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Ahmad Nasfy SN, Abdul Hamid H, Md Khairuddin A, Mohamad Fauzi MK. Fertility-sparing approach in concurrent gliomatosis peritonei and growing teratoma syndrome in a young woman. BMJ Case Rep 2024; 17:e257326. [PMID: 38627058 PMCID: PMC11029277 DOI: 10.1136/bcr-2023-257326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024] Open
Abstract
Gliomatosis peritonei (GP) and Growing Teratoma Syndrome (GTS) are rare and clinically significant conditions often associated with ovarian teratomas. GP involves the development of benign glial implants on the peritoneal surface, while GTS is characterised by the growth of benign, yet enlarging peritoneal implants following chemotherapy for malignant germ cell tumours. These implants are typically histologically mature teratomas devoid of malignancy. Our report documents a unique case where both GP and GTS manifested in a patient undergoing treatment for an immature ovarian teratoma. This dual occurrence is scarcely reported in the existing literature. The patient, a nulliparous woman in her 20s, developed a tumour indicative of GTS immediately after completing three cycles of bleomycin, etoposide and cisplatin therapy. This chemotherapy regimen followed fertility-sparing surgery for a stage IIIb ovarian immature teratoma. Given that total tumour resection is pivotal in positively influencing the prognosis of GTS, early minimally invasive surgical intervention before significant tumour growth is essential. This approach is particularly crucial considering that ovarian germ cell tumours are commonly present in younger patients, necessitating a focus on fertility preservation in most cases.
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Affiliation(s)
| | - Habibah Abdul Hamid
- Obstetrics and Gynaecology, Universiti Putra Malaysia, Serdang, Selangor, Malaysia
| | - Azalea Md Khairuddin
- Hospital Sultan Abdul Aziz Shah Universiti Putra Malaysia, Serdang, Selangor, Malaysia
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Guo F, Liu Y, Lu J, Wu Z, Zhu X. Human chorionic gonadotropin elevation in gliomatosis peritonei complicated with immature teratoma: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e31305. [PMID: 36316907 PMCID: PMC9622604 DOI: 10.1097/md.0000000000031305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Gliomatosis peritonei (GP) refers to the implantation of glial tissue on the visceral and parietal peritoneal surface, often associated with immature teratoma. It is a rare condition and the pathogenesis is not fully understood. In addition, the indistinguishable radiological appearance of immature and mature teratomas, and limited pathology samples make an accurate diagnosis difficult in most cases. More importantly, patients are also at risk of recurrence after surgery. This report aims to describe the process of diagnosis and treatment of GP with immature teratoma. PATIENT CONCERNS The patient, a 38-year-old woman presented with GP complicated with immature teratoma after laparoscopic ovarian cyst excision. DIAGNOSES On physical examination, a 15 cm-pelvic mass, with poor mobility, was palpated. And tumor marker demonstrated a moderate increase in α-fetoprotein and carbohydrate antigen 125. We suspected malignancy according to the comprehensive preoperative evaluation, the postoperative pathology revealed an immature teratoma of the left ovary and complicated with gliomatosis peritonei. Three months after the second surgery, possible recurrence of immature teratoma was considered and the patient underwent the third laparotomy. But the postoperative pathology indicated mature teratoma and mature glial components in the pelvic lesions. INTERVENTIONS AND OUTCOME The patient underwent 2 more surgical resections after the initial resection and 3 cycles of bleomycin, etoposide, and cisplatin regimen chemotherapy. She was regularly followed up in the outpatient after surgery, and no recurrence has been reported in the pelvic cavity till date. LESSON The case illuminated that the primary diagnosis of GP complicated with immature teratoma is critical but highly challenging for both gynecologists and pathologists and more attention should be paid to "GP complicated with immature cystic teratoma" patients to avoid inappropriate treatment.
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Affiliation(s)
- Fei Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yukai Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiaqi Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhiyong Wu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaoyong Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- * Correspondence: Xiaoyong Zhu, Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China (e-mail: )
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Shrestha A, Dhakal H, Pandey SR, Amatya KS, Shrestha S, Tiwari PN, lama S. Growing teratoma syndrome: Two case reports. Clin Case Rep 2022; 10:e05803. [PMID: 35582166 PMCID: PMC9083812 DOI: 10.1002/ccr3.5803] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 04/18/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
We present two cases of 10 and 27 years old girls with recurrence of immature teratoma after an incomplete surgical staging. In both cases, there were huge abdominopelvic masses despite decrease in tumor markers with chemotherapy. Complete surgical resection of these masses was done, and histopathology showed only mature teratoma.
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Affiliation(s)
- Anju Shrestha
- Gynaecology UnitDepartment of Surgical OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Hari Dhakal
- Department of Pathology and Laboratory MedicineNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Sirish Raj Pandey
- Department of Hospital Research BoardNepal Cancer Hospital and Research CenterLalitpurNepal
| | | | - Sudip Shrestha
- Department of Medical OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Prakash Nidhi Tiwari
- Pediatric UnitDepartment of Medical OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
| | - Srijana lama
- Gynaecology UnitDepartment of Surgical OncologyNepal Cancer Hospital and Research CenterLalitpurNepal
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Kurata A, Takanashi M, Ohno SI, Fujita K, Kuroda M. Cisplatin induces differentiation in teratomas derived from pluripotent stem cells. Regen Ther 2021; 18:117-126. [PMID: 34141836 PMCID: PMC8192819 DOI: 10.1016/j.reth.2021.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/30/2021] [Accepted: 05/22/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Currently, embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSCs) can be induced to differentiate at the cellular level but not to form mature tissues or organs suitable for transplantation. ESCs/iPSCs form immature teratomas after injection into immunodeficient mice. In humans, immature teratomas often transform into fully differentiated mature teratomas after administration of anticancer agents. Methods We first investigated the ability of cisplatin to induce changes in mouse ESCs/iPSCs in vitro. Next, we designed experiments to analyze ESC/iPSC-derived immature teratoma tissue in vivo after treatment of cisplatin. Groups of six mice carrying ESC- or iPSC-derived teratomas were given either low or high dose intraperitoneal injection of cisplatin, while the control group received saline for 4 weeks. Results Treatment of ESC/iPSC cultures with cisplatin for 3 days caused a dose-related decrease in cell numbers without inducing any morphological changes to the cells. ESC/iPSC-derived teratomas showed lower growth rates with a significantly higher mature components ratio in a concentration dependent manner after cisplatin treatment (P < 0.05); however, immunohistochemical analyses demonstrated a significantly reduced PCNA labelling index and an increase in an apoptosis marker on immature neural components (P < 0.05) along with emergence of h-Caldesmon+ mature smooth muscle cells in treated mice. Moreover, newly differentiated components not found in the control group, such as mature adipose tissue, cartilage, and pancreas, as well as striated muscle, salivary glands, gastric mucosa with fundic glands, and hair follicles emerged. The identities of these components were confirmed by immunostaining for specific markers. Conclusions Cisplatin has the ability to reduce immature components in ESC/iPSC-derived teratomas, presumably through apoptosis, and also to induce them to differentiate. Transformation of immature to mature teratoma after chemotherapy was verified. Mice bearing ESC/iPSC-derived immature teratomas were used. Mice were treated with intraperitoneal injection of cisplatin for 4 weeks. Newly differentiated structures were found only in the tumors of treated mice. Cisplatin can induce differentiation in ESC/iPSC-derived immature teratomas.
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Key Words
- ALP, alkaline phosphatase
- ATP4B, ATPase H+/K+ transporting beta subunit
- CR, chemotherapeutic retroconversion
- Cisplatin
- DMEM, Dulbecco's modified Eagle's medium
- Differentiation
- ESC, embryonic stem cell
- Embryonic stem cells
- FCS, fetal calf serum
- HE, hematoxylin and eosin
- Immature teratoma
- Induced pluripotent stem cells
- KSR, knockout serum replacement
- LIF, leukemia inhibitory factor
- MEF, mouse embryonic fibroblast
- PBS, phosphate buffered saline
- PCNA, proliferating cell nuclear antigen
- RAG, recombination activating gene
- RLU, relative light units
- RT, room temperature
- iPSC, induced pluripotent stem cell
- ssDNA, single stranded DNA
- α-SMA, α-smooth muscle actin
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Affiliation(s)
- Atsushi Kurata
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Masakatsu Takanashi
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Shin-Ichiro Ohno
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Koji Fujita
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
| | - Masahiko Kuroda
- Department of Molecular Pathology, Tokyo Medical University, 6-1-1, Shinjuku, Shinjuku-ku, Tokyo, Japan
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Tsuyuguchi S, Sugiyama K, Kinoshita Y, Kolakshyapati M, Takayasu T, Usui S, Takano M, Yonezawa U, Taguchi A, Amatya VJ, Takeshima Y, Kurisu K, Yamasaki F. Primary and Recurrent Growing Teratoma Syndrome in Central Nervous System Nongerminomatous Germ Cell Tumors: Case Series and Review of the Literature. World Neurosurg 2019; 134:e360-e371. [PMID: 31751614 DOI: 10.1016/j.wneu.2019.10.074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 12/01/2022]
Abstract
BACKGROUND The term "growing teratoma syndrome (GTS)" has been used as follows: patients with germ cell tumor (GCT) who present with enlarging original/metastatic masses during or after appropriate systemic chemotherapy despite normalized serum markers. In other words, the definition of the term GTS is not fully established. We analyzed and reviewed our case series regarding GTS that developed after the treatment of central nervous system (CNS) nongerminoatous germ cell tumors (NGGCTs). METHODS Our institutional review board approved this retrospective study. Between 2003 and 2018, we treated 16 patients (16 males; age ranging from 5.4 to 51.9 years, median 13.8) with CNS-NGGCT at our institution. We reviewed those patients and also reviewed the literature about GTS of CNS. We defined primary GTS (p-GTS) as the enlargement of cyst size and/or solid tumor occurred during treatment in the absence of marker elevation, and recurrent GTS (r-GTS) as the enlargement of teratoma after complete response of initial tumors. RESULTS Among 16 patients with CNS-NGGCT, we surgically confirmed mature/immature teratoma components in 15 patients. Two patients underwent surgical removal of tumor before neoadjuvant therapy, and among the rest 14 patients, 6 developed p-GTS, and 2 patients underwent salvage surgery during chemo-/chemoradiotherapy. Those with histologic diagnosis of immature teratoma during salvage surgery had a shorter interval from the initiation of chemoradiotherapy compared with mature teratoma (P < 0.05). One patient developed r-GTS. In the literature review, most of the p-GTS consisted of enlargement with the multicystic component. Histologic diagnosis of immature teratoma during salvage surgery was observed in earlier stages of chemoradiotherapy (P < 0.05, log-rank test). Previous history of p-GTS might be a risk factor of r-GTS. CONCLUSIONS The incidence of p-GTS, enlargement of the cystic component during treatment, is not rare. Physicians need to be aware of this important phenomenon.
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Affiliation(s)
- Sayuru Tsuyuguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kazuhiko Sugiyama
- Department of Clinical Oncology & Neuro-oncology Program, Hiroshima University Hospital, Hiroshima, Japan
| | - Yasuyuki Kinoshita
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manish Kolakshyapati
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Department of Neurosurgery, B & B Hospital, Gwarko, Lalitpur, Nepal
| | - Takeshi Takayasu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Usui
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Motoki Takano
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Ushio Yonezawa
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Taguchi
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Vishwa Jeet Amatya
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Yukio Takeshima
- Department of Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kaoru Kurisu
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Fumiyuki Yamasaki
- Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
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Sun H, Ding H, Wang J, Zhang E, Fang Y, Li Z, Yu X, Wang C, Zhao Y, Chen K, Wen S, Li L, Shan S, Hong L, Chen F, Su P. The differences between gonadal and extra-gonadal malignant teratomas in both genders and the effects of chemotherapy. BMC Cancer 2019; 19:408. [PMID: 31039746 PMCID: PMC6492338 DOI: 10.1186/s12885-019-5598-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Accepted: 04/11/2019] [Indexed: 11/21/2022] Open
Abstract
Background A tumor comprising of different types of tissues (such as hair, muscle, bone, etc.) is known as a teratoma. It is a type of germ cell (cells that make sperm or eggs) tumor. When these germ cells have rapid cancerous growth, then such a teratoma is called a malignant teratoma. We have studied the differences between gonadal and extra-gonadal malignant teratomas and the effects of chemotherapy in both genders. Methods The samples of 3799 male and 1832 female patients with malignant teratoma samples, between the ages of 1 and 85+ years, were selected from the years 1973 to 2014. Trends in incidence, estimated prevalence, incidence rates, and frequency were calculated in gonadal and extra-gonadal tumors with age adjustment. The five-year observed, expected, and relative survival rates were analyzed to study the prognosis. Results The gonadal took over a majority percentage of malignant teratomas compared with the extra-gonadal (90% vs. 10% in male; 83% vs. 17% in female). For the male, the total of the gonadal and the extra-gonadal were all significantly decreased from 1973 to 2014 (p < 0.05). For the female, there were no significant trends. As for prevalence, incidence, and frequency, there were two separate peaks of malignant teratomas. One peak was at under 1 year old, which was composed of the extra-gonadal tumor; the other peak was at 20–24 for male and 10–34 for female, which was composed of the gonadal tumor. This separation of the gonadal and extra-gonadal showed a significant difference (p < 0.05). As for the prognosis, the extra-gonadal tumor showed significantly lower survival rates than the gonadal (p < 0.05). In the short term, the survival rate of the chemotherapy group was higher than the supportive care group. However, in the long term, the survival rate of the chemotherapy group was lower than the supportive care group. Conclusion The gonadal and extra-gonadal malignant teratomas show lots of differences. Chemotherapy might not help improve survival rates. Electronic supplementary material The online version of this article (10.1186/s12885-019-5598-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hang Sun
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China.
| | - Hongxin Ding
- Hospital of Yantai University, Yantai University, Yantai, China
| | - Jianjun Wang
- Tongji Hospital, Tongji University, Shanghai, China
| | - Emma Zhang
- Mannjo Informatics Studio, Shanghai, China
| | - Yihua Fang
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zhenhua Li
- Yantai Yuhuangding Hospital, Qingdao University School of Medicine, Yantai, China
| | - Xiao Yu
- Huangshan First Peoples' Hospital, Huangshan, China
| | - Chongren Wang
- Shanghai General Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yifan Zhao
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Kan Chen
- Department of Endocrinology, Shanghai Tenth Peoples' Hospital, Tongji University, No.301 Middle Yanchang Road, Shanghai, 200072, China
| | - Siwan Wen
- Tongji Hospital, Tongji University, Shanghai, China
| | - Liang Li
- Tongji Hospital, Tongji University, Shanghai, China
| | - Shan Shan
- Shanghai Sixth Peoples' Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Liu Hong
- Sam M. Walton College of Business, University of Arkansas, Fayetteville, AR, USA
| | - Face Chen
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China
| | - Pu Su
- Department of Informatics, Discovery & Analytical Solutions, PerkinElmer, Shanghai, No.1670, Zhang Heng Road, Zhangjiang Hi-Tech Park, Shanghai, 201203, China.
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Shigeta N, Kobayashi E, Sawada K, Ueda Y, Yoshino K, Hori Y, Kimura T. Laparoscopic excisional surgery for growing teratoma syndrome of the ovary: case report and literature review. J Minim Invasive Gynecol 2015; 22:668-74. [PMID: 25620216 DOI: 10.1016/j.jmig.2015.01.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/27/2022]
Abstract
Growing teratoma syndrome (GTS) is rare clinical phenomenon occurring as a sequelae of a malignant germ cell tumor. We present the case of a 20-year-old woman who developed GTS after undergoing fertility-sparing surgery and chemotherapy for an immature teratoma. She underwent left salpingo-oophorectomy, right ovarian cystectomy, and disseminated tumor reduction during her primary surgery. The postsurgical histology report identified the tumor as an immature teratoma, grade 3, International Federation of Gynecology and Obstetrics (FIGO) stage IIIb. She subsequently received 3 cycles of chemotherapy consisting of bleomycin, etoposide, and cisplatin. At 17 months after the chemotherapy, follow-up computed tomography (CT) scan revealed an enlarged mass in her right paracolic gutter and a small peritoneal lesion in the pouch of Douglas. Her serum alpha-fetoprotein level was not elevated. These findings were compatible with GTS, but it was difficult to rule out a recurrent immature teratoma. Diagnostic exploratory laparoscopic surgery revealed the enlarged tumors that had been detected by the CT scan. Although there were multiple tumors in the pouch of Douglas, we were able to resect all of them laparoscopically. Histological diagnosis of the surgically resected specimens was of a mature teratoma, and so we concluded that this tumor was a GTS. Our experience suggests that laparoscopic surgery is an effective alternative diagnostic and therapeutic approach in cases suspicious of GTS where the disease is disseminated to the peritoneum.
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Affiliation(s)
- Naoya Shigeta
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Eiji Kobayashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Kenjiro Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yumiko Hori
- Department of Pathology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Matsumoto H, Mizoguchi C, Nishida M, Sato S, Nasu K, Narahara H. Recurrent immature teratoma of the ovary with long-term disease-free interval. J Obstet Gynaecol Res 2014; 40:1455-8. [DOI: 10.1111/jog.12359] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/13/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Harunobu Matsumoto
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
- Department of Obstetrics and Gynecology; Nakatsu Municipal Hospital; Oita Japan
| | - Chiharu Mizoguchi
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
| | - Masakazu Nishida
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
- Department of Obstetrics and Gynecology; Nakatsu Municipal Hospital; Oita Japan
| | - Shimpei Sato
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
- Department of Obstetrics and Gynecology; Nakatsu Municipal Hospital; Oita Japan
| | - Kaei Nasu
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
- Division of Obstetrics and Gynecology; Support System for Community Medicine; Oita University; Oita Japan
| | - Hisashi Narahara
- Department of Obstetrics and Gynecology; Faculty of Medicine; Oita University; Oita Japan
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Ye LY, Wang JJ, Liu DAR, Ding GP, Cao LP. Management of giant ovarian teratoma: A case series and review of the literature. Oncol Lett 2012. [PMID: 23205081 DOI: 10.3892/ol.2012.793] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
The management of ovarian teratomas in normal conditions is well established, but in rare giant cases (tumor diameter over 15 cm), the choice of management, such as laparotomic or laparoscopic approaches, are controversial and may be therapeutically challenging for surgeons. The aims of the current study were to analyze the clinical features of giant ovarian teratoma and to discuss its management. The clinical data of 330 patients with giant ovarian teratoma (of whom 1 patient was treated by the authors and 329 were admitted to the Second Affiliated Hospital of Zhejiang University Medical College between January 1st 2000 and December 31st 2010) were reviewed and analyzed. The patients had an age range of 6 to 83 years and a mean tumor size of 24.9±7.1 cm. Of the 330 patients, 102 (30.9%) were asymptomatic and the majority (69.1%, 228/330) reported symptoms. There were more patients in the laparotomic group than the laparoscopic group, especially for the emergency cases (5.5 vs. 0%, P<0.05). Accidental cyst rupture was more frequent when a laparoscopic approach was used (31.5 vs. 19.6%, P<0.05). These results suggest that laparotomic resection may be preferred for the en bloc mass removal, adequate abdominal cavity irrigation and avoidance of accidental mass rupture in the management of giant ovarian teratomas. Familiarity with the imaging features of giant ovarian teratomas effectively aids preoperative diagnosis and differentiation.
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Affiliation(s)
- Long-Yun Ye
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang 310009, P.R. China
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10
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Growing teratoma syndrome and peritoneal gliomatosis. Case Rep Med 2011; 2011:123527. [PMID: 21541214 PMCID: PMC3085325 DOI: 10.1155/2011/123527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 11/18/2022] Open
Abstract
The growing teratoma syndrome (GTS) is defined as a detection of an enlarged mass during or after chemotherapy treatment for germ cell tumor. We report a case of an 18-year-old girl treated for growing teratoma syndrome after chemotherapy for malignant germ cell tumor of the ovary associated with peritoneal gliomatosis. Chemotherapy induced normalisation of alpha-fetoprotein rate whereas there was an enlargement of the mass. Subsequent complete resection was performed, and the patient remained in good control for 60 months. This clinical picture suggested the diagnosis of “GTS”. This syndrome can lead to confusion with progression or relapse of a germ cell tumour because of increase in tumour volume during chemotherapy, so it is important to recognize it.
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Kikawa S, Todo Y, Minobe S, Yamashiro K, Kato H, Sakuragi N. Growing teratoma syndrome of the Ovary: A case report with FDG -PET findings. J Obstet Gynaecol Res 2011; 37:926-32. [DOI: 10.1111/j.1447-0756.2010.01439.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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12
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Immature teratoma of the ovary with distant metastases: favorable prognosis and insights into chemotherapeutic retroconversion. Int J Gynecol Pathol 2010; 29:438-44. [PMID: 20736769 DOI: 10.1097/pgp.0b013e3181cef16b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We present a case of a young woman with an immature teratoma of the right ovary that showed systemic metastases. The patient initially experienced abdominal distention at the age of 15 years. Radiographic assessment revealed a right ovarian tumor; thus, right salpingo-oophorectomy was performed, and the resected ovarian tumor showed a multilocular cystic lesion with partially solid areas. Pathologic diagnosis was an immature teratoma, grade 2. As brain, lung, and liver metastases were discovered within 2 years after the operation, sequential resections of the metastatic foci were performed before chemotherapy as well as during the early and late stages of chemotherapy. The resected specimens of each metastatic focus contained histologically more mature elements of the primary immature teratoma and exhibited a decrease in the Ki-67 labeling index, the later the resection was performed. As far as we know, this is the first case of brain metastasis stemming from an immature teratoma of the ovary. In addition, it was highly suggestive that chemotherapy itself was the main etiological factor for the promotion of maturation. The favorable prognosis of this malignant tumor even after brain metastasis was verified by the 10-year-survival of the patient.
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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: 99] [Impact Index Per Article: 6.2] [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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Djordjevic B, Euscher ED, Malpica A. Growing Teratoma Syndrome of the Ovary: Review of Literature and First Report of a Carcinoid Tumor Arising in a Growing Teratoma of the Ovary. Am J Surg Pathol 2007; 31:1913-8. [DOI: 10.1097/pas.0b013e318073cf44] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Tangjitgamol S, Manusirivithaya S, Leelahakorn S, Thawaramara T, Suekwatana P, Sheanakul C. The growing teratoma syndrome: a case report and a review of the literature. Int J Gynecol Cancer 2006; 16 Suppl 1:384-90. [PMID: 16515629 DOI: 10.1111/j.1525-1438.2006.00492.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We present the case of a 5-year-old girl with ovarian immature teratoma, which recurred a few months after an incomplete surgical staging. The recurrent masses, located in the upper abdomen and lower pelvis, were accompanied by rise in levels of serum alpha-fetoprotein. The patient and her parents refused surgical resection of these recurrent masses; therefore, chemotherapy was promptly given. After multiple cycles of chemotherapy, all the masses remained stable in size despite normalization of the tumor marker. Subsequent complete resection of the masses showed only mature teratoma (MT) component without any residual malignant germ cell tumor. The patient was disease free for 2 years, when another episode of recurrence developed as a 5-cm mass in the perihepatic area. The third laparotomy revealed a tumor mass, histologically composed of only MT tissue. She is now doing well without any evidence of the disease, 24 months after the last surgery.
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Affiliation(s)
- S Tangjitgamol
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand.
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Abstract
Ovarian teratomas include mature cystic teratomas (dermoid cysts), immature teratomas, and monodermal teratomas (eg, struma ovarii, carcinoid tumors, neural tumors). Most mature cystic teratomas can be diagnosed at ultrasonography (US) but may have a variety of appearances, characterized by echogenic sebaceous material and calcification. At computed tomography (CT), fat attenuation within a cyst is diagnostic. At magnetic resonance (MR) imaging, the sebaceous component is specifically identified with fat-saturation techniques. The US appearances of immature teratoma are nonspecific, although the tumors are typically heterogeneous, partially solid lesions, usually with scattered calcifications. At CT and MR imaging, immature teratomas characteristically have a large, irregular solid component containing coarse calcifications. Small foci of fat help identify these tumors. The US features of struma ovarii are also nonspecific, but a heterogeneous, predominantly solid mass may be seen. On T1- and T2-weighted images, the cystic spaces demonstrate both high and low signal intensity. Familiarity with the US, CT, and MR imaging features of ovarian teratomas can aid in differentiation and diagnosis.
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Affiliation(s)
- E K Outwater
- Department of Radiology, University of Arizona, 1501 N. Campbell Ave., Rm. 1361, Tucson, AZ 85724-5067, USA.
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Quesada G, Del Carmen Velasco M, Palencia R, Marina C, García M, Marina J, Tarancón I. Immature Teratoma of the Ovary During Pregnancy. J Gynecol Surg 2000. [DOI: 10.1089/10424060051069651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Gonzalo Quesada
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
| | | | - Rafael Palencia
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
| | - Carlos Marina
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
| | - Mar García
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
| | - Javier Marina
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
| | - Ildefonso Tarancón
- Department of Obstetrics and Gynaecology, Rio Hortega Hospital, Valladolid, Spain
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Piura B, Dgani R, Zalel Y, Nemet D, Yanai-Inbar I, Cohen Y, Glezerman M. Malignant germ cell tumors of the ovary: a study of 20 cases. J Surg Oncol 1995; 59:155-61. [PMID: 7609521 DOI: 10.1002/jso.2930590305] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a study of 20 patients diagnosed with malignant ovarian germ cell tumors between 1961 and 1993, clinical and pathologic findings were evaluated. Of the 20 patients, seven (35%) had dysgerminoma, two (10%) endodermal sinus tumor, three (15%) malignant teratoma, one (5%) malignant struma ovarii, one (5%) primary ovarian carcinoid, two (10%) benign teratoma with malignant transformation, and four (20%) combination germ cell tumor. Twelve patients (60%) had stage IA, five (25%) stage IC, and three (15%) stage IIIC. Twelve patients (60%) underwent conservative surgery and eight (40%) had at least bilateral salpingo-oophorectomy. At follow-up, 18 patients (90%) were alive free of disease, one (5%) had died of disease, and one (5%) had died of intercurrent disease. The actuarial 5-year survival rate was 93.3%. It is concluded that for young women who wish to preserve child-bearing capacity, regardless of the stage of the tumor, fertility-preserving surgery with complete surgical staging followed, if necessary by cisplatin-based combination chemotherapy is an appropriate and definitive treatment in the absence of involvement of the contralateral ovary and uterus. For patients in whom child-bearing capacity is not an issue, surgery should include total abdominal hysterectomy and bilateral salpingo-oophorectomy with complete staging, followed if necessary by chemotherapy.
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Affiliation(s)
- B Piura
- Department of Obstetrics and Gynecology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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