Case of mature cystic teratoma of the greater omentum misdiagnosed as ovarian cyst

The teratoma of the greater omentum is a very rare entity. We present a case of mature cystic teratoma of the greater omentum misdiagnosed as ovarian cyst. The patient was a 36-year-old woman with an omental teratoma of 5 x 4 x 4 cm and an atrophic left ovary. The histopathologic diagnosis was mature cystic teratoma of the greater omentum and no evidence of immaturity or malignancy was noted. Preoperative tumor marker tests revealed moderate elevation of cancer antigen (CA)125, CA19-9 and carcinoembryonic antigen. The left ovary of the patient was atrophic and possible autoamputation of the ovarian tissue might be suggested.     

Cystic teratoma in a supernumerary ovary of the greater omentum. A case report.

Supernumerary ovary is a rarely described gynecologic finding. A 47-year-old woman presented with abdominal pain and a palpable lower abdominal mass. The mass, removed in a partial omentectomy, was found to consist of a supernumerary ovary with a cystic teratoma.     

Benign teratoma in an 85-year-old woman

Background: In women over the age of 50, a mature cystic teratoma is reportedly likely to change into a malignant form. A mature cystic teratoma that remained in a benign form in a very old woman is a rare event. We report a case of a benign cystic teratoma, which is the oldest in Japan. Case: An 85-year-old Japanese woman with a pelvic mass measuring 8.90×5.81 cm by ultrasonography was referred to our Department for detailed. Transvaginal ultrasonography, magnetic resonance imaging, and serum concentrations of tumor markers led to a diagnosis of a mature cystic teratoma. Histological findings postoperatively confirmed the presence of a mature cystic teratoma. Conclusions: This case report describes a mature cystic teratoma which is the second oldest case reported in the world. We reconfirmed that a mature cystic teratoma in elderly women is not frequent, but does occur. Received: November 1999 / Accepted: 10 January 2000     

Immature teratoma of the ovary

The purpose of this study was to establish the optimal management of immature teratoma of the ovary. Pursuant to this, 20 previously untreated patients with immature teratoma were evaluated. Nine patients were at stage I of the disease, 2 had progressed to stage II, and 9 to stage III. Eight patients had grade 1 tumors, 11 had grade 2 tumors, and 1 had a grade 3 tumor. Postoperative chemotherapy was performed in 19 cases. Vincristine, actinomycin D, and cyclophosphamide (VAC) were administered in 9 cases, chemotherapy including cisplatin (P) was administered in 8 cases, and other regimens were followed in the 2 remaining cases. The median follow-up period was 62 months (range 19-108 months), and no patient was lost to follow-up. After completion of the follow-up period, 18 patients were alive and disease free, 1 was alive with liver metastasis, and 1 had died. The patient who died had suffered from a grade 3 tumor, and the recurrent tumor was a rhabdomyosarcoma. As a result of this study, it was found that immature teratoma of grades 1 and 2 can be managed successfully with VAC or P therapy. Thus, a hysterectomy should not be automatically performed in patients who still hope to give birth, yet suffer from a grade 1 or 2 immature teratoma at the time of a second operation.     

Immature teratoma of the ovary

Results of treatment of 9 cases of pure immature teratoma of the ovary seen at the University Hospital, Kuala Lumpur, are presented. Six patients were in Stage 1 and three in Stage 3. A majority of them had grade 2 or 3 tumors. Four patients in Stage 1 had the conservative surgery of salpingo-oophorectomy performed, the more radical procedure of total hysterectomy, bilateral salpingo-oophorectomy omentectomy, and tumor debulking where feasible being carried out in the others. Adjuvant chemotherapy consisted of either pulsed cyclophosphamide, VAC (vincristine, actinomycin D, and cyclophosphamide) or PVB (cis-platinum, vinblastine, bleomycin) regimes. Seven patients have survived for periods up to 9 years with no clinical evidence of disease.     

Immature teratoma of the ovary

Forty-one patients with pure immature teratoma of the ovary treated at The University of Texas M. D. Anderson Hospital and Tumor Institute at Houston from 1944 to 1985 were reviewed. The median age of these patients was 17 years. The most common symptom was abdominal pain, which occurred in 39 (95%) patients. FIGO stages included 24 patients with stage I, four with stage II, 12 with stage III, and one stage IV. The tumors ranged in size from 6 to 31 cm in greatest diameter, with a median of 17 cm. Of 39 cases reexamined microscopically, four were grade 1 tumors, 22 were grade 2 tumors, and 13 were grade 3 tumors. Initial surgery included ovarian cystectomy in one patient, unilateral salpingo-oophorectomy in 27 patients, and bilateral salpingo-oophorectomy in 13 patients. Fifteen of 16 patients treated with surgery alone developed recurrent disease; 11 are surviving after further therapy. Two patients died after treatment with radiotherapy plus chemotherapy. Twenty-one patients received a combination of vincristine, actinomycin-D, and cyclophosphamide postoperatively, and 18 are alive and well. One of two patients who received other combination regimens is alive and well. Therefore, 29 of the 41 patients (71%) are alive and well. Optimal management of patients with pure immature teratoma of the ovary consists of initial surgery (with preservation of a normal contralateral ovary in most patients) followed by combination chemotherapy in all patients except those with stage I, grade 1 disease; the latter may be treated safely with surgery alone.     

Immature teratoma of the ovary

Twenty-five cases of patients with pure immature teratoma of the ovary, accrued from the Connecticut Tumor Registry from 1969 to 1984, were reviewed. Two patients had grade 1 tumors, twelve had grade 2 tumors, and eleven had grade 3 tumors. The majority of patients (23) were stage I at the time of initial surgery. Twenty-one of the twenty-three patients were treated with some form of unilateral adnexal surgery with or without adjuvant combination chemotherapy (VAC). Two of the twenty-three patients were treated with total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) with the addition of either VAC chemotherapy or radiation therapy. Recurrence occurred in two patients, both of whom had grade 3 tumors and were subsequently treated with surgical resection plus VAC chemotherapy. One patient, who recurred after initial therapy with unilateral salpingo-oophorectomy (USO) plus VAC chemotherapy, was successfully treated with surgical resection and further chemotherapy. Two patients were stage III at the time of initial surgery, one of whom was treated with USO plus adjuvant combination chemotherapy and radio-therapy. The other patient was treated with TAH/BSO plus VAC chemotherapy. In our series, no patient died from immature teratoma (one patient died from advanced breast carcinoma). It is reasonable to withhold chemotherapy from patients with stage I, grade 1 and 2, immature teratoma which may be treated initially with conservative surgery. The risk of recurrence in patients with grade 3 tumors warrants the addition of further chemotherapy.     

Cartilaginous teratoma of the ovary

A case of ovarian teratoma of unique differentiation in a woman of 35 years is reported. Within the histologic structure of the tumor there is predominated cartilaginous tissue with signs of nuclear atypia. The microscopic appearance of the tumor resembled structures seen in chondroblastoma embryonale or even chondrosarcoma. Despite of cellular atypica there are no symptoms of malignant clinical course.     

Immature teratoma of the ovary

Four cases of immature teratoma of the ovary are presented and the recent literature is reviewed. The majority of these tumors were confined to one ovary at the time of diagnosis, and more than 75% occurred in women under 25 years of age. The two most important prognostic parameters were stage of disease and histologic grade. Optimal survival occurred when surgical tumor debulking was followed by combination chemotherapy. The addition of hysterectomy with contralateral adnexectomy did not improve the survival of patients with disease confined to one ovary. Similarly, postoperative radiation therapy was not shown to be beneficial in patients with this disease. Analysis of presently available data suggests that patients with teratocarcinoma of the ovary should be treated with tumor excision followed by at least 12 courses of chemotherapy with vincristine, actinomycin D, and cyclophosphamide. alpha-Fetoprotein may be useful as a biochemical marker of disease status in selected patients.     

Soft tissue metastasis of an immature teratoma of the ovary

In patients with immature teratoma of the ovary, blood-borne metastasis to organ parenchyma, such as the lungs, liver, or brain, are uncommon. Moreover, soft tissue metastasis is extremely rare. We describe a 31-year-old woman with an immature teratoma of the left ovary, which metastasized to soft tissue of the right thigh after surgery. Because of the rarity of this condition, we report the results of treatment and review the literature.     

Gliomatosis peritonei with mature teratoma of the ovary

We report a case of menstrual mature teratoma of ovary with implants of glial tissue in peritoneum and its adnexa. After resection of the tumour and omentum laparoscopic examination was performed and revealed reduction, fibrosis of glial implants and massive cellular reaction.     

Malignant hemangiopericytoma of the omentum presenting as an ovarian tumor

Malignant hemangiopericytomas are usually found in the musculature of the extremities, the retroperitoneum, and the pelvis. Malignant hemangiopericytoma arising in the omentum is extremely rare. We recently experienced such a case, in which a malignant ovarian tumor was suspected preoperatively on the basis of the sonogram, CT scan, magnetic resonance image, and increased CA-125 value. Microscopically, the tumor showed many mitoses, increased cellularity, and cytologic atypia. The patient was treated with CAP combination therapy following resection of the tumor; however, an intraperitoneal recurrence probably due to implantation was recognized 11 months later.     

Benign cystic teratoma of the douglas

We report a case of a benign cystic teratoma in a 30-year-old woman who underwent laparoscopy for a persisting pelvic mass in the posterior cul-de-sac. Our review of the literature indicates that, this is the second teratoma case of the douglas and the first one removed laparoscopically.     

Solid teratoma of the ovary.

Although ovarian teratomas are rare, a working knowledge of the differential characteristics of the cystic and solid teratoma is essential in order to properly inform the patients of their prognosis. The prognosis of cystic teratomas is excellent, whereas the prognosis of the solid teratomas is primarily dependent upon gross extension of the disease and histology of the primary tumor. Thurlbeck and Scully's classifications for histologically grading solid teratomas on the basis of differentiation of the cellular elements of the tumor does seem to have useful application. (Thurlbeck, H., and Scully, R. E. Cancer13, 804–813, 1960). A grave prognosis is indicated with solid teratomas composed primarily of undifferentiated, atypical, and mitotically active elements; however, solid teratomas, composed of predominantly mature, benign elements, support a favorable prognosis. If the tumor mass remains confined to the ovary, the recommended mode of therapy is unilateral salpingo-oophorectomy with bivalving of the contralateral ovary.