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Luo W, Zheng J, Su B. Low-Grade Glioma within Mature Cystic Teratoma in a Patient with Anti-N-Methyl-D-Aspartate Receptor Encephalitis: A Case Report. Case Rep Oncol 2024; 17:430-437. [PMID: 38449876 PMCID: PMC10917429 DOI: 10.1159/000535708] [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: 09/20/2023] [Accepted: 11/21/2023] [Indexed: 03/08/2024] Open
Abstract
Introduction Mature cystic teratoma (MCT) is a common type of ovarian tumors that can, in rare cases, undergo malignant transformation. It has been discovered that MCT patients may experience psychiatric symptoms due to the presence of anti-N-methyl-D-aspartate receptor (NMDAR) antibodies, which is the underlying cause of autoimmune encephalitis. Here, we present the first documented case of a patient with anti-NMDAR encephalitis who also had a morphology of low-grade glioma within MCT. Case Report A 45-year-old woman presented with seizures, altered consciousness, abnormal NMDAR antibody IgG titers, and abnormal brain MRI findings confirm the diagnosis of anti-NMDAR encephalitis. Physical examination revealed an oval mixed echo mass measuring 54 × 37 mm in the left adnexal area on ultrasound of the uterine appendage. The patient underwent laparoscopic left ovarian and fallopian tube resection. The pathological gross examination revealed a pile of grayish-red cystic and solid fragmented tissue measuring 7 × 6 × 2.2 cm. Histological examination revealed characteristic components of MCT. Furthermore, the solid component of the gross tissue showed proliferative and densely arranged astrocytes with cellular atypia, which were positive for GFAP and Olig-2, negative for IDH1 and EMA. And the Ki67 index was approximately 10%, suggesting the presence of low-grade glioma lesions. The patient was diagnosed with malignant transformation of MCT into a morphology of low-grade glioma, not otherwise specified. After the removal of the ovarian tumor, the patient's psychiatric symptoms improved. Conclusions Low-grade glioma within MCT is a rare occurrence, and the presence of this malignant transformation in patients with anti-NMDAR encephalitis is even more uncommon.
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Affiliation(s)
- Wenwen Luo
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Jinyue Zheng
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
| | - Bojin Su
- Department of Pathology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, PR China
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2
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Elmuti L, Amundson J, Oberman E, Kamat A, Sedig L, Lastra RR, Aldape K, Quezado M, Pratt DW, Cimino PJ, Abdullaev Z, Pytel P, Applebaum MA, Bennett JA. Diffuse Pediatric-type High-grade Glioma Arising in an Ovarian Mature Cystic Teratoma. Int J Gynecol Pathol 2024; 43:90-96. [PMID: 37046379 PMCID: PMC10715565 DOI: 10.1097/pgp.0000000000000954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023]
Abstract
Immature neuroectodermal tissue can be found in the ovary as part of an immature teratoma or as part of a teratoma with malignant neuroectodermal transformation. Such lesions may closely resemble central nervous system tumors, but their biologic similarity is unclear. We describe an 18-yr-old female who presented with abdominal pain caused by an ovarian mass with widespread metastases. Histology showed a primitive, high-grade tumor arising in the background of a mature teratoma. The tumor was SOX10 positive, with focal expression of GFAP, S100, NSE, and synaptophysin. Molecular analysis demonstrated co-amplification of PDGFRA and KIT , alterations common in high-grade gliomas. By whole-genome methylation profiling, it clustered into the "diffuse pediatric-type high-grade glioma, RTK1 subtype, subclass c" group. Despite progressing through 2 lines of chemotherapy with widespread metastatic disease, she achieved an excellent response to chemotherapy directed toward aggressive germ cell tumors. This case emphasizes the importance of immunohistochemical, genomic, and epigenetic analyses to accurately classify these exceedingly rare tumors and determine the optimal therapy.
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Bussies PL, Chau DB, Hunt JT, Policarpio-Nicolas MLC, Friedman C, McKenney JK, Yeaney GA, Peereboom DM, Beffa L. Secondary somatic glioblastoma arising from a mature ovarian cystic teratoma in a patient with underlying Li-Fraumeni syndrome. Gynecol Oncol Rep 2023; 49:101279. [PMID: 37840845 PMCID: PMC10570697 DOI: 10.1016/j.gore.2023.101279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 10/17/2023] Open
Abstract
•First report of a secondary somatic glioblastoma arising from MCT-MT in a patient with underlying Li-Fraumeni syndrome.•The rarity of glioblastoma arising from MCT-MT warrants investigation for underlying genetic predisposition.•Glioblastomas arising from MCT-MT appear to exhibit wild type IDH gene status.•Advanced-stage glioblastoma arising from MCT-MT exhibits aggressive behavior and requires adjuvant therapy.•Optimal adjuvant therapy regimen for glioblastoma arising from MCT-MT remains unknown.
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Affiliation(s)
- Parker L. Bussies
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Danielle B. Chau
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Jonathan T. Hunt
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | | | - Cameron Friedman
- Genomic Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Jesse K. McKenney
- Genomic Medicine Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Gabrielle A. Yeaney
- Department of Pathology, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - David M. Peereboom
- Brain Tumor and Neuro-Oncology Center, Cleveland Clinic Foundation, Cleveland, OH, United States
| | - Lindsey Beffa
- Women's Health Institute, Cleveland Clinic Foundation, Cleveland, OH, United States
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Abstract
Ovarian germ cell tumors are a diverse group of benign and malignant neoplasms that occur in a wide age range, but with a predilection for younger age group. The majority are represented by the frequently encountered mature cystic teratomas. Malignant germ cell tumors are uncommon, and in some cases have a characteristic clinical presentation. However, from a histologic standpoint these tumors can sometimes be challenging to diagnose due to overlapping morphology with epithelial, and in some cases sex cord tumors. In these cases, a panel of immunohistochemical stains often facilitates the correct diagnosis. This review article discusses the clinicopathologic findings and pertinent ancillary studies of both common and uncommon germ cell tumors of the ovary.
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Affiliation(s)
- Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA.
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5
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Kanzawa M, Kodama T, Maruguchi H, Gon H, Tsukamoto R, Komatsu M, Nomura T, Hirose T, Itoh T. Pineal gland differentiation in mature teratoma: An under-recognized condition and potential pitfalls for overdiagnosis. Pathol Int 2021; 71:771-776. [PMID: 34473871 DOI: 10.1111/pin.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/12/2021] [Indexed: 11/30/2022]
Abstract
We herein report three cases of mature teratomas with pineal gland differentiation, which is a less recognized phenomenon. Case 1 was a 6-year-old male with a neck mass, Case 2 was a 23-year-old female with a retroperitoneal mass, and Case 3 was a 45-year-old female with a retroperitoneal mass. Each case showed the typical macroscopic and histological findings of mature teratoma, such as solid and cystic lesions mainly lined with a mature squamous epithelium. All cases also showed glial differentiation. Small foci of lobulated cell nests were detected in the center of or adjacent to mature glial tissue. Cells had a clear to pale eosinophilic cytoplasm with small round nuclei. Immunohistochemically, cells were positive for synaptophysin, neurofilament protein with a perivascular "club-shaped swelling" pattern, and cone-rod homeobox protein. To the best of our knowledge, this is the first report of pineal gland differentiation arising in mature teratoma, which may be easily overlooked or misdiagnosed as somatic-type tumors, particularly neuroendocrine tumors. To avoid overtreatment, pathologists need to be aware that pineal gland differentiation may occur in mature teratomas.
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Affiliation(s)
- Maki Kanzawa
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Takayuki Kodama
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Hayato Maruguchi
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidetoshi Gon
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ryuko Tsukamoto
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Masato Komatsu
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
| | - Tadashi Nomura
- Department of Plastic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takanori Hirose
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan.,Department of Diagnostic Pathology, Hyogo Cancer Center, Hyogo, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Hospital, Kobe, Japan
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6
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Schwock J, Mirham L, Ghorab Z. Cytology of Extraneural Metastases of Nonhematolymphoid Primary Central Nervous System Tumors: Six Cases with Histopathological Correlation and Literature Update. Acta Cytol 2021; 65:529-540. [PMID: 34311461 PMCID: PMC8686714 DOI: 10.1159/000517480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/27/2021] [Indexed: 01/30/2023]
Abstract
INTRODUCTION Extraneural/-cranial metastases (ENM) of primary central nervous system (CNS) tumors are rare and may be diagnostically challenging. We describe the cytomorphological and pertinent clinical features of ENM in a case series assessed by fine-needle aspiration (FNA). A search of the laboratory information systems of 2 tertiary care centers in Toronto (2000-2015) was performed. Cases with direct extracranial/-spinal extension of CNS neoplasms were excluded. Microscopic slides of FNA and surgical specimens were reviewed. Demographic and clinicopathological data were retrieved. CASE PRESENTATION Six cases were identified with the original diagnoses of glioblastoma, glioblastoma with primitive neuroectodermal tumor-like components, anaplastic ependymoma, myxopapillary ependymoma, atypical meningioma, and hemangiopericytoma. Median patient age at first diagnosis was 44 years (range 22-56). The time interval between initial diagnosis and first metastatic disease manifestation was 3 months to 19 years. All FNA diagnoses were rendered correctly. In 4 cases, immunohistochemistry was used to support the diagnosis. All cases had prior surgical intervention at the primary tumor site. In 4 cases, the ENM location was the ipsilateral parotid or buccal area. Two primary tumors in midline location developed ENM in the scapular area. DISCUSSION/CONCLUSION ENM are a rare manifestation of a range of different primary CNS tumors and may involve the ipsilateral head and neck mimicking clinically a salivary gland neoplasm. FNA can rapidly discriminate ENM from other, potentially more indolent conditions. Awareness of the clinical history is paramount to avoid diagnostic confusion.
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Affiliation(s)
- Joerg Schwock
- Division of Pathology, University Health Network, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Lorna Mirham
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Zeina Ghorab
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Division of Anatomic Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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7
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Persistent Ependymal Tumor Arising from an Immature Ovarian Teratoma: A Rare Case. JOURNAL OF MOLECULAR PATHOLOGY 2020. [DOI: 10.3390/jmp1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary ovarian ependymoma is a rare neuroectodermal neoplasm that can arise from immature ovarian teratoma. Due to the paucity of this entity, a complete molecular analysis of these tumors has not been done, thus creating a challenge for finding an effective and safe therapeutic treatment. In the limited literature, patients with primary ovarian ependymoma showed various responses to an array of individualized therapies, ranging from surgeries to chemotherapies. Here, we present a 38-year-old female with persistent ovarian ependymoma, with a molecular profile similar to traditional central nervous system ependymoma that is irresponsive to multiple cytoreduction and clinical experimental therapies. Therefore, a prompt recognition and reporting of this entity can greatly aid in expanding the understanding and standardization of therapies for this neoplasm.
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8
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Collision Glial Neoplasms Arising in an Ovarian Mature Cystic Teratoma: A Rare Event. Case Rep Pathol 2020; 2020:7568671. [PMID: 32082676 PMCID: PMC7021464 DOI: 10.1155/2020/7568671] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 01/27/2020] [Indexed: 12/29/2022] Open
Abstract
Germ cell neoplasms represent around 20% of all ovarian tumors. They most frequently affect children and young adults. Mature cystic teratoma is a common benign ovarian neoplasm comprising about 95% and is made up of all three germ cell embryonic layers. By definition, mature cystic teratoma may be derived from any of the three germ cell lines. On the other hand, immature teratomas contain primitive neuroepithelial elements. However, it is quite uncommon in the English literature to have a neuroepithelial glial neoplasm arising in a mature cystic teratoma of an adolescent. Interestingly enough, all published cases described a single type of glial neoplasm arising in mature ovarian teratoma. Herein, the authors discuss a unique case of concomitant occurrence of two different glial neoplasms, namely pilocytic astrocytoma and subependymoma arising in an ovarian mature cystic teratoma. To the best of our knowledge, this is the first reported case with such a distinctive histopathologic finding.
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Abstract
Ovarian germ cell tumors are a histologically diverse group of neoplasms with a common origin in the primitive germ cell. The vast majority are represented by mature cystic teratoma. In the minority are malignant germ cell tumors including immature teratoma, dysgerminoma, yolk sac tumor, embryonal cell carcinoma, and choriocarcinoma. This article reviews the histologic and immunohistochemical features of the most common ovarian germ cell tumors. The differential diagnoses for each are discussed.
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10
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Neuroglial Differentiation and Neoplasms in Testicular Germ Cell Tumors Lack Immunohistochemical Evidence of Alterations Characteristic of Their CNS Counterparts. Am J Surg Pathol 2019; 43:422-431. [DOI: 10.1097/pas.0000000000001206] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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11
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Abstract
Ovarian anaplastic ependymoma is a rare gynecologic malignancy. Owing to its rarity, treatment is challenging. Unilateral ovarian ependymoma was found during laparoscopy in a 19-year-old woman. After cytoreductive surgery, three cycles of bleomycin, etoposide, and cisplatin were administered. Four years after chemotherapy, the patient experienced relapse. After the secondary cytoreductive surgery, no further treatment was performed. She is in good condition, ~19 months after secondary cytoreductive surgery using hormone-replacement therapy without chemotherapy. Some cases of ovarian ependymoma can be treated with surgery alone without chemotherapy and the outcome has been satisfying. Choosing treatment based on malignant ovarian germ cell tumors may be not optimal. Therefore, we suggest individualized treatment for ovarian ependymoma.
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Affiliation(s)
- Zhen Yuan
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China,
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China,
| | - Yu Chen
- Department of Obstetrics and Gynecology, LuHe hospital, Capital Medical University, Beijing, China
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12
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Central Nervous System-type Neuroepithelial Tumors and Tumor-like Proliferations Developing in the Gynecologic Tract and Pelvis. Am J Surg Pathol 2018; 42:1429-1444. [DOI: 10.1097/pas.0000000000001131] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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13
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Lopez LV, Bhattacharyya S, Carlsen ED, Bartlett D, Rao UNM. NF2 and ATRX gene copy number losses on a case of ovarian ependymoma. Hum Pathol 2018; 83:204-211. [PMID: 29944970 DOI: 10.1016/j.humpath.2018.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 05/21/2018] [Accepted: 06/08/2018] [Indexed: 10/28/2022]
Abstract
Ovarian ependymomas are rare glial neoplasms that typically occur in women on their third to fourth decades of life. They are histologically similar to ependymomas of the central nervous system but may have a broader immunophenotype. We describe a 27-year-old woman who presented to the emergency department with a 3-week history of cough and shortness of breath. Further workup disclosed a left pelvic mass and extensive intra-abdominal metastases. Pathology revealed sheets of monomorphic cells within a fibrillary stroma, papillary projections, true ependymal rosettes, and pseudorosettes consistent with an ependymoma of ovarian origin. Next-generation sequencing showed ATRX and NF2 copy number losses. Fluorescence in situ hybridization for EWSR1 demonstrated monosomy of 22q in greater than 90% of cells. These molecular alterations have not been previously reported in ovarian or extra-central nervous system ependymomas.
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Affiliation(s)
- Liurka V Lopez
- Bone and Soft Tissue Pathology Department, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, PA 15232, USA.
| | - Siddharth Bhattacharyya
- Molecular Anatomic Pathology Department, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA.
| | - Eric D Carlsen
- Department of Pathology, University of Pittsburgh Medical Center Presbyterian Hospital, Pittsburgh, PA 15213, USA.
| | - David Bartlett
- Department of Surgical Oncology, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, PA 15232, USA.
| | - Uma N M Rao
- Bone and Soft Tissue Pathology Department, University of Pittsburgh Medical Center Shadyside Hospital, Pittsburgh, PA 15232, USA.
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14
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Granular Cell Tumor Within an Ovarian Mature Cystic Teratoma: Report of a Unique Case and Review of the Literature. Int J Gynecol Pathol 2018; 36:453-458. [PMID: 27750257 DOI: 10.1097/pgp.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Granular cell tumors involving the female reproductive tract are rare, with only a small number of cases described. Of the reported cases, none are documented within an ovarian mature cystic teratoma (MCT). This report documents a case of a granular cell tumor, incidentally discovered within an ovarian MCT in a 50-yr-old woman undergoing a supracervical hysterectomy and left salpingo-oophorectomy. Although malignant transformation and other secondary ovarian neoplasms in MCT have been well documented, synchronous nonovarian benign neoplasms are reported much less frequently. The histogenesis of secondary tumors arising in MCT is incompletely understood, and the current case provides additional insight, especially pertaining to schwannian and neuroectodermal tumors arising in this setting. The current case, to the best of our knowledge, represents the first report of a granular cell tumor involving a mature teratoma of any site, with the diagnosis being supported by morphologic and immunohistochemical staining characteristics.
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Gorski JW, Taylor JS, Zhang J, Liu J, Jazaeri AA. Hormonal based treatment of ovarian anaplastic ependymoma with anastrozole. Gynecol Oncol Rep 2017; 20:93-96. [PMID: 28393092 PMCID: PMC5376265 DOI: 10.1016/j.gore.2017.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/02/2017] [Accepted: 03/11/2017] [Indexed: 11/08/2022] Open
Abstract
Objective Ovarian anaplastic ependymoma is a rare gynecologic malignancy that poses diagnostic and treatment challenges. Treatment of sub-optimally debulked disease usually portends poor prognosis. Molecular testing of tumor specimen can identify more specific targets for additional therapy such as estrogen and progesterone receptors (ER/PR). Case A 29-year-old woman presented with incidental finding of large bilateral adnexal masses and elevated CA 125. Biopsy proved anaplastic ovarian ependymoma with high ER/PR expression. She underwent sub-optimal surgical debulking followed by adjuvant chemotherapy with bleomycin, etoposide and cisplatin (BEP) which resulted in a partial response. Due to extensive residual disease she has been maintained on anastrozole for over fifteen months without increased tumor burden. Targeted somatic mutation testing was negative for all high risk clinically useful variants. Conclusion Aromatase inhibitors may be considered in patients with extra-axial anaplastic ependymoma and can produce prolonged stable disease. Ovarian anaplastic ependymoma is a rare gynecologic malignancy. Histology shows perivascular rosettes, hypercellularity, and nuclear atypia. Standard therapy includes surgical debulking followed by chemotherapy with BEP. Molecular diagnostics can identify estrogen and progesterone receptor expression. ER/PR expression can help direct treatment with aromatase inhibitors.
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Affiliation(s)
- Justin Wayne Gorski
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Unit 1362, P.O. Box 301439, Houston, TX 77230-1439, USA
| | - Jolyn Sharpe Taylor
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Unit 1362, P.O. Box 301439, Houston, TX 77230-1439, USA
| | - Jing Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0085, Houston, TX 77230-1439, USA
| | - Jinsong Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 0085, Houston, TX 77230-1439, USA
| | - Amir Anthony Jazaeri
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Unit 1362, P.O. Box 301439, Houston, TX 77230-1439, USA
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Shintaku M, Sakuma T, Ohbayashi C, Maruo M. Well-formed cerebellum and brainstem-like structures in a mature ovarian teratoma: Neuropathological observations. Neuropathology 2017; 37:122-128. [PMID: 28042664 DOI: 10.1111/neup.12360] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 11/15/2016] [Accepted: 11/15/2016] [Indexed: 11/27/2022]
Abstract
In the surgical case of a mature cystic teratoma of the ovary that arose in a 16-year-old girl, a large amount of well-differentiated and highly organized cerebellar tissue was found. Three layers of the cerebellar cortex were well formed, and synaptophysin-positive "glomeruli" were found in the granule cell layer. Some Purkinje cells exhibited focal expansion and a dysmorphic appearance of the dendrites. Adjacent to the cerebellar tissue, a large space lined by the ependymal layer and a club-shaped CNS tissue mass resembling the brainstem were found, and structures reminiscent of the midbrain tectum and pontine nuclei were distinguished within this mass. The CNS tissue was surrounded by the leptomeninges and a skull-like, bony shell. Structures consistent with the supra-tentorial CNS tissue were not found. This case represents an example of infra-tentorial CNS tissue that was well-differentiated and organized to an exceptionally high degree in an ovarian mature teratoma. Various degenerative changes have been documented in CNS tissue in ovarian teratomas, but the dendritic abnormalities of Purkinje cells seen in the present case are novel findings.
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Affiliation(s)
- Masayuki Shintaku
- Department of Pathology, Shiga Medical Center for Adults, Moriyama, Shiga, Japan
| | - Toshiko Sakuma
- Department of Pathology, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Chiho Ohbayashi
- Department of Diagnostic Pathology, Nara Medical University, Kashihara, Nara, Japan
| | - Motoyoshi Maruo
- Department of Obstetrics and Gynecology, Hyogo Prefectural Kaibara Hospital, Tamba, Hyogo, Japan
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