Transformación de teratoma en rabdomiosarcoma / Transformation of teratoma in rabdomiosarcoma

Los teratomas son tumores germinales malignos compuestos por dos o más capas de tejido, que ocasionalmente se transforman en estirpes con crecimiento agresivo. Se presenta el caso de un paciente de 29 años con un tumor germinal gonadal localizado en testículo, cuya evolución fue desfavorable por presentar transformación en un fenotipo correspondiente a un rabdomiosarcoma. La patología aquí descripta deviene del crecimiento diferencial de un componente ya existente en el tumor original o la transformación en un linaje somático que se hace dominante. Los tumores transformados como el del caso descripto son raros y presentan características diferentes de la mayoría de las neoplasias germinales respecto del comportamiento, el pronóstico y la sensibilidad a los tratamientos establecidos.

Teratomas are malign germ cell tumors composed of two or more tissue layers. When there is specific organ differentiation they are called mature teratoma. They rarely grow aggressively. We report the case of a 29 year-old man with a diagnosis of gonadal germ cell tumor whose evolution was unfavorable owing to transformation into a different phenotype corresponding to a rhabdomyosarcoma. This phenomenon occurs through differential growth of a single histological component of the original tumor or transformation of a somatic lineage that becomes dominant. Transformed tumors such as the one herein described differ from most germ cell neoplasms regarding behavior, prognosis, and susceptibility to established treatments.

Malignización de teratoma maduro de ovario / Malignant transformation of ovarian mature teratoma

Presentar dos casos con malignización de teratoma maduro de ovario. Con clínica inicial inespecífica y aumento progresivo de la circunferencia abdominal. En ambos el ultrasonido y la TAC de abdomen revelaron imágenes de aspecto tumoral por lo que se realizaron otros estudios, no identificando enfermedad a distancia. La biopsia definitiva de la intraoperatoria del anexo derecho e izquierdo respectivamente de cada caso, concluyó adenocarcinoma bordeline mucinoso y adenocarcinoma borderline seroso en un teratoma maduro de ovario. El estadio clínico fue IIIC y recibieron quimioterapia adyuvante. Ambos se mantienen libres de enfermedad

The malignancy of an ovarian mature teratoma is a rare find. We present two cases with nonspecific initial clinical and progressive increase in abdominal girth. In both ultrasound and CT of the abdomen revealed tumor-like images so other studies were conducted to identify distant disease. The final biopsy Annex intraoperative right and left respectively of each case, borderline mucinous adenocarcinoma concluded borderline serous adenocarcinoma in a mature teratoma of the ovary. Clinical stage was IIIC and received adjuvant chemotherapy. Both patients remain free disease

Immature teratoma of the ovary: A clinicopathological study of 28 cases.

Aim: Immature teratoma (IT) of the ovary represents 1% of all ovarian cancers and 20% of malignant ovarian germ cell tumors. This retrospective study of 28 such cases aims to look at its morphological spectrum and to study the correlation of the grade and stage of the tumor with prognosis. Materials and Methods: A retrospective study of 28 cases of IT of the ovary was done. Neuroepithelium was graded as grade I, II and III according to the standard criteria. The presence of immature mesenchyme was also looked for and similarly graded. Results: The median age for the cases was 19 years and abdominal pain was the commonest symptom. Neuroepithelium was seen in 26 cases (6 were grade I, 13 were grade II, and 7 were grade III); and two showed immature mesenchymal tissue (IM) only. IM was seen in all 28 cases, but no correlation with the grade of the IT of the ovary is found. The follow up is available in 23 cases ranging from 6 months to 78 months (median 33 months). Of these, 13 were stage I, 3 were stage II and 7 were stage III ITs. Out of 23 patients, 17 patients were alive without evidence of disease recurrence during the last follow up. Adverse events in the form of death and local recurrence occurred in 6 patients. One patient died of the disease at 7 months duration from the disease onset (stage III, grade II IT). Conclusion: Morphological spectrum of IT of ovary is varied. Immature mesenchyme was seen in all the cases of IT of ovary and its presence should prompt a careful search for immature neuroepithelium. Stage I IT of ovary has better prognosis. Combination of surgery and chemotherapy can give longer survival even in recurrent disease.

Teratoma imaturo de ovário na gestação: relato de caso e revisão da literatura / Immature ovarian teratoma in pregnancy: case report and literature review

O teratoma imaturo de ovário é uma neoplasia maligna derivada de células embrionárias de diferenciação somática. Sua incidência é baixa, e rara em gestantes. Costuma se manifestar em pacientes jovens, sendo, frequentemente, assintomáticos. Relata-se aqui o caso de uma paciente de 21 anos que veio à consulta apresentando ecografia obstétrica de 25 semanas, com presença de massa anexial à esquerda. Uma nova ecografia, realizada dois dias após a primeira avaliação, revelou massa de aspecto heterogêneo, sólido-cístico, septada, com 9,4cm em seu maior diâmetro. Havia presença de líquido livre na cavidade abdominal, ocupada por formações teciduais de distribuição ampla. Duas semanas após a primeira consulta, foi submetida à laparotomia exploradora com salpingo-ooforectomia unilateral e ressecção de implantes peritoneais, obtendo citorredução ótima. O laudo histopatológico revelou teratoma imaturo de ovário grau III, com líquido de ascite negativo para células malignas. Realizados 3 ciclos de quimioterapia adjuvante, segundo protocolo BEP (bleomicina, etoposide e cisplatina), os dois primeiros com a gestação em curso. Com 36 semanas de gestação, iniciou-se a indução de trabalho de parto, com boa evolução. O recém-nascido apresentou um índice de Apgar de 8/8, sem sinais de danos secundários à quimioterapia. No momento, a paciente encontra-se assintomática e livre de doença no décimo quarto mês pós-operatório. Acredita-se que esse trabalho possa acrescentar ao conhecimento atual da doença, visto a raridade do caso e a escassa quantidade de literatura disponível.

Retroperitoneal teratoma with predominance of nephroblastic elements: a case report

The morphological features of a retroperitoneal teratoma in a 10-month-old girl are reported. Unlike the usual pattern of the teratoma, this tumor was composed predominantly of nephroblastomatous tissue. Histologically, glomeruloid and tubular structures were identified in nests of undifferentiated blastemal elements. Hyaline cartilage, adipose tissue, glial tissue and glands lined by mucin-secreting columnar epithelium were minor elements. A focal cystic structure lined by thin flattened epithelium was also noted. Retroperitoneal teratoma with predominance of nephroblastic elements is of interest not only because of its rarity but also because it needs to be differentiated from extrarenal Wilms' tumor, since both of these tumors have different origins.