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

Abstract

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.

Gliomatosis peritonei as a natural experiment in tissue differentiation

“…Long follow-up studies have demonstrated its benign course (Fortt et al, 1969;Robboy et al, 1970). A recent study comparing ovarian immature teratomas with and without GP demonstrated a similar overall good survival but with a higher incidence of early recurrences in the cases associated with GP (Mann et al, 2008;Yoon et al, 2012). Occasionally, GP may precede highly malignant neuroectodermal tumours (Dadmanesh et al, 1997;Shefren et al, 1991;Trabelsi et al, 2002).…”

“…Among serum markers, CA125 levels are elevated in GP (Yoon et al, 2012) and some authors (Bahari et al, 1980;de Graaff et al, 1980;Hokama et al, 1991) have also reported elevated alphafetoprotein levels, possibly related to endodermal elements present in the immature teratoma deposits.…”

“…All those features would indicate a teratoid maturation from embryonal, immature precursors from the ovarian tumour. Local differentiation would occur either spontaneously or induced by platin-based chemotherapy (Gibas et al, 1993;Kane et al, 2009;Yoon et al, 2012). Although most cases of implanted glial tissue mature spontaneously, chemotherapeutic conversion of neural immature cells into benign ones is the proposed mechanism for cases of growing teratoma syndrome associated with GP (Hsieh et al, 2009;Umekawa et al, 2005).…”

Growing Teratoma Syndrome

“…In one study the 2-yr recurrence-free survival rates were 59.3 and 96.3%, respectively, for patients with immature teratoma associated with gliomatosis, and those without gliomatosis. The authors concluded that gliomatosis was an adverse prognostic factor in patients with immature teratoma (28).…”

Gliomatosis peritonei with 18F-fluorodeoxyglucose accumulation and contrast enhancement secondary to immature teratoma: A case report

“…Thus, it is important to assess for recurrence in the follow-up examination. In addition to IM recurrence, gliomatosis peritonitis (GP) and growing teratoma syndrome (GTS) can develop after treatment for IM (5)(6)(7).…”