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.

BACKGROUND:Ovarian tumour in children and adolescent girls form an uncommon but important part of gynaecological malignancies. They account for 1% of all the childhood malignancies and 8% of all abdominal tumours in children. Since the ovarian cysts are thought to arise from mature follicles, these tumours were considered to be infrequent in the paediatric population.AIM:The rarity of this condition prompted us to conduct this study and share our experience on the incidence and clinicopathological features of different ovarian tumours in girls up to 20 years of age observed in last 25 years at a single tertiary care hospital.MATERIAL AND METHODS:This was a retrospective study conducted in the Department of Pathology at a tertiary hospital, Delhi. All ovarian tumours up to the age of 20 years in the past 25 years (1990-2014) were included for the purpose of studying the clinicopathological aspects of ovarian tumours in this age group. Descriptive statistics for prevalence and age-wise prevalence was done. Chi-square test, to find an association between the age, laterality and size with malignancy was performed.RESULTS:We received a total of 1102 cases of ovarian tumours over the period of 25 years (1990 to 2014), of which 112 (10%) cases were seen in girls up to 20 years of age. The mean age of the patients was 15.3 ± 4 years. The most common presenting complaint was pain abdomen (46.4 %) There was a statistically significant correlation found between size and malignancy status of tumours in our study (p = 0.00). Of 112 cases of ovarian tumours, 39/112 (34.8%) were malignant and 73/112 (65.2%) were benign. Mature cystic teratoma (27.6%) was the most common type of benign tumour in this age group and immature teratomas were the most common type of malignant ovarian neoplasms.CONCLUSION:Premenarchal girls with ovarian masses may have varied presentations. Abdominal pain is the most common presenting complaint of young adolescent girls with adnexal masses. So the index of suspicion should be kept high and prompt investigations like ultrasound must be performed early to rule out such adnexal masses. Immature Teratoma was the most common malignant and mature cystic teratoma was the most common benign tumour in our study.

IntROduCtIOnThe term 'Teratoma' is derived from a greek word "teraton" which means monster. It was named so because these tumours contain elements derived from all the 3 germ cell layers of the ovary. MCT are the most common germ cell tumours of the ovary accounting for 10-20% of all the ovarian tumours. They comprise approximately one third of all the benign ovarian neoplasms and are most common ovarian tumour in patients between 20 to 40 years of age [1]. Torsion, rupture and infection are more common complications of MCT [2,3] and only very rarely do these tumours undergo a malignant transformation. The possibility of such malignant transformation must be kept in mind when either the patient is over 45 years of age or the tumour diameter is more than 10 cm. [4]. Although there are several studies of MCT in Asian countries, there are only very few retrospective cross sectional studies from India to understand the epidemiology of the disease [5]. Since the prognosis for malignant transformation of MCT is very poor with a five year survival of only 15-30%, it is essential to diagnose and treat them early in the course of disease [6]. We retrospectively analysed the clinicopathological characteristics and the trends of all the teratomas of the ovary at our institution over a 25-year study period. MAtERIALS And MEtHOdSThis was a retrospective study of all the teratomas of the ovary received in the Department of Pathology at a tertiary care hospital, India. It included a total of 242 cases of ovarian teratomas over a period of 25 years from 1990 to 2014. The data regarding age, size, laterality, gross, morphological features, complications and surgery performed was retrieved from the pathological archives and analysed using SPSS software version 22. Descriptive statistics was used and the results were expressed as percentages. RESuLtSA total of 1102 ovarian neoplasms were received in our department during a period of 25 years from 1990 to 2014. 25.7% (284/1102) of all the ovarian tumours so received in our department were Germ cell tumours. Of the consecutive 242 cases of ovarian teratoma 223 were MCT. These were the most common tumours in our study forming 20.2% of the total ovarian neoplasms and 78.5% of all the germ cell tumours. [Table/ Fig-1] represents the age wise distribution of various germ cell neoplasms found in our study. As is evident from the histogram, MCT was most common tumour in all the age groups. Apart from MCT there were 11 cases of immature teratoma and 8 cases of malignant teratoma each. The rate of malignant transformation of mature cystic teratoma was 3.5% in this study.The mean age of the patients with MCT was 32.5 ± 13.11 (mean ± standard deviation) years ranging from 8 years to 70 years. The median age was 30 years. [Table/ Fig-2] represents the age wise distribution of all the MCT included in our study. It was seen that maximum number of cases i.e., 39.4% were in the age group of 21-40 years and only 8% of patients presented beyond 50 years of age. It was noted that although the tumour ...

Primary splenic pregnancy is an extremely rare form of extratubal ectopic pregnancy. These cases often cause splenic rupture in very early course of their gestation thereby presenting with hemoperitoneum in emergencies. Owing to the higher risk of exsanguination and death caused by hemoperitoneum, it is essential to diagnose these cases for proper management and better prognosis of the patients. we present the case of a 23-year-old female, gravida 2, para 1, live issue 1 presenting to the emergency outpatient department with acute abdomen and hemoperitoneum. There was no history of trauma. The patient had a positive urine pregnancy test and raised beta HCG levels. emergency laparotomy revealed an otherwise unremarkable fallopian tube and ovary with a hemoperitoneum of 2.5 liters. A tiny splenic laceration was considered to be the source of bleeding and splenectomy was performed. Microscopy was suggestive of a primary ectopic pregnancy, spleen. Since hemoperitoneum in pregnancy is a rare but potentially fatal condition with a high risk of mortality, an accurate preoperative diagnosis is crucial in the management of such patients. The possibility of a ruptured extratubal ectopic pregnancy must be considered as one of the differential diagnoses of acute abdomen with hemoperitoneum in women of childbearing age.