Morphological Spectrum of Ovarian Teratomas: A 6 Years Experience at a Specialized Diagnostic Institute

Fatima Khalid,Samina Zaman,Anila Chughtai,Sameen Afzal,Akhtar Sohail Chughtai,Ghazi Zafar

doi:10.47489/pszmc-805-35-3-31-36

Abstract

Introduction: Ovarian teratomas include mature cystic teratoma (MCT), immature teratoma (IT) and monodermal teratoma (MoT). Malignant transformation (MT) can occur in MCT and MoT, which remains a diagnostic challenge.Aims & Objectives: To discuss the morphological spectrum of ovarian teratomas reported during the last six years at our specialized diagnostic institute and determine the frequency of MT in MCT and MoT.Place and duration of study: The study was carried out at Chughtai Institute of Pathology from January 2015 to December 2020.Material & Methods: A retrospective study was performed by retrieving 1018 cases of ovarian teratomas reported in last 6 years. SPSS version 20 was used for data analysis.Results: MCT was most frequent ovarian teratoma with frequency of 95.6% (n=973), 2.26% (n=23) being IT and 2.16% (n=22) being MoT. IT were mostly seen in pediatric age group. MT in benign MCT was seen in 0.72% of MCT (n=7). Squamous cell carcinoma was most frequent malignancy 71.4% (n=5). One case of MoT also showed MT into papillary thyroid carcinoma, classic type, with frequency of MT in Mot being 4.76% (n=1). All MT in MCT had age >30 yearswhich was a significant finding (p <0.001).Conclusion: Ovarian masses in postmenopausal patients with suspicious radiological features, irrespective of lesional size warrant a thorough gross examination, extensive sampling and a careful microscopic evaluation.

Highlights

Ovarian teratomas include mature cystic teratoma (MCT), immature teratoma (IT) and monodermal teratoma (MoT)
A total of 95.6% (n=973) were MCT with 94.9% (n=966) diagnosed as benign MCT (Table-2). 0.72% (n=7) of the cases showed a malignancy arising in MCT. 5 cases were of squamous cell carcinoma (71.4%), 1 was mucinous adenocarcinoma, 1 was high grade B-cell NonHodgkin Lymphoma (NHL)
All malignancies arising in MCT had age >30 years with 3.05% chance of malignancy over the age of 40 years compared to overall chance of malignancy of 0.72% for all age groups

Summary

Introduction

Ovarian teratomas include mature cystic teratoma (MCT), immature teratoma (IT) and monodermal teratoma (MoT). That arise from ectopic pluripotent stem cells that fail to migrate from yolk sac endoderm to the urogenital ridge during embryogenesis They comprise elements from all three embryological germ layers i.e. endoderm, mesoderm and ectoderm.[1] Teratomas include mature cystic teratomas (MCT), immature teratomas (IT) and monodermal teratomas (MoT). MCT are well differentiated relative to the germ cell layers while immature teratomas are incompletely differentiated and contain embryonic tissue along with neuroepithelium.[2,3,4,5] The IT are graded from I to III on the basis of quantity of neuroepithelium.[6,7] MoT are composed of a single tissue type and usually contain thyroid tissue, in which case they are referred to as struma ovarii.[8] Malignancy can arise in struma ovarii. The age of presentation of malignancy in struma ovarii is usually in the 5th decade of life, with thyroid type malignancies being the most common.[9,10,11]

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Discussion

Conclusion