Ovarian Immature Teratoma Research Articles

An elevated maternal serum α-fetoprotein leading to the diagnosis of an immature teratoma

A case report is presented of a woman with a maternal serum α-fetoprotein 17.46 multiples of the median (MOM), who was found to have an ovarian immature teratoma. It is suggested that patients who present with a maternal serum α-fetoprotein value greater than 9 multiples of the median receive a more comprehensive evaluation remembering that the α-fetoprotein in the adult can be a tumor marker.

Retroconversion of immature teratoma of the ovary: CT appearances

We have studied seven patients presenting to the Royal Marsden Hospital between 1983 and 1989 with metastatic immature teratoma of the ovary. All patients underwent initial surgery followed by combination chemotherapy and a second laparotomy. Serial CT scans were performed at 2-3 monthly intervals from diagnosis until the second laparotomy, and the results of this were correlated with the CT appearances. In six of the seven patients CT scanning demonstrated 'retroconversion' of immature malignant tumour masses to benign mature disease during treatment. CT features of maturation included increased density of mass lesions, whose margins became better circumscribed in relation to adjacent tissues, and the onset of internal calcification, with fatty areas and cystic change. These changes on CT correlated exactly with normalization of an initially raised serum tumour marker, alpha feto-protein (AFP) in all six patients. The second laparotomy revealed only mature teratoma in all patients following chemotherapy. In three patients show continued growth of the mature deposits necessitated further surgery for local pressure symptoms, but overall, none has shown malignant relapse, and all are currently well between 1 and 6 years after diagnosis. This is the first report of the CT appearances of retroconversion of immature ovarian teratoma in a series of patients, which is an important radiological diagnosis to make in order to avoid confusion with advancing malignancy. A review of the literature is presented.

Management of malignant ovarian immature teratoma. Role of adriamycin

Sixteen consecutive patients with pure ovarian immature teratoma have been treated at The Norwegian Radium Hospital between 1975 and 1987. The median age was 22 years. Thirteen patients had International Federation of Gynecology and Obstetrics (FIGO) Stage I disease and three had Stage III disease. None of the patients with Stage I disease had bilateral disease. In nine patients at least one ovary was conserved. Four cases were Grade 1, seven cases Grade 2, and five cases Grade 3. Adjuvant treatment consisted mainly of Adriamycin (Adria Laboratories, Columbus, OH). The chemotherapy regimen appeared to be highly effective because all patients are alive without evidence of disease (median follow-up, 85 months). No severe toxicity was observed. In patients without residual tumor after primary surgery, the authors prefer the adjuvant treatment with Adriamycin because this treatment has a lower toxicity and is as effective as combination chemotherapy (vincristine, dactinomycin, and cyclophosphamide or cisplatin, vinblastine and bleomycin). Some comments on initial surgery and second-look surgery are also given.

Placental site trophoblastic tumor associated with immature ovarian teratoma

This paper describes a woman who developed three malignancies within a very short time. Two of these, immature teratoma and placental site trophoblastic tumor, were rare gynecological neoplasms. The third was a breast carcinoma. This is the first report of an association of placental site trophoblastic tumor with a primary germ cell tumor of the ovary.

Immature Teratoma of the Ovary Grade 3, with Karyotype Analysis

The relationship between dermoid cysts and immature teratomas has been investigated by study of gross and microscopic data. Karyotypes with banding analysis, already numerous for dermoid cysts, have recently been obtained for immature teratomas. This grade 3, Stage III immature ovarian teratoma was of probable premeiotic origin, as evidenced by chromosome heteromorphisms identical to those of the host cells. The relationship of this pattern to that of other immature teratomas and dermoid cysts is discussed.

Gliomatosis Peritonei in Childhood and Adolescence: Clinicopathological Study of 13 Cases Including Immunohistochemical Findings

Gliomatosis peritonei (GP) can be defined as the metastatic implantation of neural tumor tissue on surfaces of the peritoneum in patients with immature ovarian teratomas. Data from 13 patients with GP were evaluated. The average age at time of biopsy was 11 years (median: 11.5 years; range: 2.9 to 18.6 years); average time of follow-up was 26.6 months (median: 22 months; range: 4 to 77 months). In 11/13 patients the GP was discovered at the same time as the primary tumor, in two patients it was detected at second-look surgery. Degree of maturity according to scheme of Robboy and Scully was 8 x G 1, 4 x G 2, and 1 x G 3 for the ovarian teratomas (x = 1.46), and 11 x G 0 and 2 x G 3 for the GP implants (x = 0.46). Light microscopically, the mature glial nodules consisted almost exclusively of GFAP and S-100 protein positive astroglia. Twelve of the 13 patients are alive and clinically healthy. One patient with metachronic immature GP is receiving chemotherapy. 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.

Normal pregnancy and delivery two years after adjuvant chemotherapy for grade III immature ovarian teratoma

A 27-year-old woman with grade 3 immature teratoma of the ovary was treated with unilateral salpingo-oophorectomy and VAC combination chemotherapy. She received 6 postoperative courses, although initially 12 were planned. Chemotherapy had to be discontinued because of severe bone marrow toxicity. Eighteen months later the patient became pregnant and was ultimately delivered of a normal child. This is the second report of a successful pregnancy following VAC chemotherapy for immature teratoma.

Gliomatosis peritonei with endometriosis externa

A case of gliomatosis peritonei developed 9 years after the removal of an immature ovarian teratoma is reported. An unique association of gliomatosis with endometriosis externa was found without the usual symptoms of endometriosis. The prognosis of gliomatosis is generally excellent and depends on the histological grade of the primary tumor and on the presence of organ metastasis or immature tumor elements in the implants. Pathogenetical aspects of both lesions are discussed briefly.

Stevens-Johnson Syndrome and Fatal Pulmonary Toxicity to Combination Chemotherapy Containing Bleomycin: A Case Report

Bleomycin is a commonly used anticancer agent; in particular, it is an important component of multidrug regimens for germ cell tumors. The limiting toxicity of bleomycin is represented by pulmonary interstitial fibrosis; mucocutaneous side effects are common, but usually harmless. We describe a case of a young girl who developed Stevens-Johnson syndrome following the administration of bleomycin in a three-drug regimen containing vinblastine and cisplatin, for an ovarian immature teratoma. The severe dermatologic toxicity was kept under control, but a rapidly evolving respiratory insufficiency due to lung fibrosis developed soon thereafter and caused the patient's death.

Immature Ovarian Teratoma: A Review of 14 Cases

We conducted a clinical and pathologic review of 14 patients with immature ovarian teratoma. In this series of patients, one had monodermal malignant neuroectodermal teratoma and two others had immature ovarian teratoma in association with immature presacral teratoma. Because of the small number of cases of immature ovarian teratoma and the diverse therapeutic modalities used in this study, we cannot recommend a specific treatment for patients with this tumor on the basis of our findings. The histologic grade of the tumor seemed to be a reliable indicator of prognosis. Grade 0 metastatic lesions should be considered benign and are associated with a favorable prognosis.

Pregnancy After Intensive Chemotherapy for an Ovarian Immature Teratoma

Pregnancy After Intensive Chemotherapy for an Ovarian Immature Teratoma

Immature teratomas of childhood: Report of 21 cases

The benign or malignant nature and the biological behaviour of immature teratomas of childhood are difficult to predict. The age of the patient at diagnosis, the anatomical site of the tumour and the degree of immaturity are considered to be important prognostic parameters. In this study the pathological-anatomical findings and the most important clinical features of 21 patients with immature teratoma (including two with supposedly malignant monodermal teratoma with immature neuroectodermal structures) were evaluated. Significant results were: Twelve tumours occurred in infancy or infants who died in the perinatal period, the other nine tumours in children between the ages of 7 and 16 years. The most frequent anatomical sites were the ovary (6 tumours), sacrococcygeal region (4), testis (4) and mediastinum (3). In contrast to most of the tumours of other localizations, immature ovarian teratomas did not occur in children under 7 years of age (in four cases in association with gliomatosis peritonei). The immature tissue components of the tumours were mostly neuroectodermal structures. Eight tumour specimens showed grade 1, four grade 2 and nine grade 3 malignancy. Grade 3 tridermal teratomas chiefly occurred in young children, whereas two grade 3 monodermal tumours developed in older children. Immunohistochemical analysis of the neuroectodermal components showed that mature astrocytes contained glial fibrillary acid protein, whereas mature nerve cells, nerve fibres and a few groups of immature cells reacted with an antibody to neuron-specific enolase. Six of the 21 patients died; two were stillborn immature infants, two were premature infants, one died postoperatively and one died of metastatic disease. One patient with metastatic disease was alive. None of the 19 children with tridermal immature teratoma showed distant metastases. Metastatic disease was observed in only two patients with presumptive monodermal malignant teratoma. In early childhood the biological behaviour of immature teratomas is evidently similar to that of mature teratomas (provided that the tumour can be totally excised). In older children malignancy must be assumed when the tumour is located in the ovary and/or grade 3 immaturity is determined.

Histologic grade and karyotype of immature teratoma of the ovary.

Seven cases of ovarian "pure" immature teratoma were encountered in patients 10 to 38 years of age, six cases being in Stage Ia and one case in Stage IIc. The primary tumors and recurrent growth observed in one case were histologically graded from 0 to 3 according to the criteria of Norris et al. Karyotypes of the tumors and the patients were determined using culture and banding techniques. The only nonsurviving case was in Stage IIc. Four primary tumors belonging to grades 0, 1, and 2 showed a normal 46,XX female karyotype and the patients are alive and healthy. Three grade 3 tumors showed various types of karyotype abnormalities (48,XX,+14,+21; 47,XX,+20; 47,XXX). One patient died, one is alive after experiencing a recurrent tumor, and one has only been followed for 22 months. All seven patients had a normal 46,XX female chromosome constitution. Evidence to date indicates that karyotype of ovarian immature teratoma is either normal female 46,XX or a slight deviation from normal. It is postulated that in ovarian immature teratoma normal 46,XX karyotype is an indicator of favorable prognosis, whereas deviations in karyotype suggest a possibility of poor prognosis.

Gliomatosis peritonei

Gliomatosis peritonei, a rare complication of solid ovarian teratomas, is a miliary, mature glial implantation on the peritoneum or omentum. Two new cases are reported and 30 previously reported cases are reviewed. Gliomatosis peritonei is thought to be benign in almost all cases and thus deserves no treatment except for confirmatory biopsy. It must be differentiated from teratomatous implants because the latter may imply poor prognosis and require aggressive therapy. The prognostic value of serum alpha-fetoprotein levels in patients with immature ovarian teratoma is not conclusive. The presence of glial fibrillary acidic protein confirms the glial nature of the implants.

Sacrococcygeal teratomas: a review of 68 cases.

Sixty-eight cases of sacrococcygeal teratoma were reviewed and graded according to the quantity of immature tissue present. Seventy-five percent were benign (grade 0), 11.8% immature (Grades 1-3), and 13.2% malignant. Although the immature component in most tumors was neuroepithelial, in two cases it was exclusively renal. There were no instances of local recurrence or metastasis of immature elements. The malignant lesions were all endodermal sinus tumor, stained positively for alpha-fetoprotein and were uniformly fatal, with an average duration of survival of 8.9 months. Early adequate treatment of sacrococcygeal teratomas results in a favorable prognosis. This experience is different from that reported for immature ovarian teratomas. Immature metanephric tissue in sacrococcygeal teratomas should be interpreted the same way as immature neuroepithelial elements. Immature sacrococcygeal teratomas should be separated from tumors containing malignant elements because of their vastly different prognoses.

Metanephrogenic tissue in immature ovarian teratoma.

Nogales, Francisco F. Jr. M.D.; Ortega, Isicio M.D.; Rivera, Francisco M.D.; Armas, José R. M.D. Author Information

Pregnancy Following Chemotherapy for an Ovarian Immature Embryonal Teratoma

Abstract A patient with an immature embryonal teratoma of the ovary treated with intensive multiagent chemotherapy became pregnant after her second-look operation. The importance of this new facet in the management of patients with malignant teratomas is discussed.

Pregnancy following chemotherapy for an ovarian immature embryonal teratoma

A patient with an immature embryonal teratoma of the ovary treated with intensive multiagent chemotherapy became pregnant after her second-look operation. The importance of this new facet in the management of patients with malignant teratomas is discussed.

Case report: ultrastructure of mature neurogenic implants from ovarian immature teratoma

An ultrastructural study of mature (grade O) neurogenic peritoneal implants from an ovarian immature teratoma grade I is presented. The presence of different types of neuroectodermal cells challenges the current terminology of this lesion, which implies a single proliferating cell type. The ultrastructural features were indicative of maturity in all cell lines and even the neurons exhibited well formed synapses. Marked cytoplasmic fibrillary change, similar to that found in central nervous system gliosis, was observed in the astrocytes. The ependymal cells had abnormal cilia with an altered configuration and number of microtubules.

腹腔内散布とアルファフェトプロティン高値を示した左卵巣奇形腫の一妊婦例

腹腔内散布とアルファフェトプロティン高値を示した左卵巣奇形腫の一妊婦例