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Pediatric Blood & Cancer Nov 2021There is increasing recognition that contralateral metachronous tumor may occur following treatment of unilateral mature ovarian teratoma. We aimed to define this risk... (Review)
Review
There is increasing recognition that contralateral metachronous tumor may occur following treatment of unilateral mature ovarian teratoma. We aimed to define this risk to guide appropriate surveillance strategies. We undertook a systematic review of three large medical databases (Ovid Medline, Embase, and Cochrane Controlled Trials Register) to April 2020 using a defined search strategy. From 1831 articles retrieved, 23 were included, reporting 1101 girls with unilateral mature ovarian teratomas. The intensity and duration of follow-up varied between studies, with only five reporting close surveillance. Overall prevalence of metachronous contralateral mature teratoma was 2.1%, with a prevalence per study of 0%-23% (median 0%). Prevalence was higher (7%) among studies with more robust surveillance. These data suggest a small but real risk of metachronous contralateral tumors. Surveillance ultrasonography is proportionate and indicated alongside further prospective data collection to record the natural history and impact of surveillance in greater detail.
Topics: Female; Humans; Neoplasms, Second Primary; Ovarian Neoplasms; Prevalence; Teratoma; Ultrasonography
PubMed: 34331503
DOI: 10.1002/pbc.29237 -
Journal of Minimally Invasive Gynecology May 2021To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To review short- and long-term complications associated with intraoperative rupture of benign ovarian cysts.
DATA SOURCES
The Cochrane Central Register of Controlled Trials, BIOSIS, Medline (Ovid), Web of Science, ClinicalTrials.gov, and Google Scholar were searched using the following terms and their combinations: "spillage," "rupture," "leakage," "ovarian cyst," "teratoma," "dermoid," "operative," "surgery," "outcome."
METHODS OF STUDY SELECTION
Randomized controlled and observational studies evaluating the operative outcomes of surgical treatment of ovarian cysts with intraoperative spillage compared with those of surgical treatment of ovarian cysts without spillage were included. A systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was performed.
TABULATION, INTEGRATION, AND RESULTS
A total of 28 studies were included in the qualitative analysis and 12 in the quantitative analysis. Ovarian cyst diameter was not found to be associated with the risk for spillage (relative risk [RR] 0.75; 95% confidence interval [CI], -0.33 to 1.82). Intraoperative benign ovarian cyst rupture was not associated with adverse short- and long-term outcomes such as reoperation (RR 1.16; 95% CI, 0.39-3.48), infertility (RR 0.73; 95% CI, 0.15-3.63), transient fever (RR 3.22; 95% CI, 0.83-12.51), and readmission (RR 1.00; 95% CI, 0.33-2.98). However, intraoperative spillage was found to be associated with increased risk for benign recurrence (RR 3.1; 95% CI, 1.05-9.14). A subgroup analysis of the studies that included only dermoid cysts showed an association between intraoperative cyst rupture and postoperative chemical peritonitis (RR 9.36; 95% CI, 1.20-73.28).
CONCLUSION
Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes. Although the surgical approach (minimally invasive vs open) should not be affected by the concern regarding an intraoperative cyst rupture, maximal efforts should be made to prevent intra-abdominal spillage.
Topics: Female; Humans; Laparoscopy; Neoplasm Recurrence, Local; Ovarian Cysts; Peritonitis; Postoperative Complications; Teratoma
PubMed: 33279627
DOI: 10.1016/j.jmig.2020.11.025 -
European Journal of Obstetrics,... Jul 2021Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to... (Review)
Review
INTRODUCTION
Extragonadal teratomas (EGTs) are rare and the commonest intra-abdominal subtype is omental. We present two cases: 1) a parasitic omental teratoma likely secondary to auto-amputation of an ovarian teratoma with subsequent omental reimplantation and 2) an omental immature teratoma likely due to parthenogenetic activation of displaced primordial germ cells. We subsequently conduct a systematic review to characterise EGTs.
METHODS
We sourced for English, peer-reviewed case reports of extragonadal teratomas in women and female adolescents aged 11 and above published from inception of each database through 31st June 2020 following PRISMA guidelines. Two authors reviewed each case for appropriateness and each case was graded for methodological quality utilising a modified Newcastle Ottawa Scale. PROSPERO Registration Number: CRD42020190131 RESULTS: Upon literature review between 1920-2020, from an initial screen of 818 articles, 67 articles were selected featuring 70 cases. One case featured an immature teratoma while the remaining were mature. Omental EGTs were the most common (56.5 %) followed by Pouch of Douglas and uterosacral ligament (23.2 %) and upper abdomen (14.5 %). There were statistically significant differences in EGT mean sizes between each location with the largest being in the upper abdomen (10.9 cm) and the smallest being in the adnexa or hernia (6.2 cm). Auto-amputation was deemed the commonest cause amongst omental EGTs (55.3 %) and Pouch of Douglas and uterosacral ligament EGTs (37.5 %) while 70 % of upper abdominal EGTs were likely due to displaced primordial germ cells. We characterise clinical features associated with each pathogenic mechanism and imaging characteristics of EGTs. Characterisation of EGT tumour marker profiles was limited as only 42.9 % of cases reported them but 19.2-25.0 % had raised tumour markers. The main risks are torsion, rupture, immature components and potential malignant change of the cell lines. Treatment is largely surgical. The mean size of EGTs approached laparoscopically and via laparotomy was 5.23 cm and 9.16 cm respectively.
CONCLUSIONS
While rare, EGTs should be considered when evaluating pelviabdominal masses with imaging characteristics consistent with teratomas. Confirmation is usually intraoperative and a laparoscopic approach is reasonable if there is good surgeon comfort and the size is about 5 cm.
Topics: Abdominal Wall; Adolescent; Female; Humans; Omentum; Ovarian Neoplasms; Teratoma; Uterus
PubMed: 34022590
DOI: 10.1016/j.ejogrb.2021.05.005 -
Journal of Minimally Invasive Gynecology Jun 2021The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The incidence of adnexal masses in pregnancy is 1% to 6%. Although surgery is often indicated, there are no definitive management guidelines. We aimed to investigate the optimal approach to surgical management of adnexal masses in pregnancy on the basis of a meta-analysis of previous studies.
DATA SOURCES
We performed a systematic review using MEDLINE, Embase, Cochrane Library, and Clinicaltrials.gov from inception to July 17, 2020.
METHODS OF STUDY SELECTION
There were no restrictions on study type, language, or publication date. Comparative and noncomparative retrospective studies that reviewed operative techniques used in surgery of adnexal masses in pregnancy were included. Meta-analyses were performed to assess outcomes. This study was registered in the International Prospective Register of Systematic Reviews (CRD42019129709).
TABULATION, INTEGRATION, AND RESULTS
Comparative studies were identified for laparoscopy vs laparotomy and elective vs emergent surgery (11 and 4, respectively). Elective surgery is defined as a scheduled antepartum procedure. For laparoscopy vs laparotomy, the mean maternal ages and gestational ages at time of surgery were similar (27.8 years vs 27.7 years, p = .85; 16.2 weeks in laparoscopy vs 15.4 weeks in laparotomy, p = .59). Mass size was larger in those undergoing laparotomy (mean 8.8 cm vs 7.8 cm, p = .03). The most common pathologic condition was dermoid cyst (36%), and the risk of discovering a malignant tumor was 1%. Laparoscopy was not associated with a statistically increased risk of spontaneous abortion (SAB) or preterm delivery (PTD) (odds ratio [OR] 1.53; 95% confidence interval [CI], 0.67-3.52; p = .31 and OR 0.95; 95% CI, 0.47-1.89; p = .88, respectively). The mean length of hospital stay was 2.5 days after laparoscopy vs 5.3 days after laparotomy (p <.001). The decrease in estimated blood loss in laparoscopy was not statistically significant (94.0 mL in laparotomy vs 54.0 mL in laparoscopy, p = .06). Operative times were similar in laparoscopy and laparotomy (80.0 minutes vs 72.5 minutes, p = .09). Elective surgery was associated with a decreased risk of PTD (OR 0.13; 95% CI, 0.04-0.48; p = .05). Noncomparative studies were identified for laparoscopy and laparotomy. Laparotomy had more SABs and PTDs than laparoscopy (pooled proportion = 0.02 vs 0.07 and pooled proportion = 0.02 vs 0.14, respectively).
CONCLUSION
Laparoscopy for the surgical management of adnexal masses in pregnancy is associated with shorter length of hospital stay and similar risk of SAB or PTD. Elective surgery is associated with a decreased risk of PTD.
Topics: Adnexal Diseases; Female; Humans; Infant, Newborn; Laparoscopy; Laparotomy; Pregnancy; Retrospective Studies; Treatment Outcome
PubMed: 33515746
DOI: 10.1016/j.jmig.2021.01.020 -
The Journal of Craniofacial SurgeryIntracranial epidermoid cyst (EC) and craniofacial fibrous dysplasia (CFD) were histogenetically different rare congenital benign diseases. The coexistence of...
OBJECTIVES
Intracranial epidermoid cyst (EC) and craniofacial fibrous dysplasia (CFD) were histogenetically different rare congenital benign diseases. The coexistence of intracranial EC and CFD was extremely rare and had not been reported yet.
MATERIALS AND METHODS
We retrospectively reviewed the clinical and radiologic information of 3 patients diagnosed with concomitant EC and CFD at Beijing Tiantan Hospital from January 2003 to January 2021 and summarized their clinicopathological features, treatment modalities, and outcomes. In addition, we performed a systematic review of cases of the coexisting intracranial EC and other intracranial abnormalities to explore the potential connections.
RESULTS
There were 2 women and 1 man with the mean age of 31 years old. Satisfactory resection was fulfilled for all the 3 ECs. CFD, however, was managed with watchful waiting. During the mean follow-up time of 58 months, all the ECs showed no sign of recurrence, and all the CFD lesions remained stable. Two EC specimens underwent genetic study, showing no GNAS mutations and negative G s α protein expression. In the literature review of concomitant intracranial EC and other intracranial abnormalities, 23 studies were included. With 5 reported cases, the intracranial aneurysm was found to be the most common intracranial disease that coexisted with EC.
CONCLUSIONS
The coexistence of intracranial EC and CFD was extremely rare. However, no convincing mechanism and evidence underlying such coexistence had been found. To provide more profound understanding about these 2 diseases and improve diagnosis and treatment strategy, further research and verification should be considered.
Topics: Male; Humans; Female; Adult; Dermoid Cyst; Retrospective Studies; Fibrous Dysplasia of Bone
PubMed: 36727926
DOI: 10.1097/SCS.0000000000009166 -
International Journal of Surgery Case... Jul 2021Endobronchial teratoma is sporadic disease. The study aims to present a case with endobronchial teratoma with a brief literature review. A 26-year-old male presented...
INTRODUCTION
Endobronchial teratoma is sporadic disease. The study aims to present a case with endobronchial teratoma with a brief literature review. A 26-year-old male presented with a history of frequent attacks of chest infection for the last two years. Chest examination showed diffuse wheeze all over the left side of the chest. Chest x.ray showed opacification involving all of the left side of the chest with elevated left hemi diaphragm while computed tomography scan confirmed complete collapse of the left lung with consolidations and air bronchogram. Flexible bronchoscopy showed near-total obstruction of the left main bronchus. Under general anesthesia, left pneumonectomy was performed. The result of the histopathological examinataion showed mature teratoma.
CONCLUSION
Endobronchial teratoma is an exceedingly rare type of intrathoracic teratoma that mainly affects males and is usually diagnosed at the 3rd decade of life; lobectomy or pneumonectomy are optimal managements for these cases.
PubMed: 34186457
DOI: 10.1016/j.ijscr.2021.105877 -
Cureus Dec 2019The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients' and... (Review)
Review
The role of preoperative CA 19-9 levels in patients with ovarian mature cystic teratoma (MCT) and the association of elevated levels of the biomarker with patients' and tumor characteristics were evaluated. Four electronic databases were searched for articles published up to September 2019. Trials that evaluated the significance of elevated CA 19-9 in patients with ovarian MCTs and publications with > 20 patients were considered eligible for inclusion. Seven studies that included 995 patients with an ovarian MCT who were evaluated with elevated (n = 364) or normal (n = 631) CA 19-9 levels were included. Mean tumor size was significantly increased in patients with elevated CA 19-9 levels (p = 0.038). The rate of ovarian torsion was significantly increased in the elevated CA 19-9 group (p = 0.04). The present study highlights the importance of CA 19-9 as a marker in the diagnosis of MCT, and a meta-analysis supports that it could raise a high degree of clinical suspicion of early recognition of torsion and early surgical management due to complications related to increased size. Nonetheless, the diagnostic value of CA 19-9 is still limited and CA 19-9 can still serve only as a supplementary diagnostic tool in patients with MCTs.
PubMed: 31938630
DOI: 10.7759/cureus.6342 -
Urology Jan 2020To summarize the clinical characteristics and surgical management of adrenal teratoma in adults.
OBJECTIVE
To summarize the clinical characteristics and surgical management of adrenal teratoma in adults.
PATIENTS AND METHODS
We retrospectively reviewed 14 patients with adrenal teratoma from January 2002 to June 2017, at 2 large centers in China and performed a systematic review of 39 patients from our series and published literatures. The clinicopathological characteristics, imaging features, surgical management and outcomes of this rare disease were analyzed.
RESULTS
Our series includes 12 females and 2 males with the median age of 35. Seven patients were treated by open adrenalectomy (OA) and 7 by laparoscopic adrenalectomy (LA) without perioperative complications. All patients were alive without recurrence or canceration over a mean follow-up of 77.1 months. In the systemic review, the male-female ratio was nearly 1:3, with a median age of 29 years. Mean tumor size was 9.4 cm and the distribution was almost the same between left and right side (53.8% vs 46.2%). The most common symptoms were flank or abdominal pain (46.2%), whereas 53.8% patients were asymptomatic. Tumors were often cystic (63.9%) with intratumoral fat (91.7%) and calcifications (80.6%). All patients underwent surgery including 17 (43.6%) OA and 22 (56.4%) minimally invasive surgery. All tumors were pathologically confirmed mature teratoma except for one.
CONCLUSION
Adrenal teratoma is an extremely rare entity, frequently found to be large, benign and cystic. The patient's prognosis is generally good. As for its large volume, OA is the first choice for teratoma in most cases, while the LA can be an option in the small one.
Topics: Adrenal Gland Neoplasms; Adrenal Glands; Adrenalectomy; Adult; Asymptomatic Diseases; China; Female; Follow-Up Studies; Humans; Laparoscopy; Male; Prognosis; Rare Diseases; Retrospective Studies; Teratoma; Treatment Outcome
PubMed: 31195014
DOI: 10.1016/j.urology.2019.05.032 -
Journal of Korean Neurosurgical Society Nov 2021The occurrence of posterior fossa teratomas in adulthood is extremely rare. In this study, we aimed to report our experience with two cases of posterior fossa mature...
OBJECTIVE
The occurrence of posterior fossa teratomas in adulthood is extremely rare. In this study, we aimed to report our experience with two cases of posterior fossa mature teratoma in adults who underwent surgical resection. We also performed a systematic review of published papers available to date.
METHODS
We retrospectively reviewed the electronic medical records of patients who had onset of posterior fossa teratomas in adulthood at our institute between 1995 and 2020. We evaluated the clinical, radiographic, and pathological features of mature teratomas at the posterior fossa in adulthood. Furthermore, we searched the PubMed, EMBASE, and Web of Science database and reviewed published articles.
RESULTS
We found 507 articles on database review; of them, 102 were duplicates and 389 were excluded based on the inclusion criteria. Finally, 16 cases of posterior fossa from the web search and related articles. Subsequently, we added two cases that underwent surgery at our institute. We analyzed a total of 18 cases of mature teratomas. Headache was the most common (55.6%) symptom. The teratomas showed heterogeneous signals on magnetic resonance imaging. Thirteen patients (72.2%) had lesion at midline, five patients (27.8%) had calcification. Surgical resection was performed in all patients. No studies reported recurrence after resection.
CONCLUSION
The occurrence of posterior fossa teratomas in adulthood is difficult to diagnose at the initial stage. Radiographic diagnosis alone can lead to misdiagnosis. Pathological confirmation is essential. Surgical resection is a curative option for posterior fossa teratomas in adulthood.
PubMed: 34521185
DOI: 10.3340/jkns.2020.0343 -
Child's Nervous System : ChNS :... May 2022Here, we report a case of a 3-year-old female who presented to clinic with an enlarging mass in the posterior cervical midline. The mass was present since birth and...
Here, we report a case of a 3-year-old female who presented to clinic with an enlarging mass in the posterior cervical midline. The mass was present since birth and demonstrated no cutaneous stigmata. Plain film, CT, and MRI of the cervical spine (C3-C5) revealed enlargement of the spinal canal, soft tissue calcification, spinal dysraphism, and an intramedullary, predominantly fatty, mass. The mass had associated calcifications and a highly proteinaceous cyst. Surgical resection of the spinal lesion was subsequently performed. Histopathological evaluation revealed a mature teratoma. Cervical spinal teratomas in the pediatric population are rare entities with few cases currently reported in the literature. We conducted a systematic review to outline the current evidence detailing cases of intramedullary spinal cord teratomas. Six articles were included for final review. All patients in the included articles underwent maximal surgical resection with one patient also receiving chemotherapy and radiation. With our report, we aim to add to the literature on cervical intramedullary spinal cord teratomas in the pediatric population.
Topics: Cervical Vertebrae; Child; Child, Preschool; Female; Humans; Neck; Spinal Cord Neoplasms; Spinal Dysraphism; Teratoma
PubMed: 34676426
DOI: 10.1007/s00381-021-05385-4