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M SC, Peethambar BA. Mature cystic teratoma without intratumoral fat: A diagnostic dilemma. Radiol Case Rep 2023; 18:3109-3112. [PMID: 37416320 PMCID: PMC10319638 DOI: 10.1016/j.radcr.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 05/29/2023] [Accepted: 06/02/2023] [Indexed: 07/08/2023] Open
Abstract
Teratomas are the most common benign ovarian neoplasms in young women. Typical computed tomography imaging findings include fat, fat fluid level, tooth or calcification, rokitansky nodule, floating balls sign, and tufts of hair. They can have unusual imaging features leading to diagnostic dilemmas. Studies have shown the presence of intratumoral fat to be specific to ovarian cystic teratoma. However, there are reports in the literature of mature cystic teratoma that do not contain fat in the lumen of the cyst which can hinder an accurate diagnosis. They can be associated with various complications like torsion, rupture, malignant transformation, infection, and autoimmune hemolytic anemias. Presented here is a case of mature cystic teratoma without visible intracystic fat which underwent torsion.
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Affiliation(s)
- Sandra C M
- Department of Radiology, MES Medical College, Palachode Post, Perinthalmanna, Kerala, India
| | - Breman Anil Peethambar
- Madras Medical College and Government General Hospital, Emergency Department, Chennai, Tamil Nadu, India
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Guo Y, Zhou S, Zhao B, Wen L, Liu M. Ultrasound Findings and O-RADS Malignancy Risk Stratification of Ovarian Collision Tumors. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:2325-2331. [PMID: 34931350 DOI: 10.1002/jum.15919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 12/01/2021] [Accepted: 12/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES To describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O-RADS system. METHODS This was a retrospective analysis of 25 ovarian collision tumors from 8739 patients between May 2010 and January 2020. All clinical characteristics, ultrasound images, and histological findings were collected and analyzed. Using the O-RADS lexicon descriptors, the O-RADS score was determined by two senior doctors. Lesions with O-RADS scores of 1 to 3 were classified as benign tumors, and lesions with O-RADS scores of 4 to 5 were classified as malignant tumors. RESULTS The mean age of the 25 patients was 30.4 years. Histological findings showed that all tumors were a combination of mature cystic teratomas and cystadenomas/cystadenocarcinomas. There were 11 benign tumors of O-RADS 2 or 3, including 3 uniocular cysts, 3 dermoid cysts, and 5 dermoid cysts with an anechoic fluid cavity. There were 12 benign tumors of O-RADS 4, including 3 uniocular-multilocular cysts with solid components, 2 multilocular cysts with irregular walls, and 8 multilocular cysts with dermoid sacs. One borderline tumor of O-RADS 4 was a multilocular cyst with irregular septation. One malignant tumor of O-RADS 5 was a multilocular cystic tumor with solid components and ascites. CONCLUSIONS The most common ovarian collision tumor was the coexistence of a mature cystic teratoma and a cystadenoma. The O-RADS system was able to sensitively detect malignant tumors in this series. A typical dermoid cyst with an anechoic cavity or a multilocular cyst with a dermoid sac may signify a benign collision tumor.
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Affiliation(s)
- Yuyang Guo
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Shan Zhou
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Baihua Zhao
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Lieming Wen
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Minghui Liu
- Second Xiangya Hospital, Central South University, Changsha, China
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Abstract
One struma ovarii with agregates of epithelial nests indistinguishable from Brenner tumor was studied. The presence of a communication between the nests and the follicles and the association of Brenner, mucinous and respiratory epithelium in the lining of 1 cyst in the same tumor strongly support the germ cell theory of Brenner tumors associated with teratomatous elements.
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Sibio S, Borrini F, Sammartino P, Accarpio F, Biacchi D, Caprio G, Iafrate F, Baccheschi AM, Cornali T, Di Giorgio A. Predominant Brenner tumor combined with struma ovarii containing a papillary microcarcinoma associated with benign peritoneal strumosis: report of a case and histologic features. Endocr Pathol 2010; 21:199-203. [PMID: 20532676 DOI: 10.1007/s12022-010-9123-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Brenner tumor and struma ovarii, two uncommon ovarian tumors arising alone or together with dermoid cysts or adenomas, are both rare entities. Both tumors rarely become malignant and rarely metastasize. Few published reports describe coexisting Brenner tumor and malignant struma ovarii. Patients in whom these malignancies coexist only occasionally have peritoneal spreading, strumosis, or a history of thyrotoxicosis. The patient we describe, a 74-year-old woman, presented with a 2 months' history of lower abdominal pain and episodic intestinal subocclusion due to a complex pelvic mass. The mass consisted predominantly of a Brenner tumor associated with struma ovarii containing a single small island of thyroid tissue that had undergone malignant transformation into a well-differentiated papillary carcinoma and also normal thyroid tissue that had spread to the peritoneum. The patient underwent radical surgical treatment and after 7 years follow-up is disease free.
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Affiliation(s)
- Simone Sibio
- Department of Surgery P. Valdoni, University of Rome La Sapienza, Via Lancisi, 2, 00155 Rome, Italy.
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Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, Mallarini G. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol 2008; 72:454-63. [PMID: 18804932 DOI: 10.1016/j.ejrad.2008.07.044] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2008] [Revised: 07/27/2008] [Accepted: 07/31/2008] [Indexed: 11/25/2022]
Abstract
Ovarian teratomas (OTs) are the most common germ cell neoplasm. They include mature cystic teratomas, monodermal teratomas (neural tumors, struma ovarii, carcinoid tumors) and immature teratomas. Teratomas are the most common benign ovarian neoplasms in women less than 45 years old. OTs are usually characterized by ultrasound (US) and magnetic resonance (MR) whereas they are usually an incidental finding on CT. The purpose of this paper is to review the most common types of teratomas and to describe CT, US and MR imaging features of the various types of mature and immature OTs.
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Affiliation(s)
- Luca Saba
- Department of Science of the Images, Policlinico Universitario (Cagliari), Italy.
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Yoshida M, Obayashi C, Tachibana M, Minami R. Coexisting Brenner tumor and struma ovarii in the right ovary: Case report and review of the literature. Pathol Int 2004; 54:793-7. [PMID: 15482570 DOI: 10.1111/j.1440-1827.2004.01757.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A bilateral ovarian tumor composed of mixed Brenner tumor and struma ovarii in the right ovary and mature cystic teratoma in the left ovary, is described. Mixed Brenner tumor and struma ovarii is rare; eight cases are reviewed. In this case, in addition to the typical Brenner tumor and struma ovarii, some nests composed of both Brenner tumor and struma ovarii in one nest were found in the right ovarian tumor. Immunohistochemically, the struma ovarii is stained for thyroglobulin, and Brenner nests showed various degrees of positive stain for thyroglobulin, which is a specific finding. Brenner tumor, in this case, may produce thyroglobulin or have a receptor to thyroglobulin or analog of thyroglobulin. The origin of mixed Brenner tumor and struma ovarii may be germ cell, as described in some literature, or the Brenner tumor may be of a metaplastic nature, although the Brenner tumor is fourfold the size of struma ovarii in the case presented.
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Affiliation(s)
- Makiko Yoshida
- Department of Pathology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Japan.
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Burg J, Kommoss F, Bittinger F, Moll R, Kirkpatrick CJ. Mature cystic teratoma of the ovary with struma and benign Brenner tumor: a case report with immunohistochemical characterization. Int J Gynecol Pathol 2002; 21:74-7. [PMID: 11781528 DOI: 10.1097/00004347-200201000-00014] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Jürgen Burg
- Institute of Pathology, Johannes Gutenberg-University Mainz, Mainz, Germany
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8
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Kim SH, Kim YJ, Park BK, Cho JY, Kim BH, Byun JY. Collision tumors of the ovary associated with teratoma: clues to the correct preoperative diagnosis. J Comput Assist Tomogr 1999; 23:929-33. [PMID: 10589568 DOI: 10.1097/00004728-199911000-00017] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Collision tumors represent a coexistence of two adjacent but histologically distinct tumors without histologic admixture in an organ. The purpose of this study was to describe the imaging findings of collision tumors of the ovary associated with teratoma and to look for clues that might lead to the correct preoperative diagnosis. METHOD Seven pathologically proven cases of collision tumor of the ovary associated with teratoma were retrospectively reviewed. Ovarian teratomas were coexistent with mucinous cystadenoma (n = 4), borderline mucinous tumor (n = 1), mucinous cystadenocarcinoma (n = 1), and dysgerminoma (n = 1). US (n = 5), CT (n = 3), and/or MRI (n = 4) findings were evaluated. RESULTS In addition to the typical findings of teratoma, the mass contained a multiloculated cystic portion filled with nonfatty fluid, suggesting the coexistent epithelial tumor in five cases. In one case, the mass contained a large solid component, suggesting the possibility of collision tumor. In the remaining one case, coexistent small mucinous cystadenoma could not be identified. CONCLUSION Preoperative imaging for ovarian teratoma revealed a collision tumor in six of seven cases. The possibility of a collision tumor should be considered when an ovarian teratoma has imaging findings that cannot be explained solely by an ovarian teratoma.
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MESH Headings
- Adipose Tissue/pathology
- Adult
- Contrast Media
- Cystadenocarcinoma, Mucinous/diagnosis
- Cystadenocarcinoma, Mucinous/diagnostic imaging
- Cystadenocarcinoma, Mucinous/pathology
- Cystadenoma, Mucinous/diagnosis
- Cystadenoma, Mucinous/diagnostic imaging
- Cystadenoma, Mucinous/pathology
- Diagnosis, Differential
- Dysgerminoma/diagnosis
- Dysgerminoma/diagnostic imaging
- Dysgerminoma/pathology
- Exudates and Transudates
- Female
- Gadolinium DTPA
- Humans
- Magnetic Resonance Imaging
- Middle Aged
- Neoplasms, Glandular and Epithelial/diagnosis
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/pathology
- Retrospective Studies
- Teratoma/diagnosis
- Teratoma/diagnostic imaging
- Teratoma/pathology
- Tomography, X-Ray Computed
- Ultrasonography
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Affiliation(s)
- S H Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University College of Medicine, Korea
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Trebeck CE, Friedlander ML, Russell P, Baird PJ. Brenner tumours of the ovary: a study of the histology, immunohistochemistry and cellular DNA content in benign, borderline and malignant ovarian tumours. Pathology 1987; 19:241-6. [PMID: 3324024 DOI: 10.3109/00313028709066557] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Brenner tumours are now generally regarded as being of ovarian epithelial origin. Most have a limited growth potential and are benign. For this reason they are usually found incidentally at hysterectomy. In common with other epithelial ovarian tumours there is a histopathological spectrum of appearances ranging from benign through borderline to invasive malignancy. In this series all 54 tumours were graded according to the degree of cytological atypia, presence of mitoses and tumour necrosis. Heterogeneity of DNA content was observed in the higher grade tumours, two of the four being diploid and two being aneuploid (all benign tumours being diploid). The presence of aneuploidy correlated with the histological features and a poor clinical prognosis. Immunohistochemical staining for keratoprotein was found to be of limited value in the diagnosis of Brenner tumours and their metastases.
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Affiliation(s)
- C E Trebeck
- Department of Histopathology, Westmead Centre
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Valente PT, Carr RF, Hanjani P. Sclerosing stromal tumor and bilateral teratomas: an unusual association. Gynecol Oncol 1985; 21:252-9. [PMID: 3988140 DOI: 10.1016/0090-8258(85)90261-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Sclerosing stromal tumor is an uncommon ovarian neoplasm that has only recently been defined and distinguished from fibrothecoma. This case report describes a 17-year-old patient who presented with a large sclerosing stromal tumor and a smaller mature teratoma in the left ovary. Eighteen months later, an immature teratoma was discovered in the contralateral ovary and microscopic spread outside the ovary was documented at staging laparotomy. Mature and immature teratomas have been observed in opposite ovaries in a small number of patients. However, sclerosing stromal tumor, in over 60 published cases, has not been associated with other forms of ovarian neoplasia. Gonadal stromal differentiation, in fact, has not been convincingly demonstrated in teratomas. The observations in this case, therefore, appear to be unique.
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Abstract
The histology of 36 benign and four proliferative Brenner tumors is reviewed, and the ultrastructural features of benign Brenner tumors are described. Evidence is presented for the origin of these tumors from celomic inclusion cysts through transitional metaplasia of the cyst lining and progressive growth of branching cords of transitional epithelium. Ovarian lesions associated with the Brenner tumor are described, particularly those containing mucinous epithelia, and their significance is discussed.
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Abstract
Strumal carcinoid of the ovary is a type of germ-cell tumor characterized by an intimate mixture of thyroid tissue and carcinoid. Fifty patients with this type of tumor ranged in age from 21 to 77 years. The tumors measured up to 26 cm in diameter and were always unilateral. In 10% of the cases, the contralateral ovary contained another type of neoplasm, usually a dermoid cyst. Three-fifths of the strumal carcinoids arose in dermoid cysts or in mature solid teratomas. Birefringent calcium oxalate monohydrate crystals were commonly identified in the thyroid colloid, and argentaffin granules, in the carcinoid cells, thus substantiating the identity of the neoplastic components. Although 31% of the tumors were accompanied by focal stromal luteinization, only 8% of the cases exhibited clinical signs of steroid hormone production (endometrial hyperplasia, hirsutism, or virilism). In 8% of the cases, there was evidence suggesting functioning of the thyroid component, but no patient had the carcinoid syndrome. Only one woman died of tumour; five others died of unrelated causes. The remaining patients remained alive and well; 23, for at least five years, and 15, for at least ten years postoperatively. Although the carcinoid component of the strumal carcinoid has been considered a malignant transformation of struma ovarii, it is almost always benign, and treatment with a simple oophorectomy or salpingo-oophorectomy is effective.
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Wagner I, Bettendorf U. Extraovarian Brenner tumor. Case report and review. ARCHIVES OF GYNECOLOGY 1980; 229:191-6. [PMID: 7416804 DOI: 10.1007/bf02108311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
We present the fourth case report of an extraovarian Brenner tumor, which was an incidental finding in a total hysterectomy 53-year-old woman. The morphology and pathogenesis of Brenner tumors are discussed.
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Abstract
Fifty-six Brenner tumors of 51 patients were analyzed. The incidence of bilaterality was 9.8%. Most tumors were smaller than 2 cm, and constituted incidental finding. Most of the patients were 30-49 years old (mean 49.7, main 44). A high incidence of associated malignant neoplasms was noticed among the patients with Brenner tumor but was considered coincidental. No evidence of hormone secretion by the tumor was found. Out of 31 tumors, 27 occupied the cortex. Urothelial metaplasia of the ovarian surface epithelium was demonstrated in one case, and continuation of the Brenner column with the surface of ovary in another. There were 12 cases of mixed Brenner tumor in this series (21.1%). The most frequent associated constituents of the mixed Brenner tumors are mucinous cystadenomas. These tumors represent a single mixed neoplasm originating in a multipotential celomic cell which proliferates and differentiates into several mullerian forms. The histogenesis of medullary and hilar Brenner tumors can be explained on the basis of celomic metaplasia. Uncertainty persists in explaining the histogenesis of Brenner tumors mixed with mature cystic teratoma.
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