Ovarian Immature Teratoma Research Articles

Anesthetic management in a patient with giant growing teratoma syndrome: a case report

IntroductionGrowing teratoma syndrome is a rare occurrence with an ovarian tumor. Anesthesia has been reported to be difficult in cases of growing teratoma syndrome of the cystic type due to the pressure exerted by the tumor. However, there have been no similar reports with the solid mass type. Here, we report our experience of anesthesia in a case of growing teratoma syndrome of the solid type.Case presentationThe patient was a 30-year-old Japanese woman who had been diagnosed with an ovarian immature teratoma at age 12 and had undergone surgery and chemotherapy. However, she dropped out of treatment. She presented to our hospital with a 40cm giant solid mass and severe respiratory failure, and was scheduled for an operation. We determined that we could not obtain a sufficient tidal volume without spontaneous respiration. Therefore, we chose to perform awake intubation and not to use a muscle relaxant before the operation. At the start of the operation, when muscle relaxant was first administered, we could not obtain a sufficient tidal volume. An abdominal midline incision was performed immediately and her tidal volume recovered. Her resected tumor weighed 10.5kg. After removal of her tumor, her tidal volume was maintained at a level consistent with that under spontaneous respiration to avoid occurrence of re-expansion pulmonary edema.ConclusionsWe performed successful anesthetic management of a case of growing teratoma syndrome with a giant abdominal tumor. Respiratory management was achieved by avoiding use of a muscle relaxant before the operation to maintain spontaneous respiration and by maintaining a relatively low tidal volume, similar to that during spontaneous respiration preoperatively, after removal of the tumor to prevent re-expansion pulmonary edema.

腹水細胞診で腹膜神経膠症と未熟神経上皮成分が示唆された卵巣未熟奇形腫の 1 例

腹水細胞診で腹膜神経膠症と未熟神経上皮成分が示唆された卵巣未熟奇形腫の 1 例

Immature ovarian teratoma. A case report and review of literature

Immature ovarian teratomas are rare tumours occurring most commonly in the first two decades of life. These tumours differ from their mature counterparts both histologically by the presence of immature tissue, and clinically by their more malignant behaviour. Microscopic examination reveals tissue from all three germ layers with at least one of the components having an immature appearance. The grade is based on the proportion of immature neuroepithelium and highly correlates with the tumour grade and hence prognosis. These tumours usually are confined to the ovary and are typically chemo- and radiosensitive. They may metastasise to peritoneum, liver or lung. We present a case of bilateral teratomas in a 25-year-old nulliparous woman who was found to have immature elements including neuroectodermal tissue, mesenchymal nodules, immature fat and cartilage within the left sided tumour. She is currently undergoing chemotherapy.

A rare case of immature ovarian teratoma with gliomatosis peritonei

Gliomatosis peritonei (GP) is a rare condition that occurs almost exclusively in the setting of ovarian immature teratoma. It is characterisized by the occurrence of nodules of mature glial tissues in the peritoneum, omentum and bowel wall. The glial tissue in such cases is usually low grade although there have been cases of malignant evolution described. In general, the prognosis for GP is good. It depends chiefly on the degree of maturity of the implants. In mature GP, usually no additional chemotherapy is necessary. In immature GP, chemotherapy can induce maturation of the implants. We present a case of immature ovarian teratoma associated with low grade GP.

Familial rhabdoid tumour 'avant la lettre '-from pathology review to exome sequencing and back again

Here we provide compelling evidence that next-generation sequencing will revolutionize diagnostics. We reappraised a case from 1991, published in 1993, describing the unique occurrence of an ovarian immature teratoma arising in a young woman and a clonally distinct intracerebral immature teratoma developing in her daughter. We conducted whole-exome sequencing on constitutional DNA from the mother and her daughter and identified a previously unreported nonsense mutation (c.3533G>A; p.Trp1178*) in the chromatin remodelling gene, SMARCA4, that was present in both individuals and was subject to nonsense-mediated decay. Tumour analysis by Sanger sequencing revealed a somatic SMARCA4 mutation in both the mother (c.2438+1G>T) and her daughter (c.3229C>T; p.Arg1077*), which are predicted to be truncating. As immature teratomas are classified as germ cell tumours, we performed a comprehensive mutation survey of 106 apparently sporadic germ cell tumours, but did not find any other clearly deleterious SMARCA4 mutations. Recently, inactivating mutations in SMARCA4 have been found in two cases of rhabdoid tumour predisposition syndrome type 2. In the light of these findings, renewed efforts to locate previously unobtainable tumour samples were successfully undertaken. Histopathological and immunohistochemical re-analysis of the daughter's tumour revealed that it was indeed a rhabdoid tumour (atypical teratoid/rhabdoid tumour). In this context, the original pathology report of the mother's ovarian tumour was re-interpreted as describing a malignant rhabdoid tumour of the ovary. This report raises the question as to whether molecular genetic analysis should be included in tumour classification, alongside more traditional microscopy-based methods. The use of new sequencing technologies, particularly when applied to archived samples, will lead to many more 'molecular rediagnoses'. This is the earliest known case of rhabdoid tumour predisposition syndrome type 2 and the first described case with an autosomal dominant pattern of inheritance, only discovered through an exome sequencing project.

Immature ovarian teratoma with unusual gliomatosis

This study aimed to investigate an unusual case of immature ovarian teratoma with onset of mature glial cells implanted on the contralateral ovary, a challenge in the diagnosis of the second ovarian tumor. We report the case of a 31- yr-old woman, who developed at the age of 16 an immature teratoma in the right ovary that was surgically removed. Six years later mature glial implants were present on the left ovary and six months later at the level of peritoneum that relapsed after other six months. The patient suffered three surgical resections after the initial one. Paraffin sections and immunohistochemical examinations using antibodies against glial and neuronal antigens were performed. In the teratoma, the neuroectodermal tissue expressed Glial fibrillary acidic protein (GFAP), S100 protein, Epithelial membrane antigen (EMA) and Cytokeratin 34 beta E12 (Ck34beta E12), wheares the implants expressed only GFAP and S100 protein. The immature teratoma is the rarest type of ovarian teratomas. Gliomatosis peritonei is an exceptional finding, expecially with onset on the contralaterally ovary. The implant of the mature glial cells has a high risk of relapse, as seen in our case, thus close follow-up of the patient is necessary.

Peritoneal and Nodal Gliomatosis with Endometriosis, Accompanied with Ovarian Immature Teratoma: A Case Study and Literature Review

Gliomatosis peritonei (GP) indicates the peritoneal implantation of mature neuroglial tissue and is usually accompanied by ovarian mature or immature teratoma. Here, we report a case of ovarian immature teratoma associated with gliomatosis involving the peritoneum, lymph nodes and Douglas' pouch, where gliomatosis coexisted with endometriosis. As far as we know, only seven cases of GP have been reported as coexisting with endometriosis. Eight cases with mature glial tissue in the lymph nodes, i.e., nodal gliomatosis, have been published either in association with GP or in its absence. Metaplasia of pluripotent coelomic stem cells has been suggested to be responsible for the pathogenesis of endometriosis and GP rather than implantation metastases of ovarian teratomatous tumor with varying maturation. This theory is also applied to GP independently of ovarian teratomatous tumors. To the best of our knowledge, nodal gliomatosis coexisting with GP and also involving endometriosis has not yet been reported.

Is It Necessary to Perform Surgical Staging in Patientswith Giant Immature Ovarian Teratomas MimickingMature Cystic Teratoma at Frozen Section

Giant mature teratomas (>20 cm in diameters) sometimes may contain malignant immature elements or tissues. These small foci of immature tissues could be missed at frozen section resulting inadequate initial surgical intervention. There is no large series in the literature either showing the accuracy of frozen section on huge ovarian teratomas or concerning the adequate surgical approach at the initial surgery for giant immature teratomas diagnosed as mature cystic teratomas at frozen section in patients with elevated tumor markers. We presented a case with unilateral giant immature ovarian teratoma and peritoneal gliomatosis which diagnosed as mature cystic teratoma at frozen section. Although elevated tumor markers (CA-125, AFP, CA-19,9 CEA, and lactate dehydrogenase), ascites and peritoneal implants were suggested malignant disease, staging surgery was not performed due to the benign report of frozen section. Since the patients having peritoneal implants of mature glial tissue have an excellent prognosis regardless of the grade of the ovarian teratomas, it may be suggested that surgical staging at the initial operation may not be performed in patients with giant immature teratoma diagnosed as mature teratoma at frozen section despite to the elevated tumor markers, presence of ascites or mature peritoneal implants. seems that using it in infertile patients has beneficial effects.

Presentation of a Patient who Underwent Fertility-Sparing Surgeries for Contralateral Recurrence of Ovarian Immature Teratoma with Gliomatosis Peritonei

We report a patient who has maintained a regular menstrual cycle despite undergoing cystectomy and chemotherapy for contralateral recurrence of ovarian immature teratoma with gliomatosis peritonei. We initially performed a fertility-sparing right salpingo-oophorectomy, omentectomy and peritoneal biopsy for immature teratoma with gliomatosis peritonei, with adjuvant chemotherapy; we performed a left ovarian cystectomy and peritoneal biopsy for mature cystic teratoma with gliomatosis peritonei 16 months after the first surgery, a fertility-sparing left ovarian cystectomy and peritoneal biopsy for contralateral recurrence of ovarian immature teratoma with gliomatosis peritonei 60 months after the first surgery, and a left ovarian cystectomy and peritoneal and external iliac lymph node biopsy for endometrial cyst with gliomatosis peritonei 71 months after first surgery. The peritoneal gliomatosis lesions gradually decreased through the 4 surgeries over 8 years. The patient has maintained a regular menstrual cycle and currently shows no evidence of disease.

Gliomatosis peritonei is associated with frequent recurrence, but does not affect overall survival in patients with ovarian immature teratoma

Gliomatosis peritonei (GP) is commonly associated with ovarian teratoma and is not thought to have an adverse prognostic effect. However, the prognostic impact and characteristics of GP remain to be clarified. In this study, we investigated the clinicopathologic features of ovarian teratoma associated with GP, and we further compared ovarian immature teratoma (IT) with GP to ovarian IT without GP. During the study period, there were a total of 16 ovarian teratomas associated with GP. Among them, 15 cases were ovarian ITs of various grades. When ovarian IT with GP (n = 15) was compared to ovarian IT without GP (n = 27), it was found that ovarian IT patients with GP had larger tumor size (median, 19 vs. 13 cm; P < 0.001), more frequent recurrence (40 %, 6/15 vs. 3.7 %, 1/27; P = 0.005), and frequently elevated preoperative CA-125 level (100 %, 12/12 vs. 50 %, 10/20; P = 0.004). All recurrences occurred within 2 years of the initial surgery. Survival curves indicated that ovarian IT patients with GP had significantly shorter recurrence-free survival compared to those without GP (P = 0.002). The 2-year recurrence-free survival rates were 59.3 and 96.3 % in IT with GP and IT without GP, respectively. However, all but one case of IT with GP are currently alive. In conclusion, GP is an adverse prognostic factor characterized by frequent recurrence in patients with ovarian IT.

High-grade Sarcoma Masquerading as Growing Teratoma Syndrome After Resection of Ovarian Immature Teratoma

A thorough literature search revealed no previous reports of this entity, and we are the first to describe a case of a high-grade sarcoma arising from a recurrent immature teratoma misdiagnosed as growing teratoma syndrome. The patient was a 23-yr-old female, diagnosed at the age of 20 with a Stage IIIB immature ovarian teratoma. After surgery and chemotherapy, the patient developed multiple liver and pelvic masses that were diagnosed as mature teratomas based on small samples obtained by computed tomography-guided core biopsy. Three years after diagnosis the patient presented with severe respiratory difficulty and following resection, the final pathology revealed multiple tumors with foci of high grade sarcoma compatible with primitive neuroectodermal tumor/extraskeletal Ewing sarcoma based on morphology and immunohistochemistry (CD99, CD56). However, on the basis of further immunostaining and fluorescent in situ hybridization studies negative for rearrangement of EWSR1, the final pathologic diagnosis was high-grade unspecified (undifferentiated) sarcoma. This case illustrates the pitfalls of biopsying 1 site in a patient with recurrence of a heterogeneous tumor such as immature ovarian teratoma, especially when rendering a benign diagnosis such as growing teratoma syndrome. It is of utmost importance to adequately sample large-volume recurrent teratomas, and we suggest biopsying several different sites, to increase the likelihood of detecting a malignant component.

Bilateral immature ovarian teratoma in a 12-year-old girl: case report

Bilateral immature ovarian teratoma in a 12-year-old girl: case report

Bilateral immature ovarian teratoma in a 12-year-old girl: case report

.IMT may present as a calcified pelvic mass, abnor-mal uterine bleeding, or pelvic pain. The most common sites of dissemination are the peritoneum and the retro-peritoneal lymph nodes. Hematogenous spread to lungs, liver, or brain is unusual. They present elevated levels of alpha-fetoprotein in 50% of cases

Adolescent With Ovarian Immature Teratoma Complicated by Wernicke’s Encephalopathy

Confusion surrounding the treatment of cancer in the pediatric population can be very daunting especially if one is not a pediatric oncologist. Herein is described a pediatric case of mixed cell ovarian germ cell tumor that was complicated by Wernick e’s encephalopathy which improved with standard treatment. This case report highlights the basic treatment plan of mixed cell ovarian germ cell tumor for the general pediatrician as sometimes the general pediatrician can be caught in the midst of a battle between specialists. doi:10.4021/ijcp6w

A case of pathologic fracture of the proximal femur resulting from metastatic bone tumor of ovarian immature teratoma

Composing of less than 1% of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. In this report, we present the first case of pathologic fracture of the proximal femur resulting from metastatic bone tumor of ovarian immature teratoma. A 33-year-old Korean female was diagnosed as immature teratoma of stage Ia and grade 3. Eleven months following initial surgery, she had developed right thigh pain and palpable mass, which was confirmed metastasis of immature teratoma. She had her right leg broken during concurrent chemoradiation. She took mass excision, closed reduction with internal fixation and allo-bone graft followed by 6 cycles of chemotherapy and 10 times of radiotherapy. Now she is on regular follow-up and remained disease-free for 14 months.

Isoenzima de fosfatasa alcalina placental-like, importancia clínica como marcador en tumores de tipo germinal

Background and purposeTo determine the clinical relevance of placental-like alkaline phosphatase isoenzyme (PLAP-like) as a marker for germ cell tumours (GCT). Patients and methodsWe report the behaviour of this isoenzyme in two patients; 1) A Child with an intracranial germinoma in the pineal region who showed 75% of PLAP-like activity at onset (normal value: 0%), with the rest of the tumour markers being negative, and 2) A girl with a stage I ovarian immature teratoma who had an elevated alpha-fetoprotein (AFP), 197ng/mL, PLAP-like 5.1%, at onset and 0.7% at tumour recurrence two years later. PLAP-like was determined by assessing the remaining activity after heat denaturation of the serum. Discussion and conclusionsPLAP-like constituted the only specific marker in the case of the pineal cell germ tumour, which justifies its use in association with neuroimaging studies in the diagnosis of cranial tumours. At follow-up analysis, PLAP-like was also critical since it confirmed the good response to treatment in the first case, while in the second one, it was the only marker to complement the assessment of tumour recurrence. We believe that this isoenzyme analysis is of relevance as a complementary marker in GCT.

Anti-N-methyl-D-aspartate receptor encephalitis with serum anti-thyroid antibodies and IgM antibodies against Epstein-Barr virus viral capsid antigen: a case report and one year follow-up

BackgroundAnti-N-methyl-D-aspartate receptor encephalitis is an increasingly common autoimmune disorder mediated by antibodies to certain subunit of the N-methyl-D-aspartate receptor. Recent literatures have described anti-thyroid and infectious serology in this encephalitis but without follow-up.Case presentationA 17-year-old Chinese female patient presented with psychiatric symptoms, memory deficits, behavioral problems and seizures. She then progressed through unresponsiveness, dyskinesias, autonomic instability and central hypoventilation during treatment. Her conventional blood work on admission showed high titers of IgG antibodies to thyroglobulin, thyroid peroxidase and IgM antibodies to Epstein-Barr virus viral capsid antigen. An immature ovarian teratoma was found and removal of the tumor resulted in a full recovery. The final diagnosis of anti-N-methyl-D-aspartate receptor encephalitis was made by the identification of anti-N-methyl-D-aspartate receptor antibodies in her cerebral spinal fluid. Pathology studies of the teratoma revealed N-methyl-D-aspartate receptor subunit 1 positive ectopic immature nervous tissue and Epstein-Barr virus latent infection. She was discharged with symptoms free, but titers of anti-thyroid peroxidase and anti-thyroglobulin antibodies remained elevated. One year after discharge, her serum remained positive for anti-thyroid peroxidase and anti-N-methyl-D-aspartate receptor antibodies, but negative for anti-thyroglobulin antibodies and IgM against Epstein-Barr virus viral capsid antigen.ConclusionsPersistent high titers of anti-thyroid peroxidase antibodies from admission to discharge and until one year later in this patient may suggest a propensity to autoimmunity in anti- N-methyl-D-aspartate receptor encephalitis and support the idea that neuronal and thyroid autoimmunities represent a pathogenic spectrum. Enduring anti-N-methyl-D-aspartate receptor antibodies from admission to one year follow-up but seroreversion of Epstein-Barr virus viral capsid antigen IgM may raise the important issue of elucidating the triggers and boosters of anti- N-methyl-D-aspartate receptor encephalitis.

Anti‐N‐methyl‐D‐aspartate receptor encephalitis associated with ovarian immature teratoma

Anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis is a treatment-responsive encephalitis associated with anti-NMDAR antibodies. Unlike classic paraneoplastic encephalitis, this disorder usually develops in young women with ovarian teratoma who typically present with marked neuropsychiatric symptoms, followed by prolonged respiratory failure, clouding of consciousness, and bizarre dyskinesia. This disorder is often treatable by resection of ovarian tumor and immunotherapy, but, delayed diagnosis results in a worse condition and sometimes fatal outcome. However, some gynecologists are not familiar with this disorder. When physicians encounter a female patient with encephalitis showing marked neuropsychiatric symptoms, search for an ovarian tumor should be promptly initiated. We present a case of anti-NMDAR encephalitis associated with ovarian immature teratoma. The symptoms were dramatically relieved by tumor resection and immunotherapy.

Ovarian immature teratoma: Treatment and outcome in a single institutional cohort

Objective The aim of this study was to evaluate clinicopathologic characteristics, treatment outcome and reproductive function in women diagnosed with ovarian immature teratoma. Methods Thirty-four women with ovarian immature teratoma stages IA to IIIA were identified and included in this study. Patients were treated at one institution; Princess Margaret Hospital, Toronto, Canada between 1970 and 2005. Results The median age at diagnosis was 25.0 years (range: 9.8–60.2 years). Twenty seven (79%) presented with stage IA disease, 5 (15%) with stage IC, 1 (3%) with stage 2B, and 1 (3%) with stage IIIA disease. Thirteen (38%) of the tumors were found to be grade 1, 12 (35%) grade 2, and 9 (27%) grade 3. Initial management was surgical for all patients: 22 (65%) unilateral oophorectomy, 7 (20%) cystectomy only, and 5 (15%) bilateral oophorectomy (4 with hysterectomy). Fourteen (41.8%) patients received adjuvant therapy. The median follow up was 4.8 years (range 0.2–24.3 years). Four patients recurred (histological grade 2 or 3) within 22 months (87.1% 2-year progression free survival). Only one clinical stage I patient who received adjuvant chemotherapy developed a recurrence. Three of the patients who recurred died from their disease. Eleven patients reported an attempt to conceive resulting in 11 pregnancies in 6 women (3 post chemotherapy). Conclusion The majority of patients diagnosed with an immature teratoma are cured of their disease. However, grade 2 or 3 tumors are associated with a greater chance of recurrence that can be fatal, predominantly within 2 years of diagnosis.

Soft tissue metastasis of an immature teratoma of the ovary

In patients with immature teratoma of the ovary, blood-borne metastasis to organ parenchyma, such as the lungs, liver, or brain, are uncommon. Moreover, soft tissue metastasis is extremely rare. We describe a 31-year-old woman with an immature teratoma of the left ovary, which metastasized to soft tissue of the right thigh after surgery. Because of the rarity of this condition, we report the results of treatment and review the literature.