Malignant transformation of ovarian mature cystic teratoma

Abstract

There have been few studies concerning the clinical pathology of malignant transformation arising in ovarian mature cystic teratoma (MCT). Thus, the objective of this study is to determine clinicopathologic factors affecting survival in this rare tumor. From November 1992 to December 2002, 11 patients with malignant transformation arising in ovarian MCT were treated at Department of Obstetrics and Gynecology in Chonnam National University Hospital. Demographic characteristics, symptoms, signs, stage, mode of therapy, and results of follow-up were reviewed retrospectively. There were 11 cases of the malignant transformation of ovarian MCT out of 637 cases of MCT (1.7%). The average age was 50.6 years. Histologically, 7 out of the 11 cases were squamous cell carcinoma (63.7%). There were no specific clinical symptoms, but palpable abdominal mass was the most frequent complaint (five cases, 45.4%). As for the stage of disease, eight cases were in stage IA (72.7%), and the other three cases were in stage IC, IIB, and IIC, respectively. All the patients had surgery, and seven of them had adjuvant chemotherapy and two had adjuvant chemoradiation. All the patients in stage I survived until the period of follow-up, and their average survival time was 31.8 months. One patient in stage IIC died of intestinal obstruction within 9 months from the surgery. The mechanism of the malignant transformation arising in ovarian MCT is not clear, but considering the fact that 80% of MCTs are diagnosed during the reproductive age, malignant transformation seems to be related to the long-term presence of nonremoved MCT in the abdomen. Accordingly, it is considered helpful for preventing and early detection of the malignant transformation to have regular ovary examination through pelvic ultrasonogram during the reproductive age.

Adenocarcinoma arising in mature cystic teratoma: a case report

“…The tissue origin of these reports was various such as sweat glands, salivary glands, mammary glands, respiratory ciliated epithelium, gastrointestinal and thyroid glands. 10,11,13,14 In this study, we could find the tissue origin of thyroid transcription factor-1 and thyroglobulin by immunohistochemistry.…”

“…Among 9 cases of adenocarcinoma in which tumor markers were measured, including this case, only 2 cases showed elevated serum CEA level, 3 cases with elevated CA 19-9 level, and 2 cases with elevated CA125 level. [8][9][10][11][12] The size of tumor varied from a smallest tumor size of 4 mm in diameter to 36 cm. 8 These results reveal that specific tumor markers and tumor sized are ineffective in contributing to the preoperative diagnosis of adenocarcinomas arising from mature cystic teratoma.…”

Undifferentiated sarcoma arising in a mature cystic teratoma of the ovary

“…대부분의 성숙 낭성 기형종을 가진 환자들 은 증상을 호소하게 된다 [3]. 난소의 성숙 낭성 기형종의 임상적 양상 은 하복부 통증과 불편함, 그리고 덩어리의 촉진이며, 진단이 되기 전 증상의 지속기간은 한 달에서 19개월 정도이다 [1,3]. 암종은 이 종양의 표피부분의 어느 곳에서도 발생되며, 양성 혹은 악성으로 변형된다 [1].…”

“…난소의 성숙 낭성 기형종의 임상적 양상 은 하복부 통증과 불편함, 그리고 덩어리의 촉진이며, 진단이 되기 전 증상의 지속기간은 한 달에서 19개월 정도이다 [1,3]. 암종은 이 종양의 표피부분의 어느 곳에서도 발생되며, 양성 혹은 악성으로 변형된다 [1]. 기형종 조직에서 유래된 악성 종양의 수술 전 진단은 매우 어려워 대부 분의 진단이 수술 후 조직검사 결과로 확진하게 된다 [1].…”

“…성숙 낭성 기형종은 거의 대부분이 양성이지 만 드물게 약 1%-3%에서 악성 변형이 발생하기도 하며 이 중 편평세 포암(squamous cell carcinoma)가 가장 많이 발견된다. 편평세포암 외 에 선암(adenocarcinoma), 유암종(carcinoid tumor), 악성 갑상선종양 (malignant thyroid struma), 악성 흑색종(malignant melanoma) 및 다양 한 종류의 육종 등이 보고된 바 있으나 미분화육종의 발생은 보고된 바 가 없다 [1,2]. 악성 변형된 종양의 치료를 위해서는 침습 혹은 전이가 되기 전에 성숙 낭성 기형종의 악성 변형을 조기에 진단하는 것이 중요 하나, 수술 전 혹은 수술 중에라도 악성 변형을 진단하는 것이 매우 어 렵다 [3].…”