Malignant transformation of ovarian mature cystic teratoma

There have been few studies concerning the clinical pathology of malignant transformation arising in ovarian mature cystic teratoma (MCT). Thus, the objective of this study is to determine clinicopathologic factors affecting survival in this rare tumor. From November 1992 to December 2002, 11 patients with malignant transformation arising in ovarian MCT were treated at Department of Obstetrics and Gynecology in Chonnam National University Hospital. Demographic characteristics, symptoms, signs, stage, mode of therapy, and results of follow-up were reviewed retrospectively. There were 11 cases of the malignant transformation of ovarian MCT out of 637 cases of MCT (1.7%). The average age was 50.6 years. Histologically, 7 out of the 11 cases were squamous cell carcinoma (63.7%). There were no specific clinical symptoms, but palpable abdominal mass was the most frequent complaint (five cases, 45.4%). As for the stage of disease, eight cases were in stage IA (72.7%), and the other three cases were in stage IC, IIB, and IIC, respectively. All the patients had surgery, and seven of them had adjuvant chemotherapy and two had adjuvant chemoradiation. All the patients in stage I survived until the period of follow-up, and their average survival time was 31.8 months. One patient in stage IIC died of intestinal obstruction within 9 months from the surgery. The mechanism of the malignant transformation arising in ovarian MCT is not clear, but considering the fact that 80% of MCTs are diagnosed during the reproductive age, malignant transformation seems to be related to the long-term presence of nonremoved MCT in the abdomen. Accordingly, it is considered helpful for preventing and early detection of the malignant transformation to have regular ovary examination through pelvic ultrasonogram during the reproductive age.     

Extragonadal mature cystic teratoma at anterior uterine wall coexisting with a pararectal corpus luteum cyst and agenesis of left fallopian tube and left ovary

ObjectiveMature cystic teratomas are mostly confined to the ovaries, but several authors have reported findings of extragonadal occurrences along the migration pathway of primordial germ cells. Extragonadal mature cystic teratomas are extremely rare; their occurrences and pathogenesis are unknown.Case reportWe report the case of a 26-year-old woman who was admitted for scheduled laparoscopic right ovarian tumor excision. An anterior uterine wall mature cystic teratoma and a pararectal corpus luteum cyst were found intraoperatively with coexistence of left adnexal agenesis.ConclusionThe existence of an extragonadal mature cystic teratoma over the anterior uterine serosal layer may be caused by autoamputation and reimplantation as a result of ovarian torsion or displacement of primordial germ cells along their migration path. The existence of an ovarian mass over the sigmoid colon combined with left adnexal agenesis may be the result of ovarian torsion with remnant tissue attached to the sigmoid colon.     

Adenocarcinoma arising from respiratory ciliated epithelium in benign cystic teratoma of the ovary: a case report with analyzes of the CT, MRI, and pathological findings

The malignant transformation of mature cystic teratoma is rare, thus occurring in only 1-2% of all cases. The most common malignancy arising in mature cystic teratoma is squamous cell carcinoma. Adenocarcinoma occurs with less frequency. We herein present a patient with an ovarian mature cystic teratoma who demonstrated a malignant transformation to well-differentiated adenocarcinoma. Malignant transformation was diagnosed preoperatively by contrast enhanced computed tomography (CT) and magnetic resonance imaging (MRI). Microscopically and immunohistochemically, the adenocarcinoma was considered to have arisen from the ciliated respiratory epithelium. After a 28-month of follow-up period, she remains free of the disease. This is the third reported case of adenocarcinoma arising in the respiratory epithelium of an ovarian mature cystic teratoma. Contrast enhanced CT and MRI are useful for making a preoperative diagnosis and an immunohistochemical study is helpful for defining its origin.     

Chemical peritonitis caused by an iatrogenic rupture of mature cystic teratoma of the ovary during labor: a report of a case didactic to all the maternity health care workers

A 37-year-old postpartum woman was presented with abdominal pain supposed to be caused by uterine involution or puerperal endometritis after vaginal delivery. During the pregnancy, she was suspected to have a subserosal myoma by ultrasound examination. The pain was finally revealed to be originated from the chemical peritonitis caused by the rupture of the mature cystic teratoma of the ovary by Kristeller's maneuver performed during vaginal delivery. When a pregnant or puerperal woman complains about abdominal pain, we need to consider the possibility of chemical peritonitis resulting from the rupture of mature cystic teratoma of the ovary.     

Malignant transformation of mature cystic teratoma of the ovary: experience at a single institution

Objectives

Malignant transformation of mature cystic teratoma (MCT) of ovary is very rare. Therefore, the clinicopathologic characteristics, treatment and prognostic factors are not yet well established. The aim of this study was to review our experience with this malignancy and previously published reports in the literature.

Study design

A review of pathologic reports for 2019 patients with ovarian MCT and 937 patients with primary ovarian cancer who were treated at the Asan Medical Center, Korea, from 1989 to 2007 identified 16 patients with malignant transformation from MCT. A retrospective chart review of these patients and a review of the literature were performed.

Results

The incidence rate of malignant transformation was 0.8% of all ovarian MCT. It accounted for 1.7% of all primary ovarian cancer. Squamous cell carcinoma was the most common histologic type, comprising 75%. The median age of the 16 patients was 50 years (range, 29–75 years). Mean tumor size was 14.5 cm (range, 5–26 cm). Twelve patients had some solid portions in the cyst containing fat fluid, hair, and/or calcification. According to the review of the patients in our study and of the literature, early detection and complete surgical resection are important for long-term survival. It seems that adjuvant chemotherapy or concurrent chemoradiation therapy have roles in treating this malignancy.

Conclusions

Early detection is important for long-term survival. Old age, large tumor size, and solid portion in mature cystic teratoma seem to predict the malignant transformation of mature cystic teratoma.     

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.     

Mucinous cystadenocarcinoma arising in mature cystic teratoma ovary and associated pseudomyxoma peritonei: report of a case

Pseudomyxoma peritonei (PMP) is most commonly associated with intra-abdominal spread of an appendiceal mucinous neoplasm and very rarely seen in cases of primary ovarian tumours. Mucinous adenocarcinoma arising in a mature cystic teratoma giving rise to PMP is even rarer. Extensive medlar search has revealed only nine cases; we are reporting tenth such case.     

Laparoscopic management of mature cystic teratoma of the ovary with multiple intracystic floating spherules

Introduction  A feature of multiple spherical structures floating free in a cystic mass is one of the very rare patterns of mature cystic teratoma. Case report  A 32-year-old unmarried nulligravida was referred. Image diagnosis showed a large cystic tumor with unusual intracystic multiple floating spherules. Serum tumor marker test showed elevated squamous cell carcinoma antigen. Laparoscopic-assisted left salpingo-oophorectomy was performed. The histopathological diagnosis was mature cystic teratoma of the ovary with marked desquamative keratin formations. Conclusions  After obtaining pathognomonic findings on diagnostic imaging, laparoscopic management of a rare form of mature cystic teratoma of the ovary with numerous intracystic floating spherules was successfully performed.     

Sebaceous carcinoma arising within an ovarian cystic mature teratoma

A 77-year-old woman presented with an abdominal swelling and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor. This was an ovarian mature cystic teratoma in which had developed a sebaceous cell carcinoma. This is a rare form of ovarian malignancy whose behavior is poorly documented. The treatment and follow-up of this case are discussed.     

Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature

The incidence of malignant transformation in mature cystic teratoma (MCT) of the ovary is less than 2% as reported in gynaecological and pathological literature. Here we present a series of five patients, who developed malignant transformation in MCT of the ovary, over a 6-year period (1999–2004). The morphological and clinico-pathological features of malignant transformation in MCT of the ovary are discussed.     

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.     

CA19-9 may have clinical significance in mature cystic teratomas of the ovary

The objective of this study was to evaluate size, bilaterality, histopathologic origin, and the serum levels of some tumor markers in patients with mature cystic teratomas (MCTs) of the ovary. Retrospective study of 80 patients operated at Department of Obstetrics and Gynecology, Gulhane Military Medical Academy, Turkey, between the years 1998 and 2003 was performed. The mean age was 33.1 +/- 11.3 years (median 34; range 15-69). The mean tumor diameter was 7.2 +/- 4.5 cm (median 5; range 3-20). The mean serum CA19-9 level was 101.2 +/- 179.7 IU/mL (range 1-841, normal value < 37), the mean serum CA125 level was 32.0 +/- 37.8 U/mL (range 2.2-205, normal value < 35), the mean carcino-embryogenic antigen (CEA) level was 1.46 +/- 1.20 ng/mL (range 0.2-4.8, normal value 3.4), and the mean serum alpha-fetoprotein (AFP) level was 2.7 +/- 3.0 ng/mL (range 0.1-10.5, normal value <8.1). The elevated rate of CA19-9, CA125, CEA, and AFP was 38.8% (31/80), 25% (18/72), 9.1% (4/44), and 8.7% (4/46), respectively. The bilaterality rate was 27.5% (22/80). Patients with an elevated serum CA19-9 level showed significantly higher bilaterality rate (51.6% versus 12.2%, P < 0.05) than the patients with low levels. Likelihood ratio for bilaterality was 2.8 for CA19-9 and 4.6 for CA125. Bilateral teratomas showed a significantly higher rate of ectodermal component than the unilateral ones (100% versus 74.3%, P < 0.05). Ovarian MCTs were diagnosed especially during the reproductive period. CA19-9 may be the only important marker in the diagnosis of MCTs. Elevated levels of CA19-9 and CA125 may be an indicator of bilaterality. Since levels of CA19-9 and CA125 may be elevated in both benign and malignant conditions, interpretation of these findings must be made in light of the clinical condition of the patient.     

Clinical significance of combined use of macrophage colony-stimulating factor and squamous cell carcinoma antigen as a selective diagnostic marker for squamous cell carcinoma arising in mature cystic teratoma of the ovary

OBJECTIVES: Mature cystic teratoma of the ovary transforms into malignant tumors, mostly squamous cell carcinomas, at an incidence of approximately 2%. Preoperative diagnosis of squamous cell carcinoma arising in mature cystic teratoma of the ovary is a difficult task. The present study aims to assess whether combined use of two serum tumor markers, macrophage colony-stimulating factor (M-CSF) and squamous cell carcinoma antigen (SCC), is effective in preoperatively diagnosing squamous cell carcinoma arising in mature cystic teratoma of the ovary, distinguishing it from mature cystic teratoma without malignant transformation. METHODS: Serum levels of M-CSF and SCC were assayed using blood samples collected preoperatively from 31 patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary and 133 patients with mature cystic teratoma of the ovary without malignant transformation. RESULTS: In 22 of the 31 (71.0%) patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary, the serum M-CSF levels exceeded the upper limit of the normal level (1056 U/ml). This positive incidence of the elevated serum M-CSF levels was significantly higher compared with that (13.5%, 18/133) observed in patients with benign cystic teratoma of the ovary (P < 0.0001). Regarding the serum levels of SCC, 13 of 31 (41.9%) patients with malignant tumors showed positive values exceeding the cutoff value of 2.0 ng/ml. Again, this incidence of positive cases was significantly higher compared with that (15.0%, 20/133) observed in patients with benign tumors (P < 0.01). There was no correlation between the serum levels of M-CSF and SCC among patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary. Patients with malignant tumors testing positive for elevated M-CSF did not necessarily test positive for SCC. Patients with positive values for excess M-CSF and/or SCC constituted 87.1% of the total (27/31). Even when patients were restricted to those with stage I tumors, a value as high as 83.3% (15/18) was still obtained for those testing positive for elevated M-CSF and/or SCC. CONCLUSION: Serum M-CSF was proven to be useful as a tumor marker for detecting squamous cell carcinoma arising in mature cystic teratoma of the ovary. Combined use of serum M-CSF and SCC as a marker seemed to be useful in the selective diagnosis of mature cystic teratoma of the ovary harboring malignant squamous carcinoma, discriminating it from that without malignant carcinoma.     

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.     

Preoperative diagnosis of mature cystic teratoma with malignant transformation: analysis of imaging findings and clinical and laboratory data

Purpose To evaluate the factors including the imaging findings and clinical and laboratory data that were useful for diagnosing mature cystic teratomas with malignant transformation.Materials and methods In 11 patients, we analyzed the imaging findings by the CT and MR focused on the soft tissue components for the following characteristics: size; the angle between the soft tissue components and the inner wall of the cyst (acute or obtuse); the configuration of the inner border (regular or irregular); and enhancement as well as tumor size. Clinical and laboratory data such as age, serum SCC, CA-125, CA 19-9, and AFP, were also determined.Results In the analysis of the imaging findings, nine (82%) of all tumors had soft tissue components and eight (89%) of nine soft-tissue-containing tumors showed an obtuse angle between the soft tissue components and the inner wall of the cyst as well as enhancement. In nine (82%) of the study patients it was shown that the largest diameter of the tumor was larger than 9.9 cm and the patients were older than 45 years. In the results of the laboratory data, six (67%) of performed nine patients had a CA-125 elevation greater than 35 U/ml and three (75%) of performed four patients had a CA 19-9 elevation greater than 37 U/ml.Conclusion We suggest that preoperative diagnosis may be improved and available in cases of synthesized imaging findings with clinical and laboratory data.     

Predictive factors for recurrence of ovarian mature cystic teratomas after surgical excision

Objective

To study the recurrence rate and predictive factors for recurrence after surgical excision of ovarian mature cystic teratomas (MCT).

Study design

Retrospective study of 382 patients who underwent surgical excision of MCT and whose post-surgical follow-up data were available over six months. Patients who underwent concomitant oophorectomy or had a history of oophorectomy were excluded. Medical records were reviewed for evidence of recurrence. The Cox-hazard model was used for the estimation of predictive factors for recurrence. Categorical data were compared using the Chi-square and Fisher's exact tests.

Results

There were 16 recurrences within a mean follow-up period of 43.0 months, with a recurrence rate of 4.2%. Young age (<30 years old, Y) (hazard ratio (HR) 2.98; 95% confidence interval (CI) 1.04–8.62, P = 0.043), large cyst (≥8 cm in diameter, L) (HR 2.75; 95% CI 1.03–7.37, P = 0.044), and bilaterality (B) (HR 2.88; 95% CI 1.07–7.76, P = 0.036) were shown to be significant predictive factors. When a patient had all these three factors, the recurrence rate was 21.0%, otherwise 3.4% (P < 0.01). Patients with Y + L, Y + B, and B + L also showed significantly higher recurrence rate (21.4%, 15.9%, and 11.4%, respectively).

Conclusion

The long-term recurrence rate after surgical excision of MCT in this study is 4.2%. A patient with young age (<30 years old) or large cyst (≥8 cm in diameter) or bilateral cysts is at high risk of recurrence, which is even higher when a patient has more than one of these factors.     

Mucinous adenocarcinoma arising in ovarian mature cystic teratoma in pregnancy

We report a case of mucinous adenocarcinoma arising from mature cystic teratoma (MCT) of the ovary ascertained incidentally during pregnancy. An ovarian adnexal mass was seen in a 38-year-old pregnant woman during cesarean section. Oophorectomy revealed a mucinous adenocarcinoma arising from MCT with additional capsule invasion. Following this, staging procedures were applied. The patient was staged as IC and adjuvant chemotherapy was applied. She has remained disease-free for over 24 months. To our knowledge, this is a case of mucinous adenocarcinoma arising from MCT and the third case of malignant transformation from MCT in pregnancy in English literature.     

Malignant degeneration of a mature ovarian teratoma

Malignant components are present in 1–2% of mature teratomas (dermoid cysts) and historically have been associated with a very poor prognosis. Patients with malignant mature cystic teratomas typically are postmenopausal and may present with a rapidly enlarging tumor or systemic symptoms suggestive of malignancy. However, the diagnosis is rarely made pre-operatively and, if the tumor is not metastatic, may not be made until the tumor is examined microscopically. Squamous cell carcinoma is the most common malignancy found in mature cystic teratomas. We present a 26-year-old woman with this cancer in whom the disease proved fatal. A surgical approach to patients with malignant mature teratomas is suggested. Prognostic factors and adjuvant therapy are discussed.