Raised serum squamous cell carcinoma antigen levels in malignant transformation of mature cystic ovarian teratoma

Mature cystic ovarian teratoma with malignant transformation to squamous cell carcinoma was diagnosed in four patients. Squamous cell carcinoma (SCC) antigen serum levels were elevated at diagnosis and during progression of the disease, but normal in complete remission. Elevated serum SCC antigen levels were also found in four out of 19 patients with mature cystic teratoma of the ovary. Cystic fluid from mature cystic teratoma could contain very high levels of the SCC antigen (> 1000 µg l⁻¹) without any sign of malignant transformation.     

Postoperative concurrent chronomodulated 5-fluorouracil/leucovorin infusion and pelvic radiotherapy for squamous cell carcinoma of the ovary arising from mature cystic teratoma

Abstract. Do VT, Thomas GM, Bjarnason GA. Postoperative concurrent chronomodulated 5-fluorouracil/leucovorin infusion and pelvic radiotherapy for squamous cell carcinoma of the ovary arising from mature cystic teratoma.
Primary squamous cell carcinoma (SCC) of the ovary arising from mature cystic teratoma (MCT) is rare. Survival is very poor. Although different postoperative treatments have been tried, none appears to have influenced outcomes. A 44-year-old patient with FIGO stage IIB SCC of the ovary arising in MCT had exploratory laparotomy and left salpingo-oophorectomy, leaving macroscopic residual pelvic disease. Postoperative treatment consisted of a continuous concurrent chronomodulated infusion of 5-fluorouracil 150 mg/m²/day and leucovorin 10 mg/m²/day with 5 weeks of pelvic radiotherapy. Three years after initial surgery, she remains disease and complication free. Given this patient's unusually long disease-free survival and the efficacy of concurrent chemotherapy and radiotherapy in other SCCs, the concurrent circadian treatment approach used for this patient should be explored in other cases of SCC of the ovary.     

Bilateral ovarian squamous cell carcinoma with an antecedent dermoid cyst in the left ovary

Ovarian squamous cell carcinoma is a rare malignancy and its occurrence is commonly attributed to malignant transformation of a pre-existing mature cystic teratoma. The de novo occurrence of primary squamous cell carcinoma is extremely rare. Malignant transformation in a mature cystic teratoma is almost always unilateral; however, there have been isolated reports of an uncomplicated mature cystic teratoma in the contralateral ovary. We report here a case of a 40-year-old woman presenting with squamous cell carcinoma of both ovaries with antecedent dermoid cyst in the left ovary, along with involvement of the fallopian tubes, cervix and omentum.     

Seven tumor markers in benign and malignant germ cell tumors of the ovary

Seven tumor markers were analyzed clinically in 135 patients with germ cell tumors of the ovary who were treated in Tokai Ovarian Tumor Study Group, an association comprising Nagoya University and its affiliated hospitals, between January 1979 and September 1990. Positive rate of AFP was 100% (36/36) in yolk sac tumor, 61.9% (13/21) in immature teratoma, and 11.8% (2/17) in dysgerminoma, but there were no positive cases of mature cystic teratoma with malignant transformation (0/7) and mature cystic teratoma (0/31). Positive rate of CA125 was over 50% in all tumor types except mature cystic teratoma, which showed a positive rate of 23.7%. CA125 was useful for the screening of malignant germ cell tumors. CA19-9 showed a high positive rate in teratomatous tumors, which were immature teratoma, mature cystic teratoma with malignant transformation, and mature cystic teratoma. Dysgerminoma and yolk sac tumor, especially dysgerminoma, had a high positive rate of LDH. TPA and CEA were not considered useful tumor markers for germ cell tumors 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.     

Squamous cell carcinoma arising in a dermoid cyst of the ovary in pregnancy

Background  

A rare complication of mature cystic teratoma of the ovary is malignant transformation, mostly being squamous cell carcinoma (SCC). Due to small case series, there are no established standard surgical and postoperative procedures.     

Squamous cell carcinoma in situ arising in mature cystic teratoma of the ovary: a case report

Introduction

Malignant transformation is a rare complication of mature cystic teratoma with squamous cell carcinoma being the most common type. We report a new case of squamous cell carcinoma in situ.

Case presentation

A 62 year old woman was admitted for an abdomino-pelvic mass and she underwent a left salpingo-oophorectomy. The histopathologic analysis revealed a squamous cell carcinoma in situ arising in mature cystic teratoma of the ovary. Then, she underwent a total hysterectomy, contralateral salpingo-oophorectomy and omentectomy without adjuvant treatment.

Conclusion

Optimal cytoreduction has been associated with a statistically significant improvement in survival for malignant transformation of mature cystic teratoma.     

Squamous cell carcinoma arising in a mature cystic teratoma of the ovary with synchronous invasive lobular breast cancer: case report

Malignant transformation of a mature ovarian cystic teratoma is the most serious complication of this relatively common neoplastic lesion. While any constituent tissue of the teratoma can undergo malignant transformation, squamous cell carcinoma represents approximately 80% of those malignancies. Furthermore, the synchronous occurrence of a second malignancy in that setting is extremely rare. Preoperative diagnosis of malignant transformation within a mature cystic teratoma is extremely difficult and poses a great challenge to current clinical surgical practice. The particularly aggressive behavior of this rare tumor, also poses significant surgical managing dilemmas. We present a case report of a premenopausal woman with an invasive squamous cell carcinoma arising in a mature cystic teratoma and a synchronous invasive lobular carcinoma of the breast.     

An evaluation of squamous cell carcinoma antigen in patients with cervical squamous cell carcinoma

In a prospective study, serum concentrations of squamous cell carcinoma antigen, a subfraction of tumor antigen (TA-4), were determined by radioimmunoassay from healthy donors, pregnant women, and subjects with various benign and malignant gynecologic diseases. Ninety-six percent of 99 healthy persons including all 52 female controls, the 15 pregnant patients, and all 23 subjects with benign gynecologic tumors, had squamous cell carcinoma antigen levels less than 2.0 ng/ml. Seven of 51 (14%) patients with cervical intraepithelial neoplasia and 16 of 24 (67%) patients with cervical squamous cell carcinoma had squamous cell carcinoma antigen levels greater than 2.0 ng/ml. Declining and rising levels of squamous cell carcinoma antigen, which were determined sequentially in nine cases of cervical carcinoma that were associated with elevated pretreatment levels of squamous cell carcinoma antigen, correlated with regression and progression of the disease. Serial serum levels of squamous cell carcinoma antigen provide a noninvasive means of monitoring the effects of individual therapy in patients with cervical squamous cell carcinoma.     

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.     

Gamma mode of infiltration associated with poor prognosis in malignant teratoma of the ovary: A case report

BACKGROUND: Although mature cystic teratoma is the most common tumor of the ovary, squamous cell carcinoma arising from a mature teratoma is a rare event. Prognosis depends on clinical stage, grade, and recently described mode of tumor infiltration. CASE: This case involves a 52-year-old woman with stage II squamous cell carcinoma arising in a mature cystic teratoma of the left ovary. Final pathology demonstrated poorly differentiated squamous cell carcinoma with gamma mode of tumor infiltration. The patient completed adjuvant chemotherapy and subsequently died of progressive disease. CONCLUSION: Squamous cell carcinoma arising from a benign cystic teratoma is a rare event. Studies have shown stage, grade, and mode of infiltration to be predictors of recurrence and prognosis. This case supports the growing evidence linking the mode of tumor infiltration with overall prognosis of survival.     

Squamous cell carcinoma arising in mature cystic teratoma of the ovary: a case series and review of the literature

OBJECTIVES: Malignant transformation of mature cystic teratomas is rare, with squamous cell carcinoma being the most common type. The prognosis is generally poor when disease has spread beyond the ovary. We conducted this study to review our experience with this disease and describe our current treatment modality. METHODS: During a 22-year period (1983-2005), we identified 17 women treated for squamous cell carcinoma arising in a mature cystic teratoma of the ovary. All pathologic diagnoses were confirmed at our institution. A retrospective chart review and comprehensive review of the literature were conducted. RESULTS: The median age was 55 (mean, 54.8; range, 37-75). Eight cases were stage I, 5 were stage II, and 4 were stage III. Mean tumor size was 14.2 cm. All patients underwent surgery, with positive lymph nodes noted in 0 of 10 cases that included lymph node dissection. Ten patients received adjuvant treatment-6 with chemotherapy and 4 with chemoradiation. Six patients had recurrent disease in the pelvis after adjuvant treatment. Four patients died of disease. The overall 1-year survival rate was 60%. The 4 patients with stages IA-IIB disease treated with adjuvant platinum-based chemotherapy and radiation survived at 12-56 months' follow-up. CONCLUSIONS: Squamous carcinomas arising in mature cystic teratomas are commonly large ovarian tumors that occur in perimenopausal women and often present as an incidental pathologic finding. While the prognosis seems highly dependent on surgical stage, there is a lack of consensus in the literature regarding adjuvant treatment. Platinum-based chemotherapy with pelvic radiation may be a reasonable adjuvant therapy for early-stage disease.     

Value of squamous cell carcinoma antigen levels in invasive cervical carcinoma

Squamous cell carcinoma (SCC) antigen (Ag) levels were measured by radioimmunoassay in 64 patients with invasive squamous cell cervical carcinoma and 9 patients with nonsquamous carcinoma before the initiation of treatment. The mean antigen level in the squamous group was 10.5 ng/ml compared with 1.3 ng/ml in the nonsquamous group. In the patients with squamous cell carcinoma, mean SCC Ag level correlated well with stage, except for bulky stage IB tumors (P less than 0.05), where mean level was much higher than expected. Patients with exophytic tumors had significantly higher SCC Ag levels than those with nonexophytic tumors. Follow-up on 62 evaluable patients ranged from 20 to 40 months. The mean pretreatment SCC Ag level for patients free of disease at last contact was 5.6 ng/ml, in contrast to 16.1 ng/ml for those with recurrent disease. Only 32% of patients free of disease had pretreatment levels of 4.0 ng/ml or greater, while 86% of those with recurrent disease had such values (P less than 0.05). Forty patients had follow-up samples drawn 1 to 14 months after treatment. Mean post-treatment SCC Ag levels dropped to 1.8 ng/ml in 21 patients free of disease (73% decrease), but remained elevated at 13.4 ng/ml (17% decrease) in 19 patients with recurrences. The specificity of follow-up SCC Ag levels as a predictive test for outcome was 90%, with a sensitivity of 63%. We conclude that pretreatment SCC Ag levels correlate well with tumor stage, lesion morphology, and extent of disease. SCC antigen levels may be used to follow patients to determine effectiveness of treatment.     

Malignant degeneration of benign cystic teratoma of the ovary

Malignant transformation of mature cystic teratoma of the ovary is a rare complication occurring preferentially during peri- and post-menopausal period. No clinical nor radiological, nor biological signs are specific to malignant transformation. The treatment is surgical and similar to that of epithelial tumors of the ovary. We report an observation of a squamous cell carcinoma developed on a mature cystic teratoma of the ovary, in a patient aged 46 years.     

Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy: a case report

Background   The question of whether patients with pure stage I squamous cell carcinoma in a mature cystic teratoma (MCT) should undergo conservative surgery, or postoperative adjuvant treatment remains unresolved. Case  A 33-year-old woman with a left ovarian cyst underwent laparoscopic cystectomy at 16 weeks of gestation. Histological examination confirmed squamous cell carcinoma arising in an MCT. At 18 weeks of gestation, she underwent left salpingo-oophorectomy, and was diagnosed as having stage Ic malignant transformation of the MCT, and was observed closely without postoperative adjuvant chemotherapy. She delivered a healthy baby at 41 weeks of gestation. No evidence of recurrence was observed 14 months after the initial laparoscopic surgery. Conclusion  Although a thorough staging procedure , histopathologic evaluation, and long-term follow-up are indispensable, patients with early stage I squamous cell carcinoma in MCT may safely undergo conservative surgery.     

Adenocarcinoma arising from the respiratory ciliated epithelium in a benign cystic teratoma of the ovary

Benign cystic teratoma of the ovary (BCTO) is the most common benign ovarian tumor, accounting for 15–20% of all ovarian tumors. It is usually diagnosed in the third and fourth decades of life. Malignant transformation is rare, occurring in approximately 1–2% of reported cases, with squamous cell carcinoma being the most common form. Adenocarcinoma arising from mature cystic teratoma is extremely rare. We present the patient with a BCTO, where a malignant transformation of respiratory ciliated epithelium resulted in well differentiated adenocarcinoma. Although respiratory epithelium is often found in BCTOs, adenocarcinoma arising from this cell type is uncommon. To our knowledge, this is the fourth reported case of adenocarcinoma arising from the respiratory epithelium of a BCTO.     

Comparison of gene expression in squamous cell carcinoma and adenocarcinoma of the uterine cervix

OBJECTIVES: Microarray expression analysis of cervical tumors has revealed differential expression of genes that may be useful as markers or targets for treatment. We question the application of array findings across the major categories of cervical cancer. We sought to identify differences between normal squamous epithelium (NSQ) and glandular epithelium (NGL) of the uterine cervix and their malignant variants: squamous cell cancer (SCC) and adenocarcinoma (ACA). METHODS: Eight genes were selected: 12-lipoxygenase (12-LOX), keratin 4, trypsinogen 2 (TRY2), Rh glycoprotein C (RhGC), collagen type V alpha 2, integrin alpha 5, integrin alpha 6, and c-myc. Ten cases each of SCC and ACA of the cervix were selected from our tumor bank. NSQ and NGL epithelia were obtained from consecutive patients undergoing surgery for benign disease. RNA extraction, cDNA synthesis, and DNA amplification of all samples were performed according to an established protocol. Electrophoresis of the multiplexed polymerase chain reaction (PCR) products was performed under standard conditions, followed by digital image capture. A ratio of target to control gene (beta-actin) was obtained for each sample. Analysis of variance was applied to the mean ratios for each tissue to establish significant differences. Individual pairwise comparisons were made by Student t tests and verified with the Tukey-Kramer test. RESULTS: Clinically valid comparisons are NSQ to NGL, NSQ to SCC, NGL to ACA, and SCC to ACA. Various expression patterns were observed between the epithelia and their malignant phenotypes. Significant differences in gene expression were observed between benign squamous and glandular epithelium in four of the eight genes and between malignant squamous and glandular epithelium in three of the eight genes. Significant differences in gene expression between benign and malignant tissues were demonstrated in four of the eight genes. CONCLUSIONS: We have defined significant differential expression changes between the two principal cervical tumor types. Differences in genes are demonstrated and must be considered if array technology is applied to the study of the biologic behavior of these tumors as well as their screening and management. The observed differential expression should be a compelling argument to perform type-specific expression analysis for other tumors with histological variants.     

Malignant degeneration of benign cystic teratoma of the bilateral ovaries: adenosquamous carcinoma in the right tumor and squamous carcinoma in the left tumor

An extremely rare case of malignant degeneration arising separately in benign cystic teratoma of the bilateral ovaries is reported in a 51-year-old woman. The solid part of the right tumour consisted basically of squamous cell carcinoma, but had a small area of adenocarcinoma, whereas the solid part of the left tumour consisted of squamous cell carcinoma. It was found that in both the cystic teratomas, squamous cell carcinoma had developed separately from the columnar epithelium by a process of squamous metaplasia and malignant change in situ. It is suggested that these malignant degenerations of benign cystic teratoma of the bilateral ovaries had occurred independently due to local carcinogenic agents in the constituents of each cyst content.     

Primary squamous cell carcinoma of the ovary associated with endometriosis

Objective

To analyze the clinical, therapeutic, and pathologic features of published cases presenting primary squamous cell carcinoma (SCC) of the ovary associated with endometriosis.

Methods

A case report, 15 cases of infiltrating SCC of the ovary associated with or arising from endometriosis, and 1 case of synchronous carcinoma in situ in the cervix and ovary from a review of the literature were studied.

Results

Young age, advanced stage of the disease, and hypogastric pain were frequent at the time of diagnosis. There was no ascites, but infiltration of neighboring organs was common. The tumor was associated with 80% patient mortality in the first few months. Adjuvant chemotherapy with paclitaxel and carboplatin or cisplatin appeared to improve the results.

Conclusion

Primary SCC of the ovary associated with endometriosis is extremely rare and has a poor prognosis. The best therapeutic results are obtained with paclitaxel and carboplatin or cisplatin after radical surgery.