An ovarian teratoma is one of the most common type of germ cell tumours. These tumors arise from a variety of both epithelial and mesenchymal (soft tissue) elements. There are two main types, a mature benign variant and an immature or malignant variant.
The mature teratoma is the commonest type of ovarian germ cell tumour. Women in their reproductive years are susceptible. A popular term is the dermoid cyst because the lining looks like skin. Immature teratomas are usually diagnosed in a younger age group and are far rarer. Immaturity refers to the histologic appearance of some of the tissue, recapitulating embryonic tissue.
Epidemiology Pathogenesis Laboratory/Radiologic/Other Diagnostic Testing Histopathological Features and Variants Prognosis Treatment Commonly Used Terms Internet Links
EPIDEMIOLOGY CHARACTERIZATION SYNONYMS Dermoid cyst AGE 30-40s for mature teratomas
Teens to 20s for immature teratomas
PATHOGENESIS CHARACTERIZATION COX-2
Expression of cyclooxygenase-2 in ovarian mature cystic teratomas with malignant transformation.
Sumi T, Ishiko O, Yoshida H, Hyun Y, Nakagawa E, Hirai K, Matsumoto Y, Ogita S.
Department of Obstetrics and Gynecology, Osaka City University Medical School, 1-4-3 Asahimachi, Abenoku, Osaka 545-8585, Japan.
Int J Mol Med 2001 Nov;8(5):495-8 Abstract quote
Cyclooxygenase-2 (COX-2) has been reported to be associated with tumor progression and angiogenesis and we previously reported that an increase in COX-2 expression might be associated with malignant transformation and tumorigenesis of epithelial ovarian neoplasms.
In this study, COX-2 expression of ovarian mature cystic teratomas with malignant transformation, a rare entity accounting for just 1.8% of all mature cystic teratomas, was investigated using immunohistochemical techniques. There were 89 cases of mature cystic teratomas treated with surgery as their initial therapy at Osaka City University Medical School Hospital between 1995 and 2001. Ten cases of these were selected for study; five cases of mature cystic teratoma with malignant transformation, and five cases of mature benign teratoma. Expressions of CD34, vascular endothelial growth factor (VEGF), and COX-2 were investigated. Expressions of VEGF and COX-2 were strong in tissues of mature cystic teratomas with squamous cell carcinoma; however, expressions of them were hardly apparent in mature benign teratomas and in mature cystic teratomas with adenocarcinomas.
These results tend to suggest that COX-2 is associated with tumor growth and progression in mature cystic teratomas with squamous cell carcinoma, as opposed to mature benign teratomas and mature cystic teratomas with adenocarcinomas.
Immature teratoma of the ovary: correlation of MR imaging and pathologic findings.
Yamaoka T, Togashi K, Koyama T, Fujiwara T, Higuchi T, Iwasa Y, Fujii S, Konishi J.
Department of Nuclear Medicine and Diagnostic Imaging, Graduate School of Medicine, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
Eur Radiol 2003 Feb;13(2):313-9 Abstract quote
The objectives of this study were to describe MR imaging findings of immature teratoma and to correlate imaging findings with histopathologic findings. The MR findings of ten patients (age range 12-29 years, mean age 19.0 years) with pathologically proven immature teratoma were retrospectively reviewed for tumor size, presence and characteristics of fatty content, presence and characteristics of solid components, and presence of ascites and implants. The MR findings were compared with gross ( n=3) and microscopic ( n=10) findings. Comparisons between relative amounts of solid components and histologic grades were evaluated by Spearman rank-order correlation.
On MR images all lesions appeared to be fat-containing tumors with solid components consisting of numerous cysts of various sizes. Solid tissue exhibited a wide variety of signal intensities on T2-weighted images. Punctate foci of fat were identified in all lesions, whereas fatty fluid was observed only in two. Predominant fluid content exhibited signal intensities similar to simple fluid in nine lesions. Ascites was observed in six lesions, and peritoneal dissemination in three.
Pathologic studies confirmed scattered foci of adipose tissue in the solid portions of all cases, and revealed numerous cystic structure formations in these solid components. The correlation coefficient between the amount of solid tissue and the tumor grade was not significant (r(s)=0.266). The MR images of immature teratoma tended to show aqueous fluids and the solid components consisting of numerous cysts with punctate foci of adipose tissue, whereas predominant fluid is sebaceous fluid in the vast majority of mature cystic teratomas.
HISTOLOGICAL TYPES CHARACTERIZATION GENERAL CYTOLOGY
Immature teratoma of the ovary on fluid cytology.
Selvaggi SM, Guidos BJ.
Department of Pathology, Loyola University Medical Center, Maywood, Illinois 60153, USA
Diagn Cytopathol 2001 Dec;25(6):411-4 Abstract quote
A case of an immature teratoma of the ovary in the peritoneal fluid of a 10-yr-old girl who presented with a pelvic mass is presented and discussed.
The ThinPrep preparation showed a few tight clusters of small tumor cells with a high nuclear/cytoplasmic ratio, round to oval nuclei with evenly distributed chromatin and one to two small distinct nucleoli, and scanty cytoplasm.
The presence of immunohistochemical-confirmed glial tissue on the cell block preparation confirmed the diagnosis of an immature ovarian teratoma. The differential diagnosis of fluid cytology is discussed.
Adenocarcinoma arising from respiratory ciliated epithelium in mature ovarian cystic teratoma.
Sumi T, Ishiko O, Maeda K, Haba T, Wakasa K, Ogita S.
Department of Obstetrics and Gynecology, Osaka City University Medical School, 1-4-3, Asahimachi, Abeno-ku, Osaka 545-8585, Japan.
Arch Gynecol Obstet 2002 Dec;267(2):107-9 Abstract quote
Malignant transformation of a mature cystic teratoma of the ovary is rare, that of an adenocarcinoma is extremely rare. A 32-year-old woman was suspected as having a malignant transformation of her mature cystic teratoma of the ovary because the preoperative level of carcinoembryonic antigen (CEA) was extremely high.
Resections of her ovarian cysts were performed, and this particular tumor was histopathologically diagnosed as an adenocarcinoma arising from a mature cystic teratoma of the left ovary.
Because adenocarcinomas arising from mature cystic teratomas of the ovary are extremely rare, we report this case with a review of some of the literature.
GLIOMATOSIS PERITONEI Is gliomatosis peritonei derived from the associated ovarian teratoma?
Kwan MY, Kalle W, Lau GT, Chan JK.
Hum Pathol. 2004 Jun;35(6):685-8. Abstract quote
Gliomatosis peritonei, a rare condition that occurs almost exclusively in the setting of ovarian immature teratoma, is characterized by the occurrence of nodules of mature glial tissues in the peritoneum. It is controversial whether glial tissues are derived from maturation of the associated teratomatous tissue that has implanted in the peritoneum, or glial differentiation of subperitoneal stem cells.
In this study, we employed the unique genetic characteristics of ovarian teratomas (often with a duplicated set of maternal chromosomes and thus homozygous at many polymorphic microsatellite loci) versus normal tissues (heterozygous pattern due to presence of maternal and paternal genetic materials) to investigate the origin of gliomatosis peritonei. DNA samples were extracted from microdissected paraffin-embedded tissues, including the glial implants, the associated ovarian teratomas, and normal tissues, to determine their patterns of microsatellite loci in a multiplex polymerase chain reaction system.
Two cases were not informative because the ovarian teratoma showed a heterozygous microsatellite pattern. In the 5 informative cases, the normal tissues showed a heterozygous pattern in the microsatellite loci, the associated teratomas showed a homozygous pattern, and the glial tissues showed a heterozygous pattern.
Thus, gliomatosis peritonei is genetically unrelated to the associated teratoma but is probably derived from nonteratomatous cells, such as through metaplasia of submesothelial cells.
Gliomatosis peritonei with mature teratoma of the ovary.
Gabrys M, Blok K, Rabczynski J, Kochman A, Latkowski K, Blok R, Ekonjo GB.
I Katedry i Kliniki Ginekologii i Poloznictwa AM we Wroclawiu
Ginekol Pol 2002 Dec;73(12):1224-7 Abstract quote
We report a case of menstrual mature teratoma of ovary with implants of glial tissue in peritoneum and its adnexa.
After resection of the tumour and omentum laparoscopic examination was performed and revealed reduction, fibrosis of glial implants and massive cellular reaction.
Compound melanocytic nevus arising in a mature cystic teratoma of the ovary.
Kuroda N, Hirano K, Inui Y, Yamasaki Y, Toi M, Nakayama H, Hiroi M, Enzan H.
First Department of Pathology, Kochi Medical School, Nankoku City, Japan.
Pathol Int 2001 Nov;51(11):902-4 Abstract quote
A 28-year-old woman complained of irregular menstruation. Abdominal ultrasound and magnetic resonance imaging (MRI) examinations revealed a cystic tumor in the left ovary. A histological examination of the resected ovary revealed that the lesion was a mature cystic teratoma.
In this tumor, components such as skin with appendages, a thyroid gland, mucosa of the digestive tract and a submandibular gland were observed. Interestingly, compound melanocytic nevus was also present in the skin component.
To the best of our knowledge, this is the sixth reported case of nevus arising in a mature cystic teratoma of the ovary. Despite the extreme rarity of such a lesion, pathologists should recognize the possibility of such lesions occurring in ovarian teratoma.
- Ovarian Mature Teratomas With Mucinous Epithelial Neoplasms: Morphologic Heterogeneity and Association With Pseudomyxoma Peritonei.
*Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR †Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY ‡Department of Pathology, Stanford University School of Medicine, Stanford, CA.
- Am J Surg Pathol. 2008 May;32(5):645-655. Abstract quote
Mucinous epithelial neoplasms arising in association with mature teratomas are a heterogeneous group of tumors, but with the exception of a single recent study, their full histologic spectrum, detailed immunophenotype, and association with classic pseudomyxoma peritonei (PMP) have not been fully studied.
The morphologic, immunohistochemical, and clinical features of 42 patients with mucinous epithelial tumors arising in association with mature ovarian teratomas were evaluated. The patients' ages ranged from 17 to 66 years (mean, 39 y). Tumor size ranged from 5.5 to greater than 200 cm. Most teratoma-associated mucinous tumors were unilateral, although 1 patient harbored bilateral mucinous tumors in association with bilateral teratomas. In all cases, the teratomatous component consisted of mature elements. Using the 2003 World Health Organization criteria for ovarian intestinal type mucinous neoplasms, 17 (40%) were classified as mucinous cystadenoma, 16 (38%) as intestinal-type mucinous epithelial neoplasm of low malignant potential (IM-LMP), 4 (10%) as intraepithelial carcinoma (IEC), and 5 (12%) as invasive mucinous carcinoma. Mucinous cystadenomas had a varied epithelial lining consisting of lower gastroenteric, gastric foveolar, or müllerian appearance. In contrast, the IM-LMP, IEC, and invasive carcinoma cases had a more uniform lower gastroenteric histology. For mucinous cystadenomas, a cytokeratin (CK) 7+/CK20- phenotype (5/13; 38%) was equally as common as a CK7-/CK20+ phenotype (5/13; 38%), with the remaining cases coexpressing both keratins (CK7+/CK20+: 3/13; 23%). In contrast, IM-LMP, IEC, and invasive adenocarcinomas more frequently had a CK7-/CK20+ phenotype (56%, 50%, and 100%, respectively). A CK7+/CK20-phenotype was rare in these later 3 morphologic groups (6%). Of the 42 total cases, 55% had pseudomyxoma ovarii and 24% had classic PMP (1 cystadenoma, 6 IM-LMP, and 3 invasive carcinomas), whereas 5% had more localized accumulations of peritoneal mucin (both IM-LMP). Pathologic evaluation of the peritoneum in these 12 cases revealed 6 with acellular mucin alone, 3 with low-grade mucinous epithelium (all 3 with ovarian IM-LMP), and 3 with high-grade mucinous carcinomatosis (all 3 with ovarian mucinous adenocarcinoma). No appendiceal lesions were identified. Follow-up was available in 48% of patients (mean, 61 mo). The only adverse outcomes occurred in the 3 patients with ovarian carcinoma and associated peritoneal carcinomatosis.
We report that a significant proportion of mucinous tumors associated with mature ovarian teratomas present with clinical PMP, which in most cases is associated with IM-LMP. PMP in this setting may harbor microscopic intra-abdominal low-grade mucinous epithelium that is histologically and immunophenotypically similar to that typically seen in appendiceal-related PMP.
Pseudomyxoma ovarii is common in this setting, particularly in tumors with IM-LMP histology, but pseudomyxoma ovarii is not predictive of PMP. Ovarian teratoma-associated benign and IM-LMP mucinous neoplasms with microscopic peritoneal low-grade mucinous epithelium do not seem to be at significant risk for intra-abdominal recurrence, but numbers are few and follow-up is limited. In contrast, teratomas with an invasive carcinomatous component and microscopic peritoneal carcinomatosis follow an aggressive clinical course.
Mucinous tumors arising in ovarian mature cystic teratomas: relationship to the clinical syndrome of pseudomyxoma peritonei.
Ronnett BM, Seidman JD.
Am J Surg Pathol 2003 May;27(5):650-7 Abstract quote
Recent studies have redefined pseudomyxoma peritonei (PMP) as a specific clinicopathologic syndrome in which mucinous ascites is accompanied by peritoneal lesions characterized by bland to low-grade adenomatous mucinous epithelium intimately associated with pools of extracellular mucin and fibrosis, diagnosed pathologically as disseminated peritoneal adenomucinosis (DPAM). Most recent studies support an appendiceal rather than ovarian origin for virtually all cases of PMP/DPAM in women. Peritoneal mucinous tumors with the histologic features of carcinoma (peritoneal mucinous carcinomatosis, PMCA) are also rarely ovarian in origin and are distinguished from DPAM, even though they may produce abundant mucin, because PMCA and DPAM are pathologically and prognostically distinct.
We report three cases of PMP (mucinous ascites) associated with ruptured mucinous tumors arising in ovarian mature cystic teratomas. Two tumors contained bland to low-grade adenomatous mucinous epithelium associated with dissecting mucin, identical to the mucinous tumors that secondarily involve the ovaries and peritoneum in PMP/DPAM derived from ruptured appendiceal mucinous adenomas. The third was composed of both low-grade adenomatous tumor and areas of mucinous carcinoma.
In all cases the appendices were microscopically normal. The mucinous ascites associated with the low-grade tumors contained only a few fragments of detached bland mucinous epithelium in one and none in the other. The mucinous ascites associated with the higher-grade tumor contained one fragment of atypical mucinous epithelium. All three mucinous tumors were cytokeratin 20-positive and cytokeratin 7-negative, consistent with a lower gastrointestinal tract-type rather than primary ovarian-type mucinous tumor immunophenotype.
Mucinous tumors arising in ovarian mature cystic teratomas are morphologically and immunohistochemically consistent with gastrointestinal tract-type mucinous tumors, which likely arise from gut elements of the teratoma. Rupture can on rare occasions produce mucinous ascites containing very scant mucinous epithelium, but additional follow-up will be required to determine whether these ovarian tumors ever lead to recurrent disease accompanied by the characteristic peritoneal lesions of DPAM or PMCA. Such tumors probably represent the only cases of ovarian origin of PMP.
Mucinous adenocarcinoma and strumal carcinoid tumor arising in one mature cystic teratoma of the ovary with synchronous cervical cancer.
Kim SM, Choi HS, Byun JS, Kim YH, Kim KS, Rim SY, Kim HR, Nam JH, Choi YD.
Department of Obstetrics and Gynaecology, Chonnam National University Medical School, Dongku, Gwangju, Korea.
J Obstet Gynaecol Res 2003 Feb;29(1):28-32 Abstract quote
Malignant transformation of mature cystic teratoma is an uncommon complication. While any of the constituent tissues of a teratoma has the potential to undergo malignant transformation, squamous cell carcinoma is the most commonly associated cancer.
We present an unusual case of a postmenopausal woman with synchronous mucinous adenocarcinoma and strumal carcinoid tumor from one of two ovarian mature cystic teratomas (one in each ovary) with synchronous cervical cancer.
We suggest that malignant transformation of mature cystic teratoma and synchronous cervical cancer be treated by hysterectomy, chemotherapy, and radiotherapy.
Teratoid carcinosarcoma of the ovary with prominent neuroectodermal differentiation.
Tanimoto A, Arima N, Hayashi R, Hamada T, Matsuki Y, Sasaguri Y.
Department of Pathology and Cell Biology, School of Medicine, University of Occupational and Environmental Health, Yahatanishi, Kitakyushu, Japan.
Pathol Int 2001 Oct;51(10):829-32 Abstract quote
We present what we believe to be only the second report of ovarian teratoid carcinosarcoma. The patient, a 59-year-old woman, was admitted to hospital complaining of a pelvic mass and of abdominal fullness.
Advanced ovarian cancer was diagnosed, and a tumorectomy was done. The tumor occupied the pelvis, and metastasis was found in the liver and spleen. The solid tumor was composed of chondrosarcoma, squamous cell carcinoma, adenocarcinoma and malignant neuroectodermal components, which contained ganglioneuroblastoma-like and medulloepithelioma-like areas. Immunohistochemically, the neuroectodermal cells were positive for both neural and epithelial markers.
This ovarian tumor consisted of frankly malignant components, with prominent neuroectodermal elements mixed with epithelial and mesenchymal elements in an organoid fashion; a quite rare tumor.
Monodermal highly specialized teratoma of the ovary: a sebaceous gland tumor.
Cicchini C, Larcinese A, Ricci F, Aurello P, Mingazzini PL, Indinnimeo M.
Department of Surgery Pietro Valdoni, University of Rome La Sapienza, Italy.
Eur J Gynaecol Oncol 2002;23(5):442-4 Abstract quote
Teratomas are neoplasms that originate in pluripotential cells and contain representations of all three germ layers in a rather mature state.
Specialized forms of teratoma with unilateral development of certain tissues, such as struma ovarii, argentaffin tumors, cholesteatoma, primary choriocarcinoma of the ovary, pseudomucinous cystoma and neurogenic cysts are known.
In this paper we describe an ovarian teratoma consisting entirely of sebaceous glands.
Malignant Struma Ovarii: an autopsy report of a clinically unsuspected tumor.
Ribeiro-Silva A, Bezerra AM, Serafini LN.
Department of Pathology, Faculty of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil.
Gynecol Oncol 2002 Nov;87(2):213-5 Abstract quote
BACKGROUND: Struma Ovarii represents less than 3% of ovarian teratomas. The malignant counterpart is very rare.
CASE: A 67-year-old female with ascites and progressive weight loss died of respiratory failure secondary to severe chronic obstructive pulmonary disease. Autopsy revealed ascites, hepatic cirrhosis, emphysema, and bronchiectasis. As an incidental finding was seen a huge tumor (10 x 9.5 x 6 cm) in the left ovary. Multiple nodules were detected in the lungs. The thyroid was normal. Microscopy revealed a follicular variant of papillary carcinoma arising in ectopic thyroid tissue in the ovary with metastasis to lungs and pleura. The thyroid gland tissue was normal.
CONCLUSION: To our knowledge, this is the first autopsy report of a clinically unsuspected malignant Struma Ovarii.
Ovarian teratomas with florid benign vascular proliferation: a distinctive finding associated with the neural component of teratomas that may be confused with a vascular neoplasm.
Baker PM, Rosai J, Young RH.
Department of Pathology, Health Sciences Center, University of Manitoba, Winnipeg, Manitoba, Canada.
Int J Gynecol Pathol 2002 Jan;21(1):16-21 Abstract quote
Prominent benign vascular proliferations associated with neural tissue in five cases of ovarian teratoma are described. The ages of the patients ranged from 15 to 35 years. Three of the five had tumors confined to the ovary, one had peritoneal implants, and one had widespread metastatic immature teratoma.
Two of the patients are alive and well, 8 and 9 years postoperatively. Follow-up is unavailable in two cases and the final case was recent. The tumor in three of the cases had features of mature cystic teratoma including abundant mature neural tissue and, in one instance, microscopic foci of primitive neuroepithelium. The tumor in the fourth case was an immature teratoma with abundant primitive neuroepithelium, and in the fifth case was a mixed germ cell tumor, composed mostly of immature teratoma with a minor component of yolk sac tumor. In all the tumors there was a prominent vascular proliferation composed of long thin-walled, curved vessels or a solid glomeruloid arrangement. Immunohistochemistry done in two cases confirmed the vascular nature of the proliferation.
Angiogenesis, likely as an expression of vascular endothelial growth factors, is a well-known phenomenon in a variety of neural and neuroendocrine neoplasms, in particular high-grade gliomas. However, very few cases of this phenomenon have been described in association with neural tissue in the ovary.
Recognition of this proliferation as a benign secondary one is important to avoid misdiagnosis of a vascular neoplasm or an immature teratoma, as happened in one of our cases.
PROGNOSIS CHARACTERIZATION GENERAL
Retrospective analysis of 67 consecutive cases of pure ovarian immature teratoma.
Li H, Hong W, Zhang R, Wu L, Liu L, Zhang W.
Department of Gynecology-Oncology, Cancer Institute, Chinese Academy of Medical Sciences, Zuo An Men Wai, Beijing 100021, China.
Chin Med J (Engl) 2002 Oct;115(10):1496-500 Abstract quote
OBJECTIVE: To investigate the development regularity, treatment methods and prognosis of ovary immature teratoma (POIT).
METHODS: Sixty-seven patients with POIT, admitted from 1958 to 1998, were retrospectively analyzed. There were 31 patients with stage I, 4 with stage II, 2 with stage III and 1 with stage IV lesions. Twenty-seven patients had recurrences and 2 had distant metastases. Unilateral adnexectomy was performed for stage I lesions. From the 1980s, this was followed by four-cycles of combination chemotherapy (VAC, PVB or BEP x 3 cycles) as post-operative adjuvant therapy. Combined chemotherapy and multiple operations were performed for advanced and recurrent lesions.
RESULTS: The overall survival rate was 75% (50/67). However, there was a remarkable difference in the results from the various periods. From 1958 to 1983, the 5-year survival rate was 40% (6/15), and it was raised to 79% (26/33) from 1984 to 1993. In the period 1994 to 1998, 95% (18/19)of patients were rescued. Thirty-five patients who had early lesions (stage I and II) had a 5-year survival rate of 91.4% (32/35). Thirty-two patients with recurrent or advanced lesions had a 5-years survival rate of 56% (18/32). There were 8 patients with grade III tumors and their 5-year survival rate was only 25% (2/8). The chief prognostic factors for this disease are clinical stage, pathological grade and adequate treatment.
CONCLUSION: POIT is a potentially curable disease in today's practice. It is characterized by the fact that recurrent tumors may be converted back to mature ones as time goes on. With chemotherapy, these is a good opportunity to rescue those patients with recurrent tumors. At present, treatment of POIT gives the most satisfactory results among all malignant ovarian germ cell tumor types. Tests of serum specific tumor markers (CA19-9, AFP, CA125, CEA) performed preoperatively or before chemotherapy and during follow-up have been found helpful in the evaluation of prognosis.
Pure immature teratoma of the ovary: analysis of 22 cases.
Kojs Z, Urbanski K, Mitus J, Reinfuss M, Pudelek J, Walasek T.
Center of Oncology, Maria Sklodowska, Curie Memorial Institute, Krakow, Poland.
Eur J Gynaecol Oncol 1997;18(6):534-6 Abstract quote
Between 1970 and 1991, 22 patients with pure immature teratoma were treated at the Center of Oncology in Krakow. Sixteen (72.7%) patients had stage I, four (18.2%) stage II, and two (9.1%) stage III of disease, nine (40.9%) patients had grade 1, 11 (50%) grade 2, and two (9.1%) grade 3 tumors. Eight stage Ia, grade 1 patients were treated with surgery only, the remaining 14 (63.6%) received postoperative chemotherapy.
Five-year NED (no evidence of disease) survival was achieved in 81.8% of patients. Out of 16 stage I patients, 15 (93.8%) survived 5-year NED, out of six stage II and III, three (50%) patients only survived this period. We cured all grade 1 patients, and 81.8% (9/11) grade 2; two grade 3 patients died because of tumors.
We also cured all six stage Ia patients, treated with unilateral salpingo-oophorectomy (with or without chemotherapy), and all eight stage Ia grade 1 patients treated with surgery only.
Pure ovarian immature teratoma, a unique and curable disease: 10 years' experience of 32 prospectively treated patients.
Bonazzi C, Peccatori F, Colombo N, Lucchini V, Cantu MG, Mangioni C.
Department of Obstetrics and Gynecology, Ospedale San Gerardo, Istituto di Scienze Biomediche San Gerardo, University of Milan, Monza, Italy.
Obstet Gynecol 1994 Oct;84(4):598-604 Abstract quote
OBJECTIVE: To report and evaluate a conservative and individualized treatment policy in a homogeneously selected series of patients affected by pure ovarian immature teratoma.
METHODS: This prospective trial, with specific treatment policies according to stage and grade, was planned and started in 1982. The study population consisted of 32 patients affected by pure immature teratoma, with the exclusion of mixed germ cell tumors. Fertility-sparing surgery was performed whenever possible. Surgery alone, with careful follow-up, was adopted for stage I or II according to the International Federation of Gynecology and Obstetrics (FIGO) and grade 1 or 2 tumors. The other patients, with stage III or with grade 3 stage I or II tumors, or those referred at relapse, were treated with platinum-based chemotherapy regimens.
RESULTS: Thirty of 32 patients underwent fertility-sparing surgery. Ten of 32 patients received chemotherapy after surgery, either as adjuvant treatment or in the presence of visible tumor. All 32 patients are alive and disease-free, with a median follow-up from surgery of 47 months (range 11-138). In six patients, regardless of the administration of chemotherapy, the tumor either spontaneously differentiated toward mature glia or increased in volume, mimicking progression but still remaining completely mature. Five of six patients wishing to procreate had a total of seven normal pregnancies.
CONCLUSIONS: Pure ovarian immature teratoma is a potentially curable disease with a unique natural history. Our data substantiate the hypothesis that low-grade and low-stage tumors do not require chemotherapy, and that a fertility-sparing surgical approach is warranted in all cases.
Malignant germ cell tumors of the ovary: 20-year report of LAC-USC Women's Hospital.
Curtin JP, Morrow CP, D'Ablaing G, Schlaerth JB.
Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, and Department of Pathology, University of Southern California School of Medicine, Los Angeles, California, USA.
Int J Gynecol Cancer 1994 Jan;4(1):29-35 Abstract quote
Thirty-six patients with malignant germ cell tumors (GCT) of the ovary were treated during the period from 1971 to 1990.
Twenty-five of these patients underwent initial surgery at this institution; 11 were referred after initial surgery. Endodermal sinus tumor (EST) was the most common subtype (N = 13), followed by immature teratoma (IMT) N = 11), dysgerminoma (N = 9), and mixed germ cell tumor (N = 3). Eight of nine patients with dysgerminoma and 14 of 27 patients with non-dysgerminomatous germ cell tumors had stage I disease. Surgical staging resulted in a change of stage in 10 of 31 patients; seven were upstaged, and three were downstaged. Thirty-five of 36 patients are alive with no evidence of disease at a median follow-up of 47 months (range 12-210 months). Two of nine patients with dysgerminoma received postoperative radiotherapy; two additional patients required radiotherapy for recurrence.
Twenty-five of 27 patients with non-dysgerminomatous tumors were treated with combination chemotherapy. Second-look laparotomy was done in 18 patients, four of whom had positive results. Three of the four patients with positive second-look laparotomy results remain free of disease after salvage chemotherapy; the fourth patient died of progressive grade 3 IMT. Nineteen of 27 patients undergoing fertility-preserving surgery have resumed normal menses, and four of these have delivered normal infants. The other eight patients remain on oral contraceptives.
We conclude that surgical staging provided important information in this study of 36 patients with ovarian germ cell malignancies. As noted by many previous reports, combination chemotherapy (developed during the past 20 years) has dramatically improved prognosis for this group of patients. Second-look laparotomy (SLL), especially for patients with advanced disease, was able to identify patients requiring additional therapy. Most patients with this disease can retain their normal, uninvolved ovary with preservation of normal menstrual and reproductive function.
Histologic grade and karyotype of immature teratoma of the ovary.
Ihara T, Ohama K, Satoh H, Fujii T, Nomura K, Fujiwara A.
Cancer 1984 Dec 15;54(12):2988-94 Abstract quote
Seven cases of ovarian "pure" immature teratoma were encountered in patients 10 to 38 years of age, six cases being in Stage Ia and one case in Stage IIc. The primary tumors and recurrent growth observed in one case were histologically graded from 0 to 3 according to the criteria of Norris et al. Karyotypes of the tumors and the patients were determined using culture and banding techniques. The only nonsurviving case was in Stage IIc.
Four primary tumors belonging to grades 0, 1, and 2 showed a normal 46,XX female karyotype and the patients are alive and healthy. Three grade 3 tumors showed various types of karyotype abnormalities (48,XX,+14,+21; 47,XX,+20; 47,XXX). One patient died, one is alive after experiencing a recurrent tumor, and one has only been followed for 22 months. All seven patients had a normal 46,XX female chromosome constitution. Evidence to date indicates that karyotype of ovarian immature teratoma is either normal female 46,XX or a slight deviation from normal.
It is postulated that in ovarian immature teratoma normal 46,XX karyotype is an indicator of favorable prognosis, whereas deviations in karyotype suggest a possibility of poor prognosis.
TREATMENT CHARACTERIZATION GENERAL
Immature teratoma of the ovary.
Koulos JP, Hoffman JS, Steinhoff MM.
Department of Obstetrics and Gynecology, University of Connecticut Health Center, Farmington 06032.
Gynecol Oncol 1989 Jul;34(1):46-9 Abstract quote
Twenty-five cases of patients with pure immature teratoma of the ovary, accrued from the Connecticut Tumor Registry from 1969 to 1984, were reviewed. Two patients had grade 1 tumors, twelve had grade 2 tumors, and eleven had grade 3 tumors. The majority of patients (23) were stage I at the time of initial surgery.
Twenty-one of the twenty-three patients were treated with some form of unilateral adnexal surgery with or without adjuvant combination chemotherapy (VAC). Two of the twenty-three patients were treated with total abdominal hysterectomy/bilateral salpingo-oophorectomy (TAH/BSO) with the addition of either VAC chemotherapy or radiation therapy. Recurrence occurred in two patients, both of whom had grade 3 tumors and were subsequently treated with surgical resection plus VAC chemotherapy. One patient, who recurred after initial therapy with unilateral salpingo-oophorectomy (USO) plus VAC chemotherapy, was successfully treated with surgical resection and further chemotherapy. Two patients were stage III at the time of initial surgery, one of whom was treated with USO plus adjuvant combination chemotherapy and radio-therapy. The other patient was treated with TAH/BSO plus VAC chemotherapy.
In our series, no patient died from immature teratoma (one patient died from advanced breast carcinoma). It is reasonable to withhold chemotherapy from patients with stage I, grade 1 and 2, immature teratoma which may be treated initially with conservative surgery. The risk of recurrence in patients with grade 3 tumors warrants the addition of further chemotherapy.
Pure malignant immature teratoma of the ovary: the role of chemotherapy and second-look surgery.
Culine S, Lhomme C, Kattan J, Michel G, Duvillard P, Droz JP.
Department of Medicine, Department of Surgery, Department of Pathology, Institut Gustave Roussy, Villejuif; and Department of Medical Oncology, Centre Leon Berard, Lyon, France.
Int J Gynecol Cancer 1995 Nov;5(6):432-437 Abstract quote
Fifteen patients with pure malignant immature teratoma of the ovary were treated at the Institut Gustave Roussy over a 17-year period. Chemotherapy was delivered as primary postoperative therapy in 11 patients. Four other patients received chemotherapy as part of their salvage treatment for recurrent disease. A second-look laparotomy was performed in eight patients.
Histological findings were: no tumor in three patients, mature teratoma in four patients, and immature grade 1 teratoma in one patient. The latter five patients had persistent radiologic abnormalities at the end of chemotherapy. Twelve patients remain free of disease 24-228 months from initiation of chemotherapy. Two children were delivered from the two patients who attempted pregnancy. All three patients who died of progressive disease had a grade 3 immature teratoma.
We conclude that the treatment of pure immature teratoma of the ovary should include primary conservative surgery and cisplatin-based chemotherapy. Second-look surgery is mandatory in patients with persistant radiologic abnormalities at the completion of chemotherapy.
Recent management of malignant ovarian germ cell tumors: a study of 34 cases.
Linasmita V, Srisupundit S, Wilailak S, Tangtrakul S, Israngura N, Bullangpoti S.
Department of Obstetrics and Gynecology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
J Obstet Gynaecol Res 1999 Oct;25(5):315-20 Abstract quote
OBJECTIVE: To review the outcome of the treatment in patients with malignant ovarian Germ cell tumors with respect to survival and surgical management at a single institution during 1990-1996.
METHODS: Thirty-four patients with malignant ovarian Germ cell tumors were studied retrospectively for their surgical management. Fourteen patients had pure dysgerminoma, 11 endodermal sinus tumor, 6 immature teratoma, and 3 mixed Germ cell tumors. Nine patients had stage IA, 8 stage IC, 2 stage IIC, 8 stage III, 3 stage IV, and 4 referred patients with recurrent diseases.
RESULTS: Nineteen patients underwent primary conservative surgery, 11 had primary nonconservative surgery. Twenty-two patients were treated with chemotherapy (BEP or EP or PVB regimen). Five patients with pure dysgerminoma received adjuvant radiotherapy. Persistent remission was achieved in 26 patients. Two patients (7.4%) had recurrence after remission. Seven patients had died of the diseases. Patients with complete clinical remission did not undergo second-look surgery. The overall survival was 78.8%, 100% for immature teratoma, 84.6% for pure dysgerminoma, 72.8% for endodermal sinus tumor, and 33.3% for mixed Germ cell tumors, with median follow-up time 31 (3-93) months.
CONCLUSION: Patients with limited diseases regardless of histologic types can be safely managed by unilateral salpingo-oophorectomy followed by, if indicated, 3-4 courses of cisplatin-based chemotherapy. For advanced diseases, conservative surgery is advisable in patients with endodermal sinus tumor.
Is there a role for second-look laparotomy in the management of malignant germ cell tumors of the ovary? Experience at Institut Gustave Roussy.
Culine S, Lhomme C, Michel G, Leclere J, Duvillard P, Droz JP.
Department of Medicine, Institut Gustave Roussy, Villejuif, France.
J Surg Oncol 1996 May;62(1):40-5 Abstract quote
The last two decades have seen great improvements in the management of patients with germ-cell tumors of the ovary. The initial treatment approach includes conservative surgery and cisplatin-based chemotherapy in most cases. At completion of chemotherapy, the role of second-look surgery remains questionable.
We retrospectively analyzed the long-term outcome (median follow-up, 8 years) of 40 patients who received various chemotherapy regimens after primary surgery and focused on the role of second-look surgery. A second-look laparotomy was performed at completion of chemotherapy in 22 patients. Histological findings were no tumor in 13; mature teratoma in 5; immature teratoma in 1; active disease in 3. Six of the latter nine patients had persistent radiologic abnormalities after chemotherapy. All three patients with active disease had elevated serum tumor markers. Five out of the six patients with residual teratoma lesions had a teratoma component in the primary tumor. According to histological findings at second-look surgery, the number of patients without long-term evidence of disease is 12, 5, 1 and 0, respectively. Eighteen patients were not subjected to second-look surgery.
One of them had clearly progressive disease and the other 17 experienced a clinical complete response at completion of chemotherapy. All patients but one are alive without evidence of disease.
We conclude that second-look surgery is not necessary in patients with elevated serum tumor marker levels and in those patients with neither radiologic abnormality nor teratoma element in the primary tumor. However, we recommend a second-look procedure for the small subset of patients with a teratoma component in the primary tumor and persistent radiologic abnormalities along with normal serum tumor markers at the end of chemotherapy.
Macpherson and Pincus. Clinical Diagnosis and Management by Laboratory Methods. Twentyfirst Edition. WB Saunders. 2006.
Rosai J. Ackerman's Surgical Pathology. Ninth Edition. Mosby 2004.
Sternberg S. Diagnostic Surgical Pathology. Fourth Edition. Lipincott Williams and Wilkins 2004.
Robbins Pathologic Basis of Disease. Seventh Edition. WB Saunders 2005.
DeMay RM. The Art and Science of Cytopathology. Volume 1 and 2. ASCP Press. 1996.
Weedon D. Weedon's Skin Pathology Second Edition. Churchill Livingstone. 2002
Fitzpatrick's Dermatology in General Medicine. 6th Edition. McGraw-Hill. 2003.
Weiss SW and Goldblum JR. Enzinger and Weiss's Soft Tissue Tumors. Fifth Edition. Mosby Elesevier 2008
Commonly Used Terms
Basic Principles of Disease
Learn the basic disease classifications of cancers, infections, and inflammation
Commonly Used Terms
This is a glossary of terms often found in a pathology report.
Learn how a pathologist makes a diagnosis using a microscope
Surgical Pathology Report
Examine an actual biopsy report to understand what each section means
Understand the tools the pathologist utilizes to aid in the diagnosis
How Accurate is My Report?
Pathologists actively oversee every area of the laboratory to ensure your report is accurate
Recent teaching cases and lectures presented in conferences
Pathologists Who Make A Difference
Search for a Physician Specialist
Last Updated May 5, 2008
mail to The Doctor's Doctor with
questions or comments about this web site.
Read the Medical Disclaimer.
Copyright © The Doctor's Doctor