting in hirsutism or virilization can occur with a hormonally active mature cystic teratoma.     

Adenocarcinoma arising from respiratory ciliated epithelium in mature ovarian cystic teratoma

Malignant transformation of a mature cystic teratoma of the ovary is rare, that of an adenocarcinoma is extremely rare. A 32-year-old woman was suspected as having a malignant transformation of her mature cystic teratoma of the ovary because the preoperative level of carcinoembryonic antigen (CEA) was extremely high. Resections of her ovarian cysts were performed, and this particular tumor was histopathologically diagnosed as an adenocarcinoma arising from a mature cystic teratoma of the left ovary. Because adenocarcinomas arising from mature cystic teratomas of the ovary are extremely rare, we report this case with a review of some of the literature.     

Clinical and Computed Tomographic Features of Ovarian Lesions in Infants,Children, and Adolescents: A Series of 222 Cases

Study ObjectiveTo investigate the clinical and computed tomography (CT) characteristics of ovarian lesions in infants, children, and adolescents.Design, Setting, and ParticipantsA retrospective analysis of the clinical and CT data was performed in 222 patients who were 20 years or younger with ovarian lesions. Patients’ age, medical history, symptoms, tumor marker levels, and CT imaging findings were recorded.InterventionsNone.Main Outcome MeasuresIdentification of the clinical and CT features of ovarian lesions in infants, children, and adolescents.ResultsA total of 136 patients had abdominal pain, and 73 patients had palpable abdominal mass. The β-HCG was elevated in 4 and AFP was elevated in 16 of the 222 cases. A total of 235 lesions were found in 222 cases, including 75 non-neoplastic and 160 neoplastic lesions. Ovarian cyst exhibited homogeneous low density. The torsion of a normal-sized ovary demonstrated mild or no enhancement. The torsion associated with an ovarian mass demonstrated a thickened, hyperdense wall. Mature teratoma presented as a cystic mass, with bulk fat and coarse calcification. Immature teratoma appeared as a solid mass with foci of fat and fine calcification. Yolk sac tumor was shown as cystic–solid mass with intense enhancement of solid component. Wall and septation of benign epithelial tumors were relatively uniform in thickness; mural nodule was detected in borderline tumor; and malignant epithelial tumor was predominantly a solid mass with intense enhancement.ConclusionOvarian cyst is the most common non-neoplastic lesion. Torsion of a normal-sized ovary was the second most common non-neoplastic lesion, almost always causing abdominal pain. Germ cell tumor has the highest incidence among neoplastic lesions. Fat and calcification are highly specific for germ cell tumor. The elevation of AFP and HCG levels in serum indicates germ cell tumor. Ovarian epithelial tumor is usually large, benign, and predominantly cystic. The combination of clinical and imaging features is helpful for correct diagnosis.     

Anti-NMDA-Receptor Encephalitis: An Adolescent with an Ovarian Teratoma

BackgroundAnti-N-methyl-D-aspartate (NMDA) receptor encephalitis has been reported to be associated with ovarian teratomas. In many patients, surgical excision has resulted in improvement.CaseA previously healthy 14-year-old girl presented with confusion which later evolved into a comatose state. Imaging revealed an adnexal mass which was surgically removed and confirmed to be a mature teratoma. Her cerebral spinal fluid was positive for antibodies to NR1/NR2 heteromers of NMDA receptors.CommentsCystic teratomas are one of the most common benign ovarian lesions in children and young women. While an association of ovarian teratomas and paraneoplastic encephalitis is published in the neurologic literature, this association needs to be clarified for the practicing gynecologist who may be asked to consult on these patients.     

Adnexal torsion in the first trimester of pregnancy: A case report

Adnexal torsion is a rare cause of acute abdominal pain during pregnancy. It is frequently associated with ovarian stimulation for in vitro fertilization (IVF) or with ovarian masses, mainly of functional origin. It is uncommon for a normal-sized ovary to undergo torsion. Torsion of the ovary during pregnancy is common during third trimester. Adnexal torsion is rarely bilateral and is more common on the right side, perhaps because the sigmoid colon leaves a limited space for left adnexal mobility. Here we report a case of 23-year-old primigravida with 8 weeks pregnancy presented with sever left abdominal pain. Left abdominal tenderness was detected. Transabdominal ultrasound scan reported left adnexal torsion. Laparotomy and then left salpingo-oophorectomy were performed.     

Adnexal masses in adolescent girls with pelvic pain: Report on 63 cases

To improve clinical appreciation of these lesions, we reviewed the presentation, evaluation, outcome, and therapeutic aspects of painful adnexal masses in adolescent females. During the period January 2005–September 2006, 63 adolescent females with painful adnexal masses were recruited. The patient management and outcomes were documented. The mean age was 15.36 ± 1.6 years, and the mean diameter of the masses was 54.5 ± 1.3 mm. Forty-nine patients (77.7%) underwent surgical management, and 45 of the 49 surgeries were achieved by laparoscopic surgery (91.8%). Two converting laparotomies (4%) were performed. Fourteen patients with a presumed functional cyst were followed up without surgery. Postoperative histopathologic evaluation revealed a benign epithelial ovarian cyst rate of 26.5%, a mature cystic teratoma rate of 22.4%, and a borderline ovarian tumor rate of 4.08%. Non-neoplastic adnexal lesions were encountered in surgeries of 22 cases. The incidence of acute ovarian torsion and true ovarian neoplasm was 9.52% and 55.1%, respectively, and none was malignant. True ovarian neoplasia remains a common indication for surgery in the majority of adolescents. Because most cases are benign, minimal access surgery should be performed whenever feasible.     

Laparoscopic management of mature cystic teratoma of bilateral ovaries with adnexal torsion occurring in a 9-year-old premenarchal girl

BACKGROUND: Laparoscopic surgery is a minimal-access procedure with many advantages. However, reports of young girls with adnexal disease treated by laparoscopic surgery are limited in the literature. CASE: A 9-yr-old premenarchal girl presenting with acute abdomen was treated by emergency laparoscopic surgery. Bilateral adnexal torsion was noted. After detorsion, bilateral cystectomy was successfully performed and ovarian tissues were preserved. Pathological diagnosis was mature cystic teratoma of bilateral ovaries. CONCLUSION: Although adnexal torsion occurring in a premenarchal girl is an extremely rare disorder and bilateral adnexal torsion is even more rare, gynecologists should possess sufficient knowledge about the manifestations of such disorder for immediate diagnosis and treatment to preserve future fertility and, if available, laparoscopic approach should be chosen for a young girl.     

Mucinous adenocarcinoma and strumal carcinoid tumor arising in one mature cystic teratoma of the ovary with synchronous cervical cancer

Malignant transformation of mature cystic teratoma is an uncommon complication. While any of the constituent tissues of a teratoma has the potential to undergo malignant transformation, squamous cell carcinoma is the most commonly associated cancer. We present an unusual case of a postmenopausal woman with synchronous mucinous adenocarcinoma and strumal carcinoid tumor from one of two ovarian mature cystic teratomas (one in each ovary) with synchronous cervical cancer. We suggest that malignant transformation of mature cystic teratoma and synchronous cervical cancer be treated by hysterectomy, chemotherapy, and radiotherapy.     

Multiple neuroectodermal tumors arising in a mature cystic teratoma of the ovary

Benign cystic teratomas are common, comprising 11-20% of all ovarian tumors. Neural elements can be identified in 38% of teratomas, but the development of a malignant neural neoplasm in an ovarian tumor of this type is rare. Multiple neuroectodermal tumor foci have not been previously described in association with a mature cystic teratoma of the ovary.     

Adjuvant and post-surgical treatment in non-epithelial ovarian cancer

Non-epithelial cancers arising from the ovary are uncommon malignancies. Germ cell tumors of the ovary arise from primordial germ cells, and sex cord-stromal tumors of the ovary represent a cluster of tumors arising from the sex cord and stromal compartment. Most patients diagnosed with germ cell tumors are young adults and adolescent females. In contrast, ovarian sex cord-stromal tumors more commonly occur in a mature age group.Advances in the adjuvant management of non-epithelial ovarian cancer following optimal surgical and pathological staging have improved patient survival outcomes. In addition, active surveillance is preferentially assigned to patients diagnosed with stage I germ cell tumor, stage 1A grade 1 immature teratoma, stage 1A yolk sac tumor, and stage 1AI sex cord-stromal tumors.This article discusses the importance of selecting the adjuvant treatment approach most suitable to the patients' surgical and pathological stages, thereby safeguarding patient outcomes.