Malignant Transformation Of Mature Cystic Teratoma Research Articles

Mature Cystic Teratoma: An Integrated Review.

Ovarian dermoid cysts, also called mature cystic teratomas (MCTs), account for 69% of ovarian germ cell tumors in young women. The tumors are formed by tissues derived from three germ layers, and sebaceous materials are most commonly seen. The origin of MCTs is widely considered to be the germ cell origin, which completes meiosis I. The clinical symptoms vary widely, but 20% of tumors could be asymptomatic. The diagnosis of MCTs is usually made without difficulty by ultrasound and confirmed by histopathology post-operatively. The imaging findings have a high diagnostic value. The typical characteristics present in the sonographic images, including a dermoid plug or Rokitansky nodule, are considered strong evidence for a teratoma. Although the malignant transformation of MCTs is rare, it can occur in some cases, especially in women of advanced age. The treatment of MCTs depends on the risk of malignancy, the age of the patient, and the patient's fertility reserve requirement. In this article, we review the epidemiology, clinical symptoms, diagnosis criteria, cellular origin, and treatment of mature cystic teratomas.

Incidental risk of malignancy in mature cystic teratoma: experience of a single tertiary center

We aimed to evaluate the incidental risk of malignancy in mature cystic teratomas (MCT) and check the management. We retrospectively reviewed records of patients diagnosed and treated with MCT and divided patients into two groups as pure MCT and malignant transformation of MCT. In our clinic incidence of incidental malignant transformation of ovarian MCTs was 2.7%. Median age (p = 0.005) and mass size (p = 0.027) were statistically higher in malignant group. The most common histological type of malignant transformations was malignant struma ovarii (35.7%). In malignant group, five-year disease-free survival was 66.7% and five-year overall survival was 86.7%. Although the risk of malignancy in mature cystic teratomas is rare, it should not be ignored. Age, mass size, and preoperative imaging should all be evaluated with suspicion and if available, frozen section should be used. Management is inconsistent as a result of its rarity. New management practices should be developed with further studies.

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

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.

Rapid malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma

Abstract Introduction: Malignant transformation of mature cystic teratoma (MCT) is extremely rare and has poor prognosis. We report a case of malignant transformation of ovarian MCT into undifferentiated carcinoma, that showed extremely rapid progression after surgery. Patient concerns: A 51-year-old woman presented with complaints of abdominal swelling, pain and fever. Computed tomography (CT) and transvaginal ultrasonography revealed a cystic mass in the pelvis. Diagnosis: Based on the CT findings, ovarian tumor with possible rupture was provisionally diagnosed. However, post-operative histopathology showed malignant transformation of mature ovarian cystic teratoma into undifferentiated carcinoma. Interventions: Total abdominal hysterectomy with bilateral salpingo-oophorectomy and omentectomy was performed. Outcomes: Positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) after surgery showed multiple FDG uptake in liver, paraaortic lymph nodes and mesentery. Adjuvant chemotherapy was started, but the patient died 3 months after the surgery due to disease progression. Autopsy findings confirmed the metastases of undifferentiated carcinoma in liver, mesentery and left lung. Conclusions: Malignant transformation of MCT into undifferentiated carcinoma can be rapid and has poor outcomes. Pre-operative diagnosis is very difficult. Moreover, limited literature makes it difficult to establish the standardized treatment strategy for these patients. This case report shows that progression of this malignancy can be rapid despite surgery and chemotherapy.

Incidence and Associated Risk Factors of Patients with Malignant Transformation Arising in Mature Cystic Teratoma of the Ovary in Rajavithi Hospital

Objectives: To review the incidence and evaluate risk factors associated with malignant transformation in mature cystic teratoma (MCT) of the ovary.Methods: A retrospective medical record review for 571 patients diagnosed as ovarian MCT who were treated at Rajavithi Hospital from January 2005 to June 2017 was performed. The demographics data, preoperative investigations, pathological findings, adjuvant treatments, and follow-up outcomes were obtained and analyzed. Results: Forty patients with malignant transformation in MCT were detected over a period of 12 years. The incidence rate was 7% of all MCT. Squamous cell carcinoma was the most common histologic type (45%) and the most of them were stage I (80%). Patients with malignant transformation were significantly older than those benign MCT (48.4 years vs 37.5 years, p 10 cm. (OR 6.68; 95%CI, 2.39-18.65), solid part from ultrasound findings (OR 5.30; 95%CI, 1.63-17.24), and RMI score ≥200 (OR 8.69; 95%CI, 1.68-44.89) were a significant predictor of malignant transformation arising in MCT. Performance validation with a cut-off level of RMI ≥200 showed the AUC was 0.879, with 47.5% sensitivity, 98.4% specificity, 82.6 % positive predictive value, and 92.2% negative predictive value, respectively. Conclusion: Early detection and complete surgical resection of ovarian cancer are important for a long-term survival. Large tumor size and solid part from ultrasound finding were associated with malignant transformation in MCT. Additionally, calculating RMI score might be a useful diagnostic tool to detect malignancy in this setting, and adequate staging surgery should also be considered.

Malignant transformation in mature cystic teratoma of the ovary: a retrospective study of eight cases and review of literature.

IntroductionMature cystic teratoma (MCT) is the most common type of ovarian germ cell neoplasm, but occasionally it may undergo malignant change in any one of its elements. In this study, these rarely encountered tumors, occurring over a period of 25 years, were studied.Material and methodsA retrospective, tertiary hospital-based study was carried out in all histopathologically diagnosed cases of MCT (230) of the ovary from January 1990 to December 2014. The clinicopathological features of malignant transformation (MT) in MCT of the ovary were retrieved from the archives of the Department of Pathology and were analyzed.ResultsTwo hundred thirty (230) mature cystic teratomas of the ovary were found. MT was noted in eight of these cases, i.e. 3.5% of all the MCT. The mean age of the patients with MCT was 32.5 ±13.11 while the mean age of the patients with malignant transformation in MCT was 44.2 ±8.94 years. Grossly the mean size of the malignant teratoma was 11.7 ±2.7 cm, whereas it was 7.6 ±2.1 cm for mature cystic teratoma. Squamous cell carcinoma (SCC) was the most frequent MT seen in four out of eight cases, while one case showed an adenocarcinoma and the other a malignant melanoma, and two cases had transitional cell carcinoma.ConclusionsThe rate of malignant transformation in MCT increases with age and is much higher in the postmenopausal age group. Moreover, although SCC is still the commonest, transitional cell carcinoma (TCC) may also develop not infrequently as malignancy apart from other rare differentiations such as adenocarcinoma or malignant melanoma in an MCT.

Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: a Taiwanese Gynecologic Oncology Group (TGOG) study.

ObjectiveThe malignant transformation (MT) of ovarian mature cystic teratoma (MCT) to squamous cell carcinoma (SCC) is very rare. This study analyzed cases from multiple medical centers in Taiwan to investigate the clinicopathologic characteristics, treatment, and prognostic factors of this disease and reviewed related literature.MethodsPathological reports of 16,001 patients with primary ovarian cancer who were treated at Taiwan medical centers from 1990 to 2011 were reviewed. In total, 52 patients with MT of MCT to SCC were identified.ResultsAmong all ovarian MCTs, the incidence of MT to SCC is 0.2%. The median age of patients was 52 years (range, 29–89 years), and the mean tumor size was 10.5 cm (range, 1–40 cm). We analyzed the patients in our study and those in the literature and determined that early identification and complete surgical resection of the tumor are essential for long-term survival. In addition, adjuvant chemotherapy or concurrent chemoradiotherapy can be used to treat this malignancy. Old age, large tumor size (≥15.0 cm), and solid components in MCTs are suitable indicators predicting the risk of MT of MCT to SCC.ConclusionSimilar to general epithelial ovarian cancers, the early detection of MT of MCT to SCC is critical to long-term survival. Therefore, older patients with a large tumor or those with a tumor containing a solid component in a clinically diagnosed MCT should be evaluated to exclude potential MT to SCC.

Papillary carcinoma of the thyroid in a mature cystic teratoma of the ovary: a case report

Mature cystic teratomas (MCT) are composed of a mixture of tissues derived from all three germ layers and are the most common ovarian tumor in both adolescents and women of reproductive age. Although most of these tumors are benign, malignant transformation of MCT occurs only in about 1-2% of cases. Any of the tissues within the MCT, can change malignant transformation. Struma ovarii is a rare ovarian tumor, reported as %0.5-1 of all ovarian masses and

Squamous Cell Carcinoma Arising in Ovarian Teratoma: A Diagnostic Conundrum.

Sir, Germ cell tumors (GCT) comprise 20–30 % of the ovarian tumors [1]. Mature cystic teratoma (MCT) is the most common benign GCT comprising 10–20 % of all tumors in women of reproductive age group. The cancers in the ovary are most commonly of epithelial origin with serous cystadenocarcinoma and mucinous cystadenocarcinoma comprising the majority of these lesions. Malignant germ cell tumors are less common and malignant transformation of MCT is rare. Most common malignancy to occur in the setting of MCT is SCC, though other malignancies including sarcomas, melanomas and carcinoid have been highlighted in case reports [2]. The other differentials of SCC in the ovary to the considered are of de novo origin, metastases and transformation in endometriotic foci. De novo origin of SCC in an ovary is extremely rare [3]. We recently reviewed two cases of SCC in the background ofMCT. Both these middle aged females presented with a few months history of vague lower abdominal pain and distension. Evaluation revealed unilateral ovarian masses. CA-125 levels were normal. Pre-operative diagnosis of malignant epithelial ovarian neoplasm was considered in both cases and staging laparotomy was performed. Histopathology, however, revealed a diagnosis of MCT with malignant transformation based on the findings of solid cystic tumor showing areas of calcification, fat and hair [Fig. 1]. The clinical features, imaging findings and per-operative findings are no different from other ovarian malignancies and the diagnosis is established by histopathology. The importance of diagnosing this entity preoperatively lies in the prognosis that has been found to be uniformly poor even after several forms of adjuvant treatment. These tumors usually present in the post-menopausal women with the age range of 45–65 years, though cases of these tumors in young women have been documented in literature [4]. Patients present with non-specific complaints of vague abdominal pain, nausea, vomiting, constipation, vaginal bleeding, abdominal enlargement and weight loss. Examination findings including the abdominal and per-vaginal examination are non-specific and reveal a pelvic or abdomino-pelvic mass. Imaging in these cases is not specific and confirms the presence of a complex pelvic mass and provides an insight into the disease extent and the presence of metastases that is critical before the surgical exploration is undertaken. However, certain clinical, imaging and biochemical markers for suspecting these cases have been suggested by various researchers. These include older age at presentation, large size (>10 cm at presentation) and proportion of solid component [5]. The most important differential diagnosis to be considered is the metastasis, particularly from cervical carcinoma, by both clinical examination and at histopathology [6]. S. Sharma (*) :N. Gupta :A. Rajwanshi Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: drsaniya.sharma@gmail.com

Malignant Transformation Arising From Mature Cystic Teratoma of the Ovary: A Retrospective Study of 20 Cases

Mature cystic teratoma (MCT) of the ovary rarely undergoes malignant transformation (MT). Malignant transformation carries a significantly worse prognosis than epithelial ovarian cancer, regardless of whether postoperative chemotherapy or radiotherapy is applied. The rarity of this tumor has posed a significant challenge to developing standardized postoperative management protocols. The aim of this study was to review our experience with MT and to describe our current treatment practices. A retrospective chart review of these patients was performed that identified 20 women treated for MT of MCT at our centers between 1988 and 2008. The median age was 52.5 (range, 29-77) years. Fifteen patients had squamous cell carcinoma (SCC), and 5 patients had other histological subtypes. The International Federation of Gynecology and Obstetrics stage distribution was as follows: 11 were stage I, 4 were stage II, 4 were stage III, and 1 was stage IV. All patients underwent an initial laparotomy. Eleven patients received adjuvant treatment: 8 were treated with chemotherapy, 2 with concurrent chemoradiation therapy, and 1 with radiation therapy. Platinum-based chemotherapy was the first-line regimen. The overall 1-year survival rate was 70%. Significant correlations between overall survival and age, stage, and residual tumor were presented (P = 0.044, P = 0.0107, P < 0.0001, respectively). Eight patients with advanced stage died of their disease. Four patients, however, were treated with adjuvant chemotherapy or concurrent chemoradiation therapy and survived more than 1 year. One stage III patient had a disease-free interval of 2 years. Two cases of SCC treated with combination platinum/taxane chemotherapy temporarily responded. In the other 2 cases of SCC, concurrent chemoradiation therapy with nedaplatin also resulted in tumor regression. The prognosis of MT is highly dependent on age, stage, and optimal cytoreduction. Adjuvant treatment has not been standardized, although our experience supports the use of combination platinum/taxane chemotherapy.

Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature

The incidence of malignant transformation in mature cystic teratoma (MCT) of the ovary is less than 2% as reported in gynaecological and pathological literature. Here we present a series of five patients, who developed malignant transformation in MCT of the ovary, over a 6-year period (1999-2004). The morphological and clinico-pathological features of malignant transformation in MCT of the ovary are discussed.

Ovarian mature cystic teratoma with malignant transformation. An interphase cytogenetic study.

The chromosomal composition of cancers arising in ovarian mature cystic teratoma (MCT) was analyzed using chromosome in situ hybridization (CISH) performed on paraffin-embedded material from 10 squamous cell carcinomas, 1 adenocarcinoma, 1 thyroid papillary carcinoma, and 1 strumal carcinoid. Cervical tissue from seven of these patients was used as a control. In the cancers, a relative gain of chromosome 16 (in 7 cases), chromosome 12 (in 9), chromosome 11 (in 10), and chromosome X (in 8) was detected. Trisomy 12 was diagnosed in eight cases. No chromosomal aberrations were detected in the strumal carcinoid. In the benign areas of the MCTs, only one case showed a gain of chromosome 11, although, in another case, there was a gain of chromosome X. Malignant transformation of MCTs often occurs in association with complex chromosome aberrations that may play a role in the development of such carcinomas.