A rare case of squamous cell carcinoma transformation in a mature cystic teratoma of the ovary

Abstract

Mature cystic teratoma of the ovary is the most common ovarian neoplasm (10%–20%). These tumors are generally benign but may undergo malignant transformation, 80% of which is squamous cell carcinoma, in postmenopausal women (1%–2%). Due to nonspecific findings, the preoperative diagnosis is challenging; most patients are detected at an advanced stage and have poor outcomes. A 40-year-old female, P2A0, complained of worsening lower abdominal pain and palpable abdominal mass. She had not been having menstrual periods for almost 4 months. For the last 3 months, she had asthenia, anorexia, and lost 10 kg. Abdominal examination was notable for an immobile, well-defined cystic mass measuring 12 × 8 × 8 cm with an irregular surface in the lower abdomen. Its overlying skin appeared reddish. A bimanual examination confirmed the adnexal origin of the cystic mass. Laboratory examination was notable for leukocytosis, thrombocytosis, increased neutrophil-to-lymphocyte ratio, and reduced absolute lymphocyte count. There was an increase in her cancer antigen 125. An abdominal ultrasonography examination showed bilateral mature cystic teratoma. A bilateral salpingo-oophorectomy was performed. A postoperative diagnosis of bilateral dermoid ovarian cysts was then established. The patient histopathology examination concluded squamous cell carcinoma (malignant transformation from benign cystic teratoma) in bilateral ovaries. The patient was referred to a gynecology oncology center for further examination and management. However, she missed the appointment for an unknown reason. The patient passed away 4 months after surgery. Clinicians should be aware of the possibility of malignant transformation of teratoma if a tumor has been present for a long time, its diameter is greater than 10 cm, there is a thickening of the cyst wall with papillary growth, there is an increase in tumor markers, and the patient is postmenopause. Malignant transformation of mature cystic teratoma remains a diagnostic and therapeutic puzzle and the prognosis is poor despite extensive initial surgery and optimal debulking.

Squamous cell carcinoma malignant transformation in mature cystic teratoma of the ovary: a case report and review of the literature

“…The precise etiology of this malignant transformation is unknown [ 11 , 12 ]. Case reports indicate that those with malignant MCTO are usually between 40 and 55 years old, which is 10 years older than women with benign MCTO [ 5 ]. The average age of malignant transformation in MCTO was reported to be 53.5 years in previous investigations [ 12 ], although limited SCC cases have been documented in women as young as 19 years old [ 12 , 13 ].…”

“…Unfortunately, there are no specific clinical indications, serum markers, or imaging findings to diagnose MCTO transformation before surgery [ 14 ]. Some suggested, although nonspecific, risk factors for this condition are old age, postmenopausal state, increased tumor size and invasion, elevated levels of some tumor markers (CA125, CA19-9, and CEA), and tumor remnants [ 5 , 6 ], but the only way to confirm malignant transformation is through histopathologic study.…”

“…MCTO transformation into malignant cells is rare, reported in only 1.4% of cases. Case reports indicate that those with malignant MCTO are usually between 40 and 55 years old, which is 10 years older than women with benign ovarian neoplasms [ 5 ]. Squamous cell carcinoma (SCC) is the malignant transformation most commonly reported in literature [ 6 , 7 ].…”

Mucinous cystadenoma and carcinoid tumor arising from an ovarian mature cystic teratoma in a 60 year-old patient: a case report

“…Certain risk factors, such as tumor size, patient age, serum tumor markers level, and imaging results may increase the likelihood of malignant transformation [ 5 ]. Case reports have shown that malignant transformation of teratomas usually occurs in postmenopausal women, who are about 15 years older than women with conventional benign ovarian neoplasms [ 6 ]. Although most patients are asymptomatic, some may experience symptoms such as abnormal uterine bleeding, postmenopausal bleeding (PMB), abdominal pain, constipation, and a noticeable mass in the abdomen or pelvic area [ 7 , 8 ].…”