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BMC Pregnancy and Childbirth Jun 2022Immature ovarian teratoma is one of the three common malignant ovarian germ cell tumors. However, immature ovarian teratoma in pregnancy is very rare. Due to the rare... (Review)
Review
BACKGROUND
Immature ovarian teratoma is one of the three common malignant ovarian germ cell tumors. However, immature ovarian teratoma in pregnancy is very rare. Due to the rare occurrence, there is little evidence regarding its diagnosis, optimal management, and prognosis. Hence, we present a case of immature teratoma diagnosed during pregnancy, and analyze its clinicopathological features, management and prognosis.
CASE PRESENTATION
A 28-year-old woman underwent a sonographic examination revealed no abnormality in the bilateral adnexal area before 29 weeks gestational age (WGA). At 29 WGA, ultrasound demonstrated a 9.7 × 8.5 × 6.4 cm complex structure in the left adnexal area. At 30 WGA, repeated ultrasound revealed rapid growth of tumor mass, measuring 25.0 × 15.0 × 13.7 cm. An elective cesarean section combined with exploratory laparotomy was performed at 33 WGA. Intraoperative frozen pathological examination suggested left ovarian immature teratoma. Then, she underwent a complete staging surgery. Subsequently, the patient received 4 cycles of bleomycin-etoposide-cisplatin (BEP) chemotherapy. After 18 months of follow-up, there is no sign of tumor recurrence till now.
CONCLUSIONS
This case report suggests that the benefits and risks of timely treatment for patients and fetuses should be fully assessed by a multidisciplinary team. The early diagnosis, the timing of surgery and chemotherapy, the choice of chemotherapy for BEP will determine the prognosis. Surgery and combination chemotherapy with BEP play an important role in the treatment of immature teratomas in pregnancy, and could gain successful and satisfactory outcomes for mother and fetus.
Topics: Adult; Cesarean Section; Female; Humans; Neoplasm Recurrence, Local; Ovarian Neoplasms; Pregnancy; Teratoma
PubMed: 35761185
DOI: 10.1186/s12884-022-04857-y -
World Journal of Clinical Cases Jun 2023We report a case of ruptured ovarian teratoma mimicking pelvic inflammatory disease (PID) and ovarian malignancy. The case indicates the need for reviewing the...
BACKGROUND
We report a case of ruptured ovarian teratoma mimicking pelvic inflammatory disease (PID) and ovarian malignancy. The case indicates the need for reviewing the information on ovarian teratomas, as the symptoms are vague, and, therefore, diagnosis and treatment had to be structured accordingly.
CASE SUMMARY
A 60-year-old woman was admitted to the emergency department with acute lower abdominal pain. She experienced weight loss and increased abdominal girth. Pelvic ultrasound and computed tomography revealed a 14-cm pelvic tumor. Laboratory examination revealed leukocytosis (white blood cell count: 12620/μL, segment: 87.7%) and high levels of C-reactive protein (18.2 mg/dL). Elevated levels of the tumor marker cancer antigen 19-9 (367.8 U/mL, normal value < 35 U/mL) were also noted. Due to the impression of a ruptured tubo-ovarian abscess or a tumor with malignancy, she immediately underwent an exploratory laparotomy. A ruptured ovarian tumor with fat balls, hair strands, cartilage, and yellowish fluid was observed on the right side. Right salpingo-oophorectomy was performed. A pathological examination revealed a mature cystic teratoma. The patient recovered after surgery and was discharged on post-operative day three. No antibiotics were administered.
CONCLUSION
This case illustrates the differential diagnosis of an ovarian tumor. Therefore, surgery is the mainstay for treating a ruptured teratoma.
PubMed: 37383124
DOI: 10.12998/wjcc.v11.i16.3852 -
Fukushima Journal of Medical Science Apr 2023Carcinoid tumors of the ovary are rare tumors, histopathologically classified as monodermal teratomas and somatic-type tumors arising from dermoid cysts. Their...
BACKGROUND
Carcinoid tumors of the ovary are rare tumors, histopathologically classified as monodermal teratomas and somatic-type tumors arising from dermoid cysts. Their malignancy varies from borderline to malignant. Carcinoid tumors can occur in young and elderly women, and are sometimes seen in mature teratoma, struma ovarii, or mucinous cystadenoma as a nodule or tumor. Strumal carcinoid and mucinous carcinoid present as special types of carcinoid tumors of the ovary.
CASE REPORT
This report describes a 56-year-old woman who presented with a large pelvic mass on abdominal ultrasonography during a medical examination. The diameter of the pelvic tumor was approximately 11 cm and was suspected to be ovarian cancer. The values of CA125 and CEA were above their reference intervals on preoperative examination. Abdominal total hysterectomy and bilateral salpingo-oophorectomy were performed. Intraoperative frozen-section histopathology suggested a diagnosis of mucinous adenocarcinoma; therefore, partial omentectomy and pelvic lymphadenectomy were also performed. Permanent-section histopathology led to a final diagnosis of strumal carcinoid of the ovary, stage IA (FIGO 2014). Six years post-operation, the patient had no sign of recurrence.
Topics: Female; Humans; Aged; Middle Aged; Struma Ovarii; Carcinoid Tumor; Ovarian Neoplasms; Teratoma
PubMed: 36878591
DOI: 10.5387/fms.2022-22 -
Journal of Neuro-ophthalmology : the... Mar 2022Opsoclonus-myoclonus syndrome (OMS) is a rare syndrome characterized by opsoclonus, which is irregular, spontaneous, multivectorial saccadic eye movements, along with...
Opsoclonus-myoclonus syndrome (OMS) is a rare syndrome characterized by opsoclonus, which is irregular, spontaneous, multivectorial saccadic eye movements, along with diffuse or focal myoclonus and sometimes ataxia. OMS is associated with paraneoplastic etiologies in 20%-40% of cases, with small-cell lung and breast cancers the most common associated primary neoplasms in adults, whereas neuroblastoma is more common in children and ovarian teratoma may occur in women younger than 30 years. Onconeural antibodies are often not identified. In existing literature, paraneoplastic OMS precedes identification of the neoplasm, and neurological recovery depends on treatment of the underlying cancer. We describe a 27-year-old woman with the delayed onset of OMS one month after resection of ovarian teratoma, likely due to immune trigger from antigen exposure at the time of resection. She was treated with intravenous methylprednisolone, immunoglobulins, and eventually rituximab with resolution of her symptoms. Identification of OMS after tumor resection and prompt immunotherapy are critical for neurologic recovery. At 30-month follow-up, this patient had not experienced recurrence of OMS.
Topics: Adult; Child; Female; Humans; Methylprednisolone; Opsoclonus-Myoclonus Syndrome; Ovarian Neoplasms; Teratoma
PubMed: 34417773
DOI: 10.1097/WNO.0000000000001384 -
Genes, Chromosomes & Cancer Jun 2021Teratomas are the most common tumors in the ovary during childhood. Previous studies suggested that they may be derived from germ cells at any developmental stage from...
Teratomas are the most common tumors in the ovary during childhood. Previous studies suggested that they may be derived from germ cells at any developmental stage from premeiotic oogonia through meiotic oocytes to post-meiotic ova. The majority of mature teratomas reveal normal karyotypes and immature teratomas show higher frequency of chromosomal abnormalities. We analyzed fresh tissue samples from 25 primary ovarian teratomas and three extraovarian deposits using whole genome single nucleotide polymorphism (SNP) array and karyotype. SNP array detected five patterns of copy neutral loss of heterozygosity (CN-LOH): failure of meiosis I (type I) in 12 tumors, failure of meiosis II (type II) in six tumors, endoreduplication of a haploid ovum (type III) in two tumors, premeiotic error (type IV) in four tumors, and both meiotic I and meiotic II errors in one tumor (type V). Three tumors with type I error had a single chromosome showing meiotic II error, and two tumors with type II error had a single chromosome showing premature sister-chromatid separation in meiosis I. Lack of recombination in multiple chromosomes in meiosis I were common, chromosomes 17, 7, 8, 21, and 22 were most commonly involved. Abnormal karyotypes were observed in four teratomas including +3, del(3q), +7, +8, +12, and i(18q). The extraovarian deposits revealed the same CN-LOH pattern as the primary teratoma. In summary, SNP array reveals the origin of ovarian teratoma and we propose a new mechanism that consecutive meiotic I and II errors occur frequently in ovarian teratomas.
Topics: Abnormal Karyotype; Adolescent; Child; Chromosomes; Female; Humans; Loss of Heterozygosity; Meiosis; Ovarian Neoplasms; Polymorphism, Single Nucleotide; Recombination, Genetic; Teratoma
PubMed: 33377559
DOI: 10.1002/gcc.22934 -
The Pan African Medical Journal 2019We describe a patient who developed nephrotic syndrome in the setting of ovarian tumor. A kidney biopsy showed minimal change nephropathy (MCN). CT scan and MR imaging... (Review)
Review
We describe a patient who developed nephrotic syndrome in the setting of ovarian tumor. A kidney biopsy showed minimal change nephropathy (MCN). CT scan and MR imaging followed by surgery lead to diagnostic of ovarian dermoid cyst. Surgery combined with corticosteroids resulted in a complete remission of nephrotic syndrome with disappearance of proteinuria after 3 weeks. Ten other cases of ovarian tumor associated with glomerulopathy are reviewed. This is the second case of an ovarian teratoma associated with MCN. Accurate history, physical examination, laboratory data, and kidney biopsy are highlighted in establishing the correct diagnosis in such patients.
Topics: Female; Humans; Magnetic Resonance Imaging; Middle Aged; Nephrosis, Lipoid; Nephrotic Syndrome; Ovarian Neoplasms; Proteinuria; Remission Induction; Teratoma; Tomography, X-Ray Computed
PubMed: 31819791
DOI: 10.11604/pamj.2019.34.75.6008 -
World Journal of Surgical Oncology Aug 2016Torsion is known to be the most frequent complication of ovarian teratomas. Torsion of the adnexa usually manifests with severe abdominal pain and is treated as an acute... (Review)
Review
BACKGROUND
Torsion is known to be the most frequent complication of ovarian teratomas. Torsion of the adnexa usually manifests with severe abdominal pain and is treated as an acute surgical emergency. However, it may be asymptomatic. Autoamputation of an ovary, along with other adnexal structures, due to previous torsion is extremely rare.
CASE PRESENTATION
A parasitic ovarian teratoma that underwent torsion, autoamputation, and reimplantation was found incidentally during laparoendoscopic single-site surgery (LESS). The amputated tumor was located in the omentum of the right upper abdomen of a patient with concomitant torsion of a left ovarian teratoma. The right ovary and tube were absent even though she had no surgical history. This finding could be interpreted as an autoamputation of the adnexa due to torsion of a previous ovarian cyst arising from the right ovary. We removed all masses by LESS.
CONCLUSIONS
Although both ultrasonography and computed tomography were performed preoperatively in our patient, the correct diagnosis of autoamputation and exact localization of the teratoma were extremely difficult. Physicians should consider the possibility of an autoamputated ovarian cyst even if preoperative radiography shows no calcification.
Topics: Aged; Amputation, Surgical; Female; Humans; Ovarian Cysts; Ovarian Neoplasms; Prognosis; Teratoma
PubMed: 27535361
DOI: 10.1186/s12957-016-0981-7 -
Reproductive Biology and Endocrinology... Nov 2020Ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is a severe autoimmune neurological disorder, and the influence of teratoma-induced...
BACKGROUND
Ovarian teratoma-associated anti-N-methyl-D-aspartate receptor encephalitis (NMDAR-E) is a severe autoimmune neurological disorder, and the influence of teratoma-induced autoantibodies on the pathogenesis remains unclear.
METHODS
Ovarian teratoma tissues were collected from teratoma patients with and without NMDAR-E. Proteins were extracted and then analyzed using iTRAQ-coupled LC-MS/MS, which was followed by bioinformatics analysis. Candidate proteins were verified by Western blotting and immunohistochemistry.
RESULTS
In total, 36 differentially expressed proteins (DEPs) were identified between the control group and NMDAR-E group, and the bioinformatics analysis revealed that the DEPs were mainly involved in immune-related pathways, especially HLA-A and HLA-DRB1. The western blotting results for HLA-A and HLA-DRB1 were consistent with the results of the iTRAQ analysis. Additionally, the immunohistochemical data revealed that the aggregation of HLA-A (+) and HLA-DRB1 (+) cells was more apparent in the teratoma tissues of NMDAR-E patients compared with that in the tissues of controls.
CONCLUSION
Our investigation indicated that HLA-A and HLA-DRB1 might be involved in mediating ovarian teratoma-associated NMDAR-E. These findings provide new insights into the pathophysiological mechanisms and provide information for the functional exploration of proteins in the future.
Topics: Adolescent; Adult; Anti-N-Methyl-D-Aspartate Receptor Encephalitis; Case-Control Studies; China; Female; Genetic Association Studies; Genetic Predisposition to Disease; HLA-A Antigens; HLA-DRB1 Chains; Humans; Ovarian Neoplasms; Teratoma; Young Adult
PubMed: 33160385
DOI: 10.1186/s12958-020-00661-5 -
Medicine Aug 2022There are debates on the management of immature ovarian teratoma and its recurrence. This study aimed to report the incidence of pelvic masses after surgery for immature...
There are debates on the management of immature ovarian teratoma and its recurrence. This study aimed to report the incidence of pelvic masses after surgery for immature ovarian teratoma and to identify prognostic factors of disease-free survival after surgery, discussing aspects of primary treatment and postoperative management. Data on the diagnosis and treatment of patients with immature teratomas were collected. Follow-up data were acquired from clinic visits and telephone interviews. Disease-free survival was defined as the time interval between the initial surgery for immature ovarian teratoma and the diagnosis of a new pelvic mass. Survival curves were drawn using the Kaplan-Meire method, and multivariate analysis was performed using the Cox proportional hazard regression model using PASW statistics software. The estimated 5-year disease-free survival and overall survival were 74.3% (95%CI 63.9%-84.7%) and 96.5% (95%CI 91.6%-100.0%), respectively. The incidence of growing teratoma syndrome and immature teratoma relapse at a median follow-up of 46 months were 20.0% and 7.7%, respectively. Two patients died of repeated relapses or repeated growing teratoma syndrome. Rupture of initial lesions (RR 4.010, 95%CI 1.035-5.531), lymph node dissection (RR 0.212, 95%CI 0.051-0.887) and adjuvant chemotherapy (RR 0.143, 95%CI 0.024-0.845) were independent prognostic factors for disease-free survival. The development of growing teratoma syndrome is more prevalent than relapse after treatment of immature ovarian teratomas. Lymph node dissection and chemotherapy are recommended to reduce recurrence. Close surveillance and active surgical intervention are important for the diagnosis and appropriate management of new pelvic masses.
Topics: Digestive System Abnormalities; Disease-Free Survival; Female; Humans; Neoplasm Recurrence, Local; Ovarian Neoplasms; Recurrence; Syndrome; Teratoma
PubMed: 35945757
DOI: 10.1097/MD.0000000000029727 -
Frontiers in Endocrinology 2021Neuroendocrine neoplasms are a heterogeneous group of cancers that develop from enterochromaffin cells of the diffuse endocrine system, with an increase in incidents...
BACKGROUND
Neuroendocrine neoplasms are a heterogeneous group of cancers that develop from enterochromaffin cells of the diffuse endocrine system, with an increase in incidents over the last years. Ovarian neuroendocrine tumors (NET) are rare neoplasms, comprising 0.1% of all ovarian neoplasms and less than 5% of all neuroendocrine tumors. They may arise alone (as monodermal, specialized teratoma - ovarian carcinoid) or as a part of other ovarian lesion: cystic mature or immature teratomas. Due to the rarity and limited amount of such cases reported in the literature, there is no consensus on diagnostic and therapeutic procedures in this group of patients.
MATERIALS AND METHODS
The group of 10 patients at the age of 19 to 77 years (mean 42.8 ± 17.9), diagnosed with unilateral NET within ovarian teratoma were analyzed. The histopathological type of tumor, progression free survival after surgical treatment and presence of hormonally active syndrome were assessed.
RESULTS
70% (n=7) of patients was diagnosed with mature cystic teratomas containing NET component and 30% (n=3) with monodermal teratoma (strumal carcinoid). All cases of monodermal teratomas were found in women at premenopausal age. Determined Ki67 ranged from 2% to 9%. Ninety percent of lesions (n=9) stained positive for synaptophysin and chromogranin, while markers: CK20, CK7, TTF-1 and CDX2 were negative in all cases, which ruled out their metastatic nature. None of the patients presented with carcinoid syndrome. All followed-up patients remain progression-free, which confirms surgical intervention being a crucial and sufficient method of treatment.
CONCLUSIONS
The prognosis and clinical behavior of NETs associated with ovarian teratomas are good with long progression-free survival.
Topics: Adult; Aged; Biomarkers, Tumor; Female; Humans; Middle Aged; Neuroendocrine Tumors; Ovarian Neoplasms; Ovary; Prognosis; Teratoma; Young Adult
PubMed: 34917031
DOI: 10.3389/fendo.2021.770266