Nodular and tumorlike gliomatosis peritonei with endometriosis caused by a mature ovarian teratoma

Abstract

Peritoneal glial implants are found in childhood, adolescence as well as in young women and are the result of a ruptured capsule of mature or immature teratoma of the ovary. The implants of glia nodules have a distinct gross feature and are localized mostly in the parietal and visceral peritoneum, in the omentum and in the space of Douglas. According to the review by Robboy and Scully (1970), seventeen other cases have been reported. A ten year old girl was operated on for a benign cystic teratoma of the right ovary. After an interval of 12-13 years, two laparotomies were performed because of recurring pains, adhesions of the abdomen and the formation of tumor-shaped resistances. Biopsies from both operations taken from the peritoneum, omentum and space of Douglas yielded disseminated gliomatosis and endometriosis. The uniqueness of this case lies in the length of the interval of 12 years after the operation, the size of the gliomatosis-tumor in the pelvis as well as its regressive changes. X-ray examination of this tissue revealed diffuse calcification. A partially infiltrative growth of the glial mass into fat tissue was determined despite the low grading of the implant. The size of the tumor-like infiltration can be understood as a result of growth and confluence of several nodes. As an expression of a local defense reaction, there was found at one location on the circumference of a glial node an intense lymphofollicular infiltration. The combination of gliomatosis and endometriosis has not been observed up until now. The formation of endometriod glands could be the result of a metaplasia of the subcoelomic mesenchyme. Peritoneal gliomatosis can be considered to be implantation metastases of ovarian teratoma with varying degrees of maturity.