Huge Anterior Mediastinal Teratoma Leading to Orthopnea in a Young Patient

The anterior mediastinal cysts and masses (AMCM) can be of varied origin and presentation. Although the space in the mediastinum is limited the cysts and masses can grow to a large size before the presentation. They displace the adjacent structures and then can grow into the pleural cavities thereby acquiring a large size. We share our experience of a case of a huge anterior mediastinal cystic mass in a young female who had a characteristic presentation of sudden onset breathlessness in the supine position and immediate relief in the sitting position. The patient recovered well after surgical treatment.

Immature cystic teratoma with contralateral mature cystic teratoma in a pediatric patient: Operative and ethical considerations to management

@#Immature cystic teratoma (IMCT) is a rare ovarian malignancy, usually presenting as a huge unilateral pelvoabdominal mass in the pediatric age. Even rarer is the occurrence of a concomitant contralateral mature cystic teratoma. Management issues include use of fertility sparing versus complete surgical staging, and the use of chemotherapy. Fortunately, IMCT carries a good prognosis, especially when diagnosed early. Chemotherapy is used only in higher stage disease and recurrence.

Malignant Transformation in Mature Cystic Dermoid: A Case Series of 8 Cases

Introduction: One of the most common types of ovarian germ neoplasm is Mature cystic teratoma(MCT) which accounts for almost 20% of all ovarian neoplasm. Objective: Analyze patients with Malignant Transformation (Mt) arising from Mature Cystic Teratoma of the ovary to evaluate Clinico-pathological features and treatment modalities. Methods: This is an observational study of 8 patients of Mt in MCT, who had taken complete treatment at GCRI between the period from September 2016 to September 2021. During this observation period, a total of two thousand one hundred and seventy seven ovarian tumors were diagnosed. Out of these patients, 9.32% (203) were MCTs. Of the consecutive cases of 203 ovarian MCTs diagnosed, 3.9% (8) had Mt of MCT, which was our study group. Results: The mean age of patients with Mt in MCT was 47.1 years (27- 65 yrs), while mean age of the patients with MCT was 42 years (35-55 years). Among the 21 postmenopausal, MCT's 28.5% (6) cases developed Mt and only 1% i.e., two cases from premenopausal showed Mt. Abdominal pain as main symptom was seen in 87.5% (7/8) patients. The duration of symptoms ranged from 3 to 6 months. CA125 was elevated in 75% patients. Germ cell markers including beta HCG, AFP, LDH were found to be normal. Conclusion: Diagnosis of malignant transformation of MCT is very difficult. There should be high index of suspicion of malignant transformation if the MCT has been present for a long time; the patient is postmenopausal, age>45 yrs; the tumor diameter is greater than 9.5 cm; or there is thickening of the cyst wall or papillary growth occurs, increased tumor markers

Malignant transformation of a mature teratoma with concurrent cervical carcinoma versus squamous cell carcinoma of the cervix with ovarian metastasis: A diagnostic dilemma / Philippine Journal of Obstetrics and Gynecology

@#Mature cystic teratoma of the ovary may occur in 10%–20% of women during their lifetime. Its biological behavior is benign, while 0.17%–2% of them may undergo malignant transformation. Various histological types of malignant transformation include Squamous cell carcinoma (SCC), adenocarcinoma, small cell carcinoma, sarcoma, malignant melanoma, and mixed histology. SCCA of the cervix occurs more commonly at ages 45–55. This is mainly caused by human papillomavirus 16 and 18. This tumor spreads to local then regional lymph nodes and can have hematogenous spread to bone and lungs, rarely to the ovaries. This report is of a 75‑year‑old Gravida 9 Para 9 (9009) with an enlarging pelviabdominal mass, managed as a case of ovarian new growth with later findings of cervical cancer. The case merits presentation because of the dilemma in diagnosis.

Clinicopathological analysis of ovarian tumors: a two year retrospective study

Background: Ovarian tumours are a heterogeneous neoplasm with a varied clinical, morphological and histological feature. Increasing mortality rate due to ovarian cancers has been reported in recent years. Ovarian tumours in post-menopausal females have high risk of malignancy and it has a very poor outcome. The aim and objective of this study was to determine clinical and histopathological spectrum and the frequency and age distribution of various ovarian tumors.Methods: It is a retrospective observational study of patients with ovarian tumors in the department of obstetrics and gynecology, SGRRI of Medical Health & Sciences and Hospital from January 2016 to December 2017 in a total number of 86 patients. All specimens were sent to pathology department and categorised according to WHO  hispathological classification.Results: Out of 86 cases examined, 64 cases were benign (74.4%), 3 cases were borderline (3.4%) and 19 cases were malignant (22.2%). Majority of the ovarian tumors (73.4%) were seen in the age group of 20 to 50 years. Most commonly encountered benign ovarian tumour was serous cystadenoma (58.1%). Surface epithelial tumors were the commonest tumors (64%) followed by germ cell tumors (29%).Conclusions: A variety of benign and malignant tumours of ovary were reported in this study. Early diagnosis and appropriate treatment of ovarian neoplasms favour the good prognosis. Most common benign tumour encountered in this study was serous cystadenoma.

Monsters Egg: The Mystery Behind

Mature cystic teratomas (MCTs) (dermoid cyst) make up almost 20% of all ovarian neoplasms and 88% are unilateral. They constitute the most common ovarian tumor in childhood. However, it is sparsely seen in postmenopausal woman. Malignant transformation is seen in approximately

Teratoma quístico maduro torcido como causa de abdomen agudo en el embarazo. Reporte de un caso / Mature cystic teratoma torsion as a cause of acute pelvic pain in pregnancy. Case Report

Resumen ANTECEDENTES: Los teratomas son el tipo más común de tumor de células germinales. El teratoma quístico maduro representa 95% de todos los teratomas ováricos y es casi invariablemente benigno. El hallazgo de una lesión quística anexial simple o compleja en el embarazo es excepcional (5%). La manifestación de teratomas maduros durante ese estado de la vida reproductiva varía de 30-50%. La torsión anexial es poco frecuente e indudablemente se requiere intervención quirúrgica. CASO CLÍNICO: Paciente de 29 años, que acudió al Hospital General Dr. Miguel Silva de Morelia, Michoacán, con embarazo de 15.2 semanas y dolor pélvico agudo. El ultrasonido reportó datos inespecíficos, por lo que se recurrió a la resonancia magnética, donde se observó una tumoración anexial derecha, bien definida y delimitada, de bordes regulares, de aproximadamente 10 x 9 x 9 cm. Se practicó una laparotomía exploradora, previo protocolo quirúrgico, que evidenció un tumor ovárico derecho, de 14 x 10 cm, con afectación vascular; por tal motivo se decidió efectuar la salpingo-ooforectomía derecha. La pieza quirúrgica midió 16 x 11 x 7 cm, el estudio histopatológico reportó un teratoma quístico maduro con afectación vascular. La evolución posquirúrgica fue favorable. CONCLUSIÓN: El abdomen agudo en el embarazo, por torsión anexial, es un suceso excepcional. Es importante establecer el diagnóstico acertado, para ofrecer el tratamiento adecuado.

Abstract BACKGROUND: Teratomas are the most common type of germ cell tumor. Mature cystic teratoma represents more than 95% of all ovarian teratomas and is almost invariably benign. The finding of a simple or complex adnexal cystic lesion in pregnancy is not an uncommon event (5%), with a presentation of mature teratoma during gestation in 30-50%. Although the mass torsion is not common, when it occurs its indicated treatment, surgery. CLINICAL CASE: A 29-year-old woman who attended the General Hospital Miguel Silva in Morelia, Michoacán, for pregnancy of 15.2 weeks of gestation plus acute pelvic pain. Pelvic ultrasound was performed with insufficient report, for which reason magnetic resonance was requested, in which well-defined and limited right adnexal tumor is reported with regular borders of approximately 10 x 9 x 9 cm. She underwent exploratory laparotomy with surgical protocol, a right ovarian tumor of 14 x 10 cm with vascular involvement was found. Right salpingo-oophorectomy was performed. The surgical specimen measured 16 x 11 x 7 cm, the histopathological study, reported mature cystic teratoma with vascular compromise. Favorable post-surgical evolution of the patient CONCLUSION: Acute pelvic pain during pregnancy secondary to an adnexal torsion is infrequent. It must have an accurate diagnostic approach for a proper treatment.

Successful in vitro fertilization pregnancy and delivery after a fertility-sparing laparoscopic operation in a patient with a papillary thyroid carcinoma arising from a mature cystic teratoma / 대한생식의학회지

Malignant transformation of ovarian mature cystic teratomas is rare, and papillary thyroid cancer occurs in 0.1%–0.3% of ovarian teratomas that undergo malignant transformation. We describe a case of successful in vitro fertilization pregnancy and delivery after a fertility-sparing laparoscopic operation in a patient with papillary thyroid carcinoma arising from a mature cystic teratoma.

Estruma ovárico maligno con foco de carcinoma papilar / Malignant struma with ovarian carcinoma papillary spotlight

Resumen ANTECEDENTES: El estruma ovárico es una variedad infrecuente de teratoma quístico. CASO CLÍNICO: Paciente de 42 años de edad en quien durante una revisión ginecológica rutinaria se evidenció, por ecografía, un quiste anexial derecho complejo, bilobulado, de 10 cm compuesto por dos formaciones heterogéneas independientes, una de aspecto uniforme ecorrefringente de 52.6 mm y otra ecorrefringencia alternante de 36.7 mm. Se categorizó como teratoma quístico, lo que se confirmó por resonancia magnética nuclear. Se efectuó anexectomía derecha laparoscópica. El estudio anatomopatológico confirmó el diagnóstico microscópico de teratoma quístico maduro, que incluía a la tiroides (menos de 50% de todo el tumor), con un carcinoma papilar de patrón folicular (estruma ovárico). La cirugía ginecológica se complementó con histerectomía total, omentectomía, lavado peritoneal e inspección de la cavidad abdominal por vía laparotómica; se descartó la neoplasia residual. El estudio endocrinológico evidenció la normalidad de la tiroides y el diagnóstico ecográfico de un nódulo; posteriormente se confirmó que se trataba de hiperplasia benigna. Los marcadores tumorales tiroideos fueron negativos y, a pesar de ello, el comité de cáncer de tiroides acordó que se efectuara la tiroidectomía total y luego se indicara tratamiento con iodo radiactivo, sin evidenciar elementos neoplásicos malignos ni ganglios linfáticos afectados. CONCLUSIONES: Debido a la baja incidencia del estruma ovárico su tratamiento comprende a la cirugía ovárica y la tiroidectomía, y al yodo radioactivo en el caso de las variedades malignas; todo esto en un contexto de controversia consecuencia de la poca experiencia acumulada.

Abstract BACKGROUND: Struma ovarii represents a rare form of ovarial quistic teratom that contains thiroid tissue and affects mostly women between 40 and 60 years of age. Its diagnosis is based on the definitive pathological study of the piece, due to the fact that these kind of tumors lack any specific clinic and diagnostic features. CLINICAL CASE: 42 year old patient, in which during a routine gynecological examination a bilobed complex right adnexal cyst of 10 cm composed of two independent heterogeneous formations (a uniform appearance ecorrefringente of 52.6mm and one alternate ecorrefrigencia of 36.7 mm) is evidenced by ultrasound. It is categorized as cystic teratoma and confirmed by nuclear magnetic resonance. Adnexectomy is performed laparoscopically. The pathological study confirmed the microscopic diagnosis of mature cystic teratoma including thyroid tissue (less than 50% of the tumor) with papillary carcinoma follicular pattern: Struma Ovarii. Gynecological surgery was completed with a total hysterectomy, omentectomy, washing and inspection peritoneal abdominal cavity by laparotomy discarding residual neoplasia. Endocrinological study showed normal thyroid function and ultrasound diagnosis of a nodule: benign hyperplasia was confirmed later. Thyroid tumor markers were negative and despite this, the thyroid cancer committee agreed to perform a total thyroidectomy and a treatment with radioiodine, without evidence of malignant neoplastic elements and affected lymph nodes. CONCLUSIONS: Its treatment is still controversial due to its low incidence, and includes not only ovarial surgery but also thyroidectomy and radioactive iodine therapy in the event of a malignant tumor.

Teratoma quístico maduro de ovario, experiencia en un hospital del norte del perú: reporte de caso / Mature cystic teratoma of the ovary, experience in a hospital in northern perú: case report

Los Teratomas Quísticos son tumores de origen embrionario que están compuestos por células germinales pluripotenciales. Se presenta el caso de una mujer de 57 años, que ingresa al servicio de emergencia por presentar como molestia principal una tumoración abdominal dolorosa a predominio de región mesogástrica. En los estudios realizados, se determinó por imagen una masa anexial derecha asociada a valores elevados del marcador tumoral Antígeno Carcinogénico 125 (CA-125). Bajo la sospecha clínica de la presencia de una neoplasia maligna de ovario, sumado a los hallazgos clínicos e imagenológicos se optó por una conducta quirúrgica. Se llevó a cabo una cirugía radical (Cistectomía, histerectomía radical ampliada, apendicectomía, omentectomía, disección ganglionar y lavado peritoneal). Los estudios anatomopatológicos postoperatorios concluyeron con el diagnóstico de un Teratoma Quístico Benigno de Ovario. Se ha demostrado que esta patología representa un cuadro clínico de comportamiento benigno, pero ante la existencia de pequeños porcentajes que podrían tener un curso maligno, se recomienda el principio de la detección y manejo temprano con la finalidad de reducir cualquier posibilidad de malignidad mediante una intervención médica oportuna.

Cystic Teratomas are tumors of embryonic origin that are composed of pluripotent germ cells. It was presented the case of a 57-year-old woman admitted to the emergency department for presenting as a major annoyance due to a painful abdominal mass to a predominance of the mesogastric region. In the studies performed, a right adnexal mass associated with high values of the tumor marker 125 Carcinogenic Antigen (CA-125) is determined. Under the suspicion of a malignant ovarian neoplasm, added to the clinical and imaging findings, a surgical approach was chosen. Radical surgery was performed (cystectomy, extended radical hysterectomy, appendectomy, omentectomy, lymph node dissection and peritoneal lavage). The postoperative anatomopathological studies concluded with the diagnosis of a Benign Ovarian Cystic Teratoma. It has been demonstrated that this pathology represents a clinical picture of benign behavior, but in the presence of small percentages that may have a malignant course. Therefore, the principle of detection and early management for unidentified purposes of a timely medical entity is recommended.

Mature cystic teratoma complicated with primary ovarian carcinoid:A report of 3 cases and literature review / 吉林大学学报(医学版)

Objective:To discuss the clinical characteristics,diagnosis,treatment experience and prognosis of mature cystic teratoma complicated with primary ovarian carcinoid,and to summarize its general charateriseics and to enhance the knowledge of clinician.Methods:Three female patients presented unilateral ovarian tumor in physical examination and were admitted to hospital.The tumor markers of three patients were normal. The preoperative diagnosis was ovarian tumor.Unilateral salpingo-oophorectomy was conducted in two patients.The resection of ovarian tumor was conducted in one patient.Results:The three patients underwent operation successfully.The postoperative pathological diagnosis was mature cystic teratoma complicated with primary ovarian carcinoid.The patients recovered well,who accepted 15-month follow-up with normal life and stable condition,and had no recurrence and metastasis.Conclusion:Mature cystic teratoma complicated with primary ovarian carcinoid is easy to be misdiagnosed before operation.Salpingo-oophorectomy is commonly used as the treatment method of mature cystic teratoma complicated with primary ovarian carcinoid and it can result in good effectiveness and better prognosis.

Mature cystic teratoma complicated with primary ovarian carcinoid: A report of 3 cases and literature review / 吉林大学学报(医学版)

Objective: To discuss the clinical characteristics, diagnosis, treatment experience and prognosis of mature cystic teratoma complicated with primary ovarian carcinoid, and to summarize its general charateriseics and to enhance the knowledge of clinician. Methods: Three female patients presented unilateral ovarian tumor in physical examination and were admitted to hospital. The tumor markers of three patients were normal. The preoperative diagnosis was ovarian tumor. Unilateral salpingo-oophorectomy was conducted in two patients. The resection of ovarian tumor was conducted in one patient. Results: The three patients underwent operation successfully. The postoperative pathological diagnosis was mature cystic teratoma complicated with primary ovarian carcinoid. The patients recovered well, who accepted 15-month follow-up with normal life and stable condition, and had no recurrence and metastasis. Conclusion: Mature cystic teratoma complicated with primary ovarian carcinoid is easy to be misdiagnosed before operation. Salpingo-oophorectomy is commonly used as the treatment method of mature cystic teratoma complicated with primary ovarian carcinoid and it can result in good effectiveness and better prognosis.

Small Cell Carcinoma arising from a mature Cystic Teratoma of the ovary: A case report / Philippine Journal of Obstetrics and Gynecology

@#Malignant transformation of a mature cystic teratoma (MCT) or dermoid cyst in the ovary occurs only 1 to 2% of cases of MCTs. Only 6 cases of small cell carcinoma arising from a MCT have been reported. The patient is a 36 year-old G2P2(2002) who presented with an enlarging abdominal mass and right lower quadrant pain. She was diagnosed with a dermoid cyst four years prior to admission, but no surgical intervention was done. On admission, ultrasound revealed multiple pelvo-abdominal masses consistent with dermoid cysts. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal fluid cytology, bilateral pelvic lymph node dissection, excision of enlarged paraaortic lymph nodes and infracolic omentectomy. Histopathology revealed a small cell carcinoma arising from a MCT in the left ovary consistent with a Stage IIIA1ii tumor. She underwent chemotherapy with 4 cycles of Etoposide-Cisplatin and has no evidence of disease 3 months after treatment.

Teratoma quístico de ovario con múltiples glóbulos flotantes intraquísticos / Ovarian cystic teratoma with multiple intracystic floating globules

Los teratomas quísticos ováricos están compuestos principalmente de un quiste cubierto total o parcialmente por epitelio que simula epidermis queratinizada con glándulas sebáceas y sudoríparas. La presencia de bolas o glóbulos flotantes dentro de un teratoma quístico de ovario es un hallazgo inusual. Se presenta el caso de una paciente de 40 años con antecedente de dolor pélvico de 6 meses de evolución. La evaluación ecográfica demostró un quiste de ovario de 26 x 16 centímetros con múltiples estructuras móviles, esféricas, ecogénicas y flotantes dentro de la tumoración quística. Se realizó salpingooforectomía derecha durante la laparotomía. El diagnóstico histopatológico fue teratoma quístico maduro. La presencia de glóbulos flotantes intraquisticos es raras veces observado, pero es patognomónico del teratoma quístico maduro.

Ovarian cystic teratomas are mainly composed of a cyst enterily or partly lined by epithelium resembling keratinized epidermis with sebaceous and sweat glands. The presence of floating balls or globules inside an ovarian cystic teratoma is an unusual finding. We report a 40-year old with a history of pelvic pain for 6 months. The ultrasonographic evaluation showed an ovarian cyst of 26 x 16 centimeters with multiple mobile, spherical echogenic structures floating in the cystic mass. Right oophorosalpingectomy was performed by laparotomy. Histopathology diagnosis was mature cystic teratoma. The appearance of intracystic floating globules is rarely seen but it is pathognomonic for mature cystic teratoma.

Mature Cystic Teratoma of Ovary with Abnormally High Levels of Ca19-9: A Case Report / Teratoma maduro cístico do ovário com níveis aberrantes de Ca19-9: caso clínico

Abstract Mature cystic teratomas, or dermoid tumors, are the most common benign ovarian neoplasms in young women. Malignant transformation is rare, and occurs in less than 2% of the cases. The heterogeneous histological composition of these tumors may be responsible for the occasional elevation of various tumor markers, such as Ca19-9 and Ca125. We describe one case of mature cystic teratoma in a 50-year old woman with the second highest level of Ca19-9 (8922.76 UI/mL) described in the literature. We concluded that abnormal levels of Ca19-9 are not necessarily associated with ovarian malignancy, and may lead to unnecessary medical intervention and patient anxiety. Therefore, the clinical features, imaging studies and antigen testing should be interpreted carefully, and should not limit the surgical approach.

Resumo Os teratomas maduros císticos do ovário, ou tumores dermoides, são as neoplasias benignas mais frequentes em mulheres jovens. A sua transformação maligna é rara, e ocorre emmenos de 2% dos casos. A composição histológica heterogénea destes tumores pode ser responsável pela ocasional elevação de marcadores tumorais, como o Ca19-9 e o Ca125. Descrevemos umcaso de teratoma maduro cístico do ovário numa paciente de 50 anos com o segundo valor mais elevado de Ca19-9 (8922,76 UI/mL) descrito na literatura. Concluímos que níveis anormalmente elevados de Ca19-9 não estão necessariamente associados a tumores malignos, e podem conduzir a intervenções médicas desnecessárias e contribuir para o aumento da ansiedade da paciente. Portanto, as características clínicas, os estudos imagiológicos e os marcadores tumorais devem ser interpretados cuidadosamente, e não devem limitar o tipo de conduta cirúrgica.

Epidermoid Cyst of Ovary: A Rare Entity.

Rare instances of epidermoid cyst of ovary have been reported in literature with incidence of <1% among all the ovarian tumors. It often mimics mature cystic teratoma of the ovary and needs extensive sampling and careful microscopic examination to rule out the presence of adnexal structures and other tissues. Most of the cases in literature were reported as an incidental finding, but large epidermoid cyst of the ovary is seen as a rare entity. We present one such quizzical case of a large epidermoid cyst of ovary occurring in a 44-year-old female presenting with multiple fibroids of uterus.

Risk factors for malignant transformation of mature cystic teratoma

OBJECTIVE: The aim of this study was to investigate the preoperative characteristics of benign mature cystic teratoma (MCT) and struma ovarii and their risk factors associated malignancies, and determine the appropriate treatment options for these tumors. METHODS: This was a retrospective study on 248 patients who were pathologically diagnosed with ovarian MCT, struma ovarii, or malignant transformations of these tumors at Inje University Haeundae Paik Hospital from March 2010 to January 2015. Routinely evaluated results of adnexal masses before surgery were compared. RESULTS: A total of six patients (2.4%) were confirmed to have malignant tumors. Of the struma ovarii patients, two out of five patients (40%) were confirmed to have malignancy. The mean age at the diagnosis of patients with malignant transformation of teratomas was 43.0 years (range, 27 to 67 years), which was higher than that of patients with benign teratomas (36.5 years). The mean diameter of the tumor before surgery in the malignant tumor group was 11.4 cm and larger than 6.5 cm of benign group (P=0.003). The mean CA-125 level in the malignant tumor group was higher than that in the benign tumor group (P=0.01). CONCLUSION: Risk factors for malignant transformation of MCT include elevated CA-125 levels, older age, large tumor masses, and postmenopausal status.

Laparoendoscopic single-site versus conventional laparoscopic surgery for ovarian mature cystic teratoma

OBJECTIVE: To compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma. METHODS: A retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups. RESULTS: There was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P<0.001). CONCLUSION: LESS was feasible and showed comparable surgical outcomes with conventional laparoscopic surgery for women with ovarian mature cystic teratoma. LESS was associated with less postoperative pain and required less analgesia.

Pelvic mature cystic teratoma with neuroendocrine carcinoma: Report of a rare association and review of literature.

Extra-gonadal malignant transformation of teratoma is rare and there are only a few reports available citing malignancy arising in the non-germ cell components. We hereby report a case of a 35-year-old female, who presented with lower backache with a radiologically identifi able mass lesion in the pre-sacral region. Clinical and radiological fi ndings suggested the possibility of a cystic teratoma. Histopathological examination and relevant immunohistochemical tests detected a mature cystic teratoma with features of a grade 2 neuroendocrine tumor in it. Like the index case, most of the previously reported cases of teratoma with malignant transformation of the somatic components were found in extra-gonadal site. This case is being reported to emphasize that any extra-gonadal mass in reproductive age group, even if it appears radiologically and per-operatively benign, must be subjected to histopathological examination to rule out possibility of malignant transformation of the germ cell or non-germ cell components.

Clinical experience in ovarian squamous cell carcinoma arising from mature cystic teratoma: A rare entity

OBJECTIVE: We sought to investigate the clinicopathologic features of ovarian squamous cell carcinomas arising from mature cystic teratomas (MCT) and to report our clinical experience and lessons learned. METHODS: From January 1993 to November 2012, a total of 6,260 women with ovarian MCT were surgically treated at Cheil General Hospital and Women's Healthcare Center. Among them, the cases with malignant transformation to squamous cell carcinoma were included in this analysis. Patient demographic characteristics, surgical findings, and prognosis were evaluated retrospectively. RESULTS: Of the 6,260 ovarian MCT patients, four (0.06%) had ovarian squamous cell carcinoma arising from MCT. The mean patient age was 43 years (range, 35-51 years), and the mean tumor size was 12 cm (range, 9-16 cm), with two patients in the International Federation of Gynecology and Obstetrics stage I and the other two in stage III. Upon preoperative imaging, all cases were expected to be benign ovarian tumors, but the preoperative squamous cell carcinoma antigen level was elevated from 1.5 ng/mL in stage Ia to 11.3 ng/mL in stage IIIc, suggesting malignancy, while the CA-125 level was normal in two of the three patients who received the test. Optimal debulking surgery was performed and adjuvant chemotherapy was used in all patients, but death from the recurrence of disease occurred in one patient, whose overall survival was 10 months. CONCLUSION: Ovarian squamous cell carcinoma arising from MCT is extremely rare, and it is rarely diagnosed preoperatively on imaging workups. Measuring the squamous cell carcinoma antigen level might be a useful diagnostic clue, and it might also be predictive of the tumor stage. An adequate staging surgery should be included in the standard treatment, but multicenter studies are needed to confirm this.