Fetal Glomeruli in a Mature Ovarian Teratoma: A Developmental Anomaly Within a Developmental Anomaly?

Abstract

A mature ovarian teratoma in a 22-year-old woman showed various commonly noted components, including respiratory epithelium, adipose tissue, nerve bundles, skeletal muscles, hemosiderin-laden macrophages, lymphocytes, and bone. In addition, there were other structures that were decidedly uncommon-fetal glomeruli (Figures 1 and 2). Mature ovarian teratomas are fascinating neoplasms that contain a plethora of tissues of ectodermal, mesodermal, and endodermal origin and include, most often, skin with adnexae, hair, neural tissues, cartilage, bone, teeth, respiratory and gastrointestinal tract tissue, adipose tissue, and smooth muscle. Thyroid tissue, cerebellum, retina, and, remarkably, even prostatic tissue has been noted. 1-8 Renal elements are rare but have been reported. 2-5 Because of the excessive ectodermal component of skin and hair, many mature teratomas are also referred to as dermoid cysts. Teratomas, even though not congenital, are the result of disordered development. Willis suggests that teratomas are tumors arising from foci of plastic pluripotential embryonic tissue, which escaped the influence of the primary organizer during early development. 9 Because the presence of fetal glomeruli in an adult could also constitute a developmental anomaly, one may wonder if this case represents a developmental anomaly within a developmental anomaly! This is not so. Mature teratomas, by definition, contain only mature tissue. 1-5 It must be noted, however, that microscopic amounts of immature glial tissue are still compatible with the diagnosis of a mature teratoma. A standard definition of mature ovarian teratoma states that "all of the components present in mature cystic teratomas should appear histologically mature." 1 Another textbook mentions that "classic mature cystic teratomas usually contain mature tissues from 2 or 3 embryonic layers," while a popular and reliable website on diagnostic pathology characterizes teratomas as "mature if only contains adult tissues." 4,6 However, another reference book states that these teratomas contain "normal fetal to adult tissues variably mixed but organized." 5 Furthermore, Sternberg's textbook mentions that "dermoid cysts are composed of adult-type tissue and sometimes a small amount of fetal-type tissue." 2 A final clarification is seen in Robboy's book, which states, "Various mature tissues are usually present" but clarifies that these tissues "correspond to that of developing fetus of over 8 weeks 877505I JSXXX10.

Mullerian Tissue (Endomyometriosis) and Intratumoral Bone Marrow Emboli From Long Bone in a Mature Ovarian Teratoma—A Keatsian Reminiscence

“…A plethora of tissues has been described in mature ovarian teratomas over the past one and a half centuries. Thus, teratomas live up to their name, which means “monster” or “prodigy.” 1 A An unexpected finding in ovarian teratomas has been their association with anti-NMDAR encephalitis. 2,3 Teratomas associated with anti-NMDAR encephalitis often show distinct features in the glial tissues and the neuropsychiatric diagnosis can be suspected, or even predicted from the morphology of the ovarian neoplasm.…”

A Hairbrained Mature Cystic Ovarian Teratoma: With Bone Marrow, Meninges, and Intraglial Hair

“…A Hairbrained Mature Cystic Ovarian Teratoma: With Bone Marrow, Meninges, and Intraglial Hair Sanjay A. Pai, MD 1 A 25-year-old woman underwent excision of a right ovarian cyst for a presumed "dermoid cyst." The specimen consisted of a 5.5 Â 2.5 cm cyst that contained a mass of hair and some bony hard areas.…”

“…Teratomas, in general, and ovarian teratomas, in particular, are unique tumors, and their fascinating history as well as their ability to continually spring surprises has been discussed recently. 1 A wide array of tissues of ectodermal, mesodermal, and endodermal origin have been reported in ovarian teratomas. Meninges and bone marrow are rare but have been reported before.…”