ABSTRACT
Gynecologic teratomas commonly present with pelvic symptoms. The authors report a case of teratoma causing acute psychosis, encephalopathy, and sudden-onset seizures in a previously healthy 33-year-old woman. After common organic causes were excluded, investigation revealed an immature teratoma containing brain tissue on her left ovary. Anti-N-methyl-D-aspartate receptor encephalitis was diagnosed and, with excision and medical management, her symptoms resolved and she was discharged home in stable condition. Encephalopathy is not commonly attributed to gynecologic causes, but anti-N-methyl-D-aspartate receptor encephalitis may be caused by ovarian teratomas with a neuronal component. Thorough gynecologic examination should be performed on any female patient presenting with new-onset psychosis, encephalopathy, and seizures, especially in the absence of other organic or structural causes. Thus, it is important to look at the whole patient and not just the symptoms.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Ovarian Neoplasms/etiology , Teratoma/diagnosis , Adult , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Biopsy , Diagnosis, Differential , Female , Humans , Ovarian Neoplasms/diagnosis , Teratoma/etiology , Tomography, X-Ray ComputedABSTRACT
Although research has shown that palliative chemotherapy is beneficial compared to lack of treatment (Schorge JO, Schaffer JI, Halvorson LM, et al. ed. Williams Gynecology. New York, NY: McGraw Hill Medical; 2008.), other studies show aggressive end-of-life treatment adversely affects quality of life and shortens life span (Arriba L, Fader A, Frasure H, von Gruenigen V. A review of issues surrounding quality of life among women with ovarian cancer. Gynecol Oncol. 2010;119(2):390-396.). Without a consensus on palliative chemotherapy, underutilization during end of life prevails, and likely will continue without additional research (Barbera L, Elit L, Krzyzanowska M, et al. End of life care for women with gynecologic cancers. Gynecol Oncol. 2010;118(2):196-201.). This article aims to evaluate and examine existing chemotherapy for palliation of malignant ascites secondary to ovarian cancer and compare commonly used regimens. Agents will be evaluated by their modes of administration. Oral agents include cyclophosphamide and thalidomide, and intraperitoneal vehicles include taxane-based agents, platinum-based agents, antibiotics, and biologic agents. In addition, cost, ethics, and quality of life discussions factor into this review. Palliative care's goal is to find a balance between life expectancy and symptom relief with minimal adverse effects.
