Malignant Transformation Of Mature Teratoma Research Articles

Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusual imaging findings.

We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (< 50% of the entire tumor) in a childbearing woman. The patient presented with non-specific abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior fat-containing locus compatible with mature cystic teratoma and a posterior predominantly solid component with low signal intensity on T2-weighted images that was histopatologically diagnosed as benign thyroid tissue. Thyroglobulin levels were in normal range. Although thyroid tissue is present in up to 20% of mature cystic teratomas, with exception of struma ovarii, it is not usually macroscopically nor radiologically identified. The differential diagnosis should include T2-hypointense adnexal lesions associated with mature cystic teratoma, malignant transformation of mature teratoma, and immature teratoma.

当院での13 年間における成熟奇形腫の悪性転化8 例の検討

成熟奇形腫の悪性転化を予測することは難しい．従来の報告では，悪性転化の予測因子として腫瘍径，腫瘍マーカー，年齢が挙げられている．今回我々は2003 年1 月から2015 年12 月までの13 年間に当院で治療した成熟奇形腫悪性転化の8 症例を検討した．8 症例で先の項目の中央値を検討したところ，従来の報告と一致していた．これらの項目と画像所見を合わせることで，成熟奇形腫の悪性転化を予測することができる可能性が示唆された．

High Frequency of Malignant Transformation of Ovarian Mature Teratoma into Squamous Cell Carcinoma in Young Patients in Northeast Brazil.

The malignant behavior of an ovarian teratoma is related to immaturity, or rarely to the malignant transformation of a somatic component in a mature teratoma (MT). The aim of this work was to review 189 consecutive ovarian teratomas diagnosed between 2006 and 2010 at a public referral center for cancer in Brazil, focusing on cases of MT with malignant transformation. MTs with transformation to squamous cell carcinoma (SCC) were further analyzed by immunohistochemistry for p16 staining. The median age of all patients was 36 yr (mean age, 39.6 yr; SD±4.9). Mature and immature teratomas represented 95.7% (181/189) and 4.2% of the cohort, respectively. Immature teratoma occurred mainly in adolescents under 18 yr. Malignant transformation of the somatic component in MT was observed in 10 of 181 patients (5.5%). SCC was the most common subtype (4/10), followed by differentiated thyroid carcinoma in struma ovarii(3/10), adenosquamous carcinoma (1/10), mucinous intestinal-type adenocarcinoma (1/10), and a well-differentiated neuroendocrine tumor/carcinoid (1/10). Two of 4 SCC cases were strong and diffusely positive for p16, and 2 were negative. In 5 further patients, MT was synchronously observed with other benign and malignant ovarian neoplasms in the ipsilateral ovary (3 mucinous cystadenomas and 1 Brenner tumor) and 1 cystadenocarcinoma in the contralateral ovary. MTs with malignant transformation were larger than those without transformation (P<0.001), but did not demonstrate any association with age. Indeed, our patients with SCC in MT were much younger [median and mean age, 37 and 38 yr (SD±4.9), respectively] than those described previously. As p16 is considered a surrogate marker for HPV infection, the malignant transformation of MT into SSC in young patients raises the possibility of HPV infection as a risk factor in some of these cases. However, molecular studies are needed to clarify the possible role of HPV in the malignant transformation of MT to SCC.

Mediastinal Teratoma with Coexisting Adenocarcinoma and Carcinoid Tumor (Somatic-Type Malignancy): A Case Report with a Review of the Literature.

Germ cell tumors constitute 10% to 15% of anterior mediastinal neoplasms. Of these, mature teratoma is the most common. Somatic malignant transformation in mature teratoma is a very rare phenomenon. In the anterior mediastinum, few cases of malignant transformation in the form of carcinoma, sarcoma, or neuroendocrine tumors have been described. We present the case of a mature mediastinal teratoma in a 24-year-old female, diagnosed on computed tomography, where both carcinoid tumor and adenocarcinoma were seen. To the best of our knowledge, this is the first report of such a case. Malignant transformation in a mature teratoma confers a significantly worse prognosis and is difficult to diagnose only on clinical and radiological evaluation. As these lesions are so rare, the treatment options for these lesions are also not clearly defined. Extensive sampling and careful microscopic examination are needed when teratomas are submitted for pathological evaluation.

Tératome médiastinal mature avec transformation maligne spontanée

Malignant teratomas can be either immature teratomas or they can develop after treatment of other malignant germ cell tumors with chemotherapy or radiotherapy. Spontaneous malignant transformation of mature teratomas is very rare. We report the case of a patient complaining of atypical chest pain. Chest plain radiography showed a right anterior mediastinal mass. Computed tomography revealed a heterogeneous mediastinal mass with fat areas and calcification. There were hilar and mediastinal lymph nodes as well as lung parenchymal nodules. CT-guided and then surgical biopsies confirmed the diagnosis of a mature teratoma, which had degenerated into a digestive adenocarcinoma. Spontaneous malignant transformation of mature mediastinal teratoma is very rare. The diagnosis of malignant transformation is based on radiological examinations, laboratory tests and histological studies.

Controversies in the management of germ cell tumours of the ovary

Ovarian germ cell tumours are rare, but curable at all stages of disease. This review gives an outline of the main controversies regarding the management of this disease. Pelvic malignancies are very rare during pregnancy, which should avoid the need for radical surgery or termination in these patients. Also during pregnancy, AFP-L2 looks to be a promising tumour marker in detecting relapse. Malignant transformation of mature teratomas may be predicted by preoperative squamous cell antigen and tumour size. OCT4 immunohistochemistry has been shown to be a very useful adjunct in the diagnosis of dysgerminomas. The traditional method for grading immature teratomas is challenged by a new classification. Patients receiving cisplatin-based chemotherapy are at a higher risk of developing cardiovascular risk factors. There is a hint that high-dose chemotherapy may play a role in relapsed patients. Rarity of the disease means many controversies are difficult to resolve, with much reliance on using data from testicular cancer studies. Many clinicians still advocate adjuvant chemotherapy for stage I nondysgerminomatous tumours of grade 2 and above despite good evidence that surveillance is a safe option, and increasing concerns about life-threatening long-term effects of treatment.