A huge ovarian mucinous cystadenoma in a 14-year-old premenarchal girl: review on ovarian mucinous tumor in premenarchal girls

Superficial epithelial ovarian tumors are unusual in adolescent girls (when compared with adult women) and extremely rare before menarche. Mucinous cystadenoma (MCA) in children that is a rare form of epithelial tumor is a benign cystic ovarian neoplasm. To our knowledge, there are only eight cases of mucinous cystadenoma, three of borderline mucinous cystadenoma, and three of mucinous cystadenocarcinoma reported in the English-language literature. We present a 14-year-old premenarchal girl with a giant ovarian mucinous cystadenoma. This review is supported by the finding that epithelial ovarian neoplasms are extremely rare prior to puberty and that only 14 mucinous tumors have been reported prior to menarche.     

Vaginal bleeding in premenarchal girls: a review

Vaginal bleeding in childhood is not a common complaint. Serious medical or sociological problems can underly this irregular symptom in young girls. Therefore it requires careful medical investigation followed by appropriate sociologic and psychologic support. The variable etiologies of vulvovaginitis are the most common causes of vaginal bleeding during the prepubertal period. External blood loss can be related to trauma or urologic factors. It can be the presenting sign of relatively rare benign and malignant neoplasms of the genital tract. Precocious menstruation in itself or as a part of precocious puberty must be suspected in these cases. Vaginal bleeding in prepubertal girls is uncommon but warrants careful evaluation because of the special status of the young patient.     

Virilization in pregnancy due to a borderline mucinous ovarian tumor

Virilization in pregnancy due to borderline mucinous ovarian tumors is very rare. A case of a 28-year-old patient who was noted at 28 weeks' gestation to have marked virilization with raised serum androgens, ascites and a large complex right adnexal mass is presented. Delivery was carried out by cesarean section and at surgery a large tumor was noted in the right ovary. Histology revealed a borderline mucinous ovarian tumor with stromal luteinization, but there was no evidence of stromal invasion. Serum androgens returned to normal levels following surgery and the maternal virilization had resolved at the 6-week postnatal visit. Stromal changes in borderline mucinous ovarian tumors may result in virilization due to androgen production; surgical removal is associated with an excellent clinical outcome.     

Extraovarian mucinous metaplasia in a patient with bilateral mucinous borderline ovarian tumors: a case report.

We present a case of a 54-year-old woman with bilateral borderline mucinous ovarian tumors that contained multiple types of epithelia. Widespread müllerian abnormalities were present and included endometrial mucinous metaplasia, mucinous epithelial inclusions with papillary changes in pelvic lymph nodes, and papillary mucinous proliferation within endocervical glands. We postulate that the widespread abnormalities present in this patient could represent precursor changes to the multifocal cancers previously described in patients with similar tumors.     

Pseudomyxoma peritonei and mucinous pyometral fluid arising from an ovarian borderline mucinous tumor: case report

An extremely rare case of a pseudomyxoma peritonei (PMP) and mucinous pyometral fluid, possibly arising from an ovarian borderline mucinous tumor is reported. A 68-year-old Japanese patient received an expolatory laparatomy under a working diagnosis of a PMP, left ovarian cystic tumor and an umbilical hernia. Surgery and platinum-based chemotherapy induced a 15-month disease-free condition.     

Response of a mucinous ovarian tumor of borderline malignancy to human chorionic gonadotropin

Plasma and urinary steroid hormones were measured before and after an injection of human chorionic gonadotropin (hCG) to a postmenopausal woman with a mucinous ovarian tumor of borderline malignancy. Hormones were also measured in blood from a vein draining the tumor, and circulating gonadotropins and plasma and urinary steroids were measured before and after tumor removal. Baseline levels of plasma progesterone (P), androstenedione (delta 4 A), and estradiol (E2), and urinary estrogens and pregnanediol were high; they increased dramatically in response to hCG and fell after tumor removal. A less striking increase in testosterone, dihydrotestosterone, dehydroepiandrosterone (DHEA), and DHEA sulfate was noted after hCG injection. A gradient existed between tumor vein and peripheral vein levels of P, 17 alpha-hydroxyprogesterone, delta 4 A, E2, DHEA, and cortisol. Plasma follicle-stimulating and luteinizing hormones initially low but rose to the postmenopausal range after surgery. These results indicate the presence of delta 4 and delta 5 androstene pathways within the tumor. The responsiveness of the tumor to hCG provides further evidence that hCG may be the endogenous stimulus to steroid hormone production by epithelial ovarian tumors.     

Primary retroperitoneal mucinous borderline tumor: a case report

BACKGROUND: Primary retroperitoneal mucinous borderline tumors are rare. These tumors can be present in women with otherwise normal pelvic anatomy. CASE: A 22-year-old woman with abdominal pain was found to have a large midline mass superior to the uterus with ascites. In surgery, a large mass was arising from the sigmoid mesentery. The pelvis was normal on inspection. Final pathology of the mass revealed borderline tumor (tumor of low malignant potential) and focus of ovarian tissue. CONCLUSION: This is a case report of primary retroperitoneal mucinous borderline tumor. The gynecologic oncologist should be aware of primary retroperitoneal tumors and the differential diagnosis.     

Bilateral sclerosing stromal tumor of the ovaries in a premenarchal girl

BACKGROUND: Sclerosing stromal tumor of the ovary is a rare benign neoplasm that is usually unilateral in menstruating women with a mean age of 27. CASE: An 11-year-old girl presented with asymptomatic bilateral sclerosing stromal tumor of the ovaries prior to menarche. We describe the clinical, radiologic and histologic findings with reference to other reported cases. CONCLUSION: We herein report a unique case of bilateral sclerosing stromal tumor of the ovaries arising in a premenarchal girl.     

Ovarian tumors in pregnancy. An ovarian tumor registry review.

Among the 2300 cases accumulated in the Emil Novak Tumor Registry between the years 1942 and 1972, there were 100 examples of ovarian neoplasia associated with gestation. Lutein cysts or luteomas were excluded since such lesions usually represent physiologic responses of the gonad to increased levels of chorionic gonadotropin. Only 10 cases of dermoids (benign cystic teratomas) were reviewed. We believe this to be the largest series reported in conjunction with pregnancy. There was a total 5-year salvage rate of 76%, which is obviously much greater than with ovarian tumors in general, although there are certain patients alive with a late recurrence. This excellent survival rate seemingly reflects the low-grade malignant potential of many of the neoplasms encountered during pregnancy. However, certain cases of extremely aggressive and advanced ovarian tumors as noted at operation seemed to do surprisingly well following termination of pregnancy, and one must speculate whether gestation impairs antibody response with an apparent immunologic rebound postpartum.     

The epidemiology of epithelial ovarian cancer: a review

Banks E, Beral V, Reeves G. The epidemiology of epithelial ovarian cancer: a review. Int J Gynecol Cancer 1997; 7: 425–438.
This paper presents a review of the scientific literature investigating the epidemiology of epithelial ovarian cancer. Epithelial ovarian cancer is an important cause of cancer death among women in industrialized countries, and incidence increases with age. It is more common among women of low parity and among those with a family history of the disease. Oral contraceptive use, hysterectomy, oophorectomy, and sterilization have all been shown to protect against epithelial ovarian cancer, while the role of other reproductive and environmental factors, such as infertility, fertility drugs and hormone replacement therapy, is less clear. The evidence to date is discussed in this review.     

Ovarian stimulation and borderline ovarian tumors: a case-control study

Objective: To assess the risk of borderline ovarian cancer among infertile women treated with fertility drugs.

Design: Case-control study.

Setting: Nationwide data obtained from public registers and postal questionnaires.

Patient(s): All Danish women <60 years old with borderline ovarian cancer during the period 1989–1994 and randomly selected population controls. The analysis included 231 cases and 1,721 controls.

Intervention(s): None.

Main Outcome Measure(s): Influence of parity, infertility, and fertility drugs on the risk of borderline ovarian cancer after multivariate confounder control.

Result(s): The odds ratio (OR) for borderline ovarian cancer among infertile untreated nulliparous women compared with fertile nulliparous women was 1.9. The OR for borderline ovarian cancer among treated nulliparous women compared with untreated infertile nulliparous women was 1.5, and the OR among treated parous women compared with untreated infertile parous women was 1.5.

Conclusion(s): Among fertile women, the difference in the risk of borderline ovarian cancer between nulliparous women and parous women was not statistically significant. Nulliparous women who were infertile and who did not receive medical treatment had a twofold higher risk of borderline ovarian cancer than fertile nulliparous women. There was no statistically significant increase in the risk of borderline ovarian cancer among nulliparous women who were treated with fertility drugs compared with nulliparous untreated infertile women or among parous women who were treated with fertility drugs compared with parous untreated infertile women.     

Yolk sac tumor in a young girl: a case report.

BACKGROUND: Yolk sac tumor is a rare neoplasm characterized by high malignancy given its premature metastasis, that is frequent in adolescence. CASE REPORT: A 21-year-old woman came to our observation for an ovarian cyst (13 cm in diameter). Following salpingo-oophorectomy, it was revealed as a yolk sac tumor by histological diagnosis. The patient exhibited a highly elevated level of alpha1-fetoprotein (AFP) (1156 UI/ml). She is now undergoing chemotherapy treatment. CONCLUSION: This is an interesting case of yolk sac tumor in a young girl, at an age typical for germ cell tumor. AFP represents a valid marker resulting in a useful diagnostic tool.     

Ovarian mucinous cystic tumor of borderline malignancy with a mural nodule of anaplastic spindle cell carcinoma: a case report

Ovarian cystic tumors with a mural nodule are a rare entity. We report a case of a mural nodule of anaplastic spindle cell carcinoma in an ovarian mucinous cystic tumor of borderline malignancy. The patient was a 45-years-old Japanese woman who presented with an ovarian cyst. She suffered from mature cystic teratoma of both ovaries 9 years before the present history. Image analysis and laboratory data showing a high serum CA19-9 level suggested ovarian malignancy. She underwent bilateral salpingo-oophorectomy with hysterectomy and omentectomy. There was a mural nodule in the ovarian mucinous cystic lesion. Microscopically, the nodule was composed of spindle-shaped cells with severe nuclear atypia. Immunohistochemical analysis allowed the cells to be categorized as anaplastic spindle cell carcinoma. Fifteen months after the operation the patient is alive without any clinical findings of tumor recurrence. To the best of our knowledge in the English literature, this is the first report of a mural nodule of an anaplastic spindle cell carcinoma within an ovarian mucinous cystic borderline tumor harboring previously confirmed cystic teratoma.