Germ cell tumors of the ovary: A clinicopathologic study of 121 cases from Nepal

Ovarian Germ Cell Tumors in North-Western India: A Comprehensive 3-Year Retrospective Study of 145 Cases at a Tertiary Cancer Hospital

Germ cell tumors encompass a broad spectrum of neoplasms arising from germ cell lineage, demonstrating varying histological profiles and clinical presentations. These tumors encompass a range of benign and malignant entities. While global trends provide insights into their prevalence, specific regional variations, such as those within North-Western India, remain less explored. This study seeks to bridge this knowledge gap by examining the prevalence and characteristics of germ cell tumors within a tertiary cancer hospital. In this retrospective analysis, all cases of germ cell tumors diagnosed over a 3-year period in the specified tertiary cancer hospital were included. Cases with incomplete records or inadequate pathological data were excluded. Data encompassing histological subtypes, patient age distribution, clinical presentations, and histopathological features were collected and analyzed. The study comprised 145 cases of germ cell tumors. Teratomas were the most prevalent subtype, with mature teratomas accounting for the majority. The highest incidence occurred within the 21-30-year age group with a mean age of 24.77 years. Abdominal mass (56%) and abdominal pain (34%) were the prominent clinical presentations. Benign cases constituted the majority 85.5%. Solid tumors (p < 0.00001) and tumors more than 10 cm (p .029028) were found to have a high propensity to be malignant, which was proven to be statistically significant. This study comprehensively explains germ cell tumors' prevalence, clinical features, and histopathological subtypes in a tertiary cancer hospital in North-Western India. The predominance of teratomas, particularly mature ones, aligns with global trends. The age distribution and clinical presentations reflect common patterns. The diverse histopathological appearances underscore the heterogeneous nature of germ cell tumors. This study offers valuable insights for clinical management and further regional research.

A rare case of extremely large mature ovarian cystic teratoma

Mature ovarian cystic teratoma, also known as the dermoid cyst, is one of the most common benign ovarian neoplasms that can occur in different age groups and could appear in various sizes. Diagnosing this problem as soon as possible is essential due to complications that can coincide, such as torsion, rupture, internal hemorrhage and malignant transformation. In this article, we reported a 66-year-old female patient with a single huge mature ovarian cyst teratoma who presented to the surgical ward with abdominal pain and swelling but did not see any doctor during that period and disregarded her problems for 4 years.

Clinicopathological Evaluation of 223 Cases of Mature Cystic Teratoma, Ovary: 25-Year Experience in a Single Tertiary Care Centre in India

INTRODUCTION

Mature Cystic Teratoma (MCT) is the most common benign neoplasm of the ovary constituting 10-20% of all the ovarian tumours. Although, much has been published about ovarian teratomas, in English literature, there are very few retrospective cross sectional studies from India to understand the epidemiology of the disease.

AIM

To evaluate the prevalence, clinicopathological characteristics and complications of MCT of the ovary.

MATERIALS AND METHODS

This was a retrospective study of 223 cases of MCT of ovary received over a period of 25 years from 1990 to 2014. The data regarding age, size, laterality, gross, morphological features, complications and surgery performed was retrieved from the archives of pathology department. Descriptive statistics was performed using SPSS software version 22 and the results were expressed as percentages.

RESULTS

MCT constituted 20.2% of the total ovarian neoplasms and 78.5% of all the germ cell tumours. The mean age of the patients with MCT was 32.5±13.11 years and the mean size of tumour was 8.6±3.1 cm. Torsion was the most common complication of these tumours. Malignant transformation of this tumour though rare was seen in 3.5% of the cases.

CONCLUSION

MCT are most common tumours of the ovary. Though predominantly seen in reproductive age group, they may also be seen in children and postmenopausal women. Torsion is the most common complication of this tumour. Age of the patient and the size of the tumour are important prognostic factors in terms of malignant transformation of teratomas. Since 8.9% of these tumours were bilateral it is essential to thoroughly examine the contralateral ovary to rule out bilaterality. Early diagnosis and early treatment is essential to preserve fertility in these patients.

Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review

Background

Mature cystic teratomas are usually found in the ovaries. They are bilateral in 10 to 15% of cases and multiple cystic teratomas may be present in one ovary. The aim of this study is to clarify if development of mature cystic teratomas of the ovaries in a single host is metachronous or due to autoimplant or recurrence.

Case presentation

We report a woman with bilateral mature cystic teratomas of the ovaries. DNA profiles of these teratomas were investigated via short tandem repeat (STR) analysis and methylation statuses were determined via methylation sensitive multiplex ligation-dependent probe amplification methods. The results showed that the cystic teratomas originated from different stages of oogonia or primary oocyte before germinal vesicle stage failure of meiosis I in female gametogenesis.

Potentially relevant literature was searched in PubMed database. Cases of bilateral or multiple mature cystic teratomas of the ovaries were analyzed. To date, there has been no reported case of multiple mature cystic teratomas in which clarification of the origin was achieved using molecular genetic methods.

Conclusions

The results of this case study provide evidence of metachronous development of mature cystic teratomas of the ovaries and may serve as a reference in the management of patients following laparoscopic cystectomy.

Electronic supplementary material

The online version of this article (doi:10.1186/s13048-017-0313-8) contains supplementary material, which is available to authorized users.

High Frequency of Malignant Transformation of Ovarian Mature Teratoma into Squamous Cell Carcinoma in Young Patients in Northeast Brazil

The malignant behavior of an ovarian teratoma is related to immaturity, or rarely to the malignant transformation of a somatic component in a mature teratoma (MT). The aim of this work was to review 189 consecutive ovarian teratomas diagnosed between 2006 and 2010 at a public referral center for cancer in Brazil, focusing on cases of MT with malignant transformation. MTs with transformation to squamous cell carcinoma (SCC) were further analyzed by immunohistochemistry for p16 staining. The median age of all patients was 36 yr (mean age, 39.6 yr; SD±4.9). Mature and immature teratomas represented 95.7% (181/189) and 4.2% of the cohort, respectively. Immature teratoma occurred mainly in adolescents under 18 yr. Malignant transformation of the somatic component in MT was observed in 10 of 181 patients (5.5%). SCC was the most common subtype (4/10), followed by differentiated thyroid carcinoma in struma ovarii(3/10), adenosquamous carcinoma (1/10), mucinous intestinal-type adenocarcinoma (1/10), and a well-differentiated neuroendocrine tumor/carcinoid (1/10). Two of 4 SCC cases were strong and diffusely positive for p16, and 2 were negative. In 5 further patients, MT was synchronously observed with other benign and malignant ovarian neoplasms in the ipsilateral ovary (3 mucinous cystadenomas and 1 Brenner tumor) and 1 cystadenocarcinoma in the contralateral ovary. MTs with malignant transformation were larger than those without transformation (P<0.001), but did not demonstrate any association with age. Indeed, our patients with SCC in MT were much younger [median and mean age, 37 and 38 yr (SD±4.9), respectively] than those described previously. As p16 is considered a surrogate marker for HPV infection, the malignant transformation of MT into SSC in young patients raises the possibility of HPV infection as a risk factor in some of these cases. However, molecular studies are needed to clarify the possible role of HPV in the malignant transformation of MT to SCC.

Huge Benign Ovarian Cystic Teratoma in a Patient with a History of Hansen's Disease

Mature ovarian cystic teratomas are common benign ovarian neoplasm derived from germ cells. With increasing availability of ultrasound services even in developing countries, the diagnosis of benign ovarian tumour is made earlier and the size of the ovarian tumour at diagnosis is relatively small. It is unusual to find an ovarian cystic teratoma larger than 10 cm. We report a huge mature ovarian cystic teratoma in a multipara with a history of Hansen's disease. We conclude that, in circumstances where women have restricted access to health care, the unusual finding of mature ovarian cystic teratoma larger than 10 cm is possible due to delayed presentation for diagnosis and treatment.

Primary squamous carcinoma of the ovary likely arising from a monodermal cystic mucinous teratoma

We present a 58-year-old woman with primary squamous carcinoma of the ovary likely arising from a monodermal cystic mucinous teratoma. Noninvolved ovary showed no Brenner tumor, endometriosis, transitional carcinoma, endometrioid adenocarcinoma, or typical multigerm layer classic mature teratoma. Moreover, no other primary site was possible because there were no prior or concomitant squamous carcinomas, or history of cervical intraepithelial neoplasia. The tumor showed strong positivity for p63 and CK5/6, reactivity that also extended from the squamous carcinoma into the basal-cell lining of the mucinous cyst of a likely monodermal teratoma. This basal-cell pattern was absent in a series of conventional benign and borderline cystic mucinous cystadenomas of the ovary, but clearly present in the mucinous cysts part of mature teratomas. We present this as a unique case of squamous carcinoma likely arising from a monodermal cystic mucinous teratoma. Moreover, we submit that the p63 and CK5/6 staining pattern may help to differentiate monodermal cystic mucinous teratoma from conventional cystic mucinous tumors.

Malignant ovarian germ cell tumors: clinico-pathological presentation and survival outcomes

OBJECTIVE

To evaluate clinico-pathological features, treatment, survival, and prognostic factors of patients with malignant ovarian germ cell tumors.

DESIGN

Descriptive study.

SETTING

Bangkok Metropolitan Administration Medical College and Vajira Hospital and Prince of Songkla University.

POPULATION

Malignant ovarian germ cell tumor patients treated between January 1996 and December 2007.

METHODS

Clinico-pathological data were collected. Patients with malignant tumors arising from benign cystic teratoma were excluded. Survival and potential prognostic factors were analyzed.

MAIN OUTCOME MEASURES

Clinico-pathological features, survival.

RESULTS

One hundred and thirty patients were identified. The median age was 21 years (range, 4-44 years). The most common complaint was pelvic or abdominal mass (63%). Primary surgery was performed by a gynecologic oncologist in only 39.2% of cases. More than half (64.2%) had early stage disease (stages I-II) and the majority had conservative surgery (73.1%). The most common histopathology was dysgerminoma. Of 124 patients with available follow-up data, 22 did not receive adjuvant treatment; 1 had whole abdominal radiation; and 101 had chemotherapy. Of 89 patients who were evaluable for responses, 4 patients had progressive disease while 85 had complete response. The five-year progression-free survival (PFS) and overall survival (OS) were 82.4% [95% confidence interval (CI), 75.4-89.5%)] and 92.4% (95% CI, 87.6-97.2%), respectively. Only preoperative tumor marker elevation was a significant poor prognostic factor for PFS.

CONCLUSIONS

Malignant ovarian germ cell tumors have a good prognosis with conservative surgical treatment. Chemotherapy is important. Elevated preoperative serum tumor markers are a poor prognostic factor for PFS.

Ovarian torsion

Ovarian torsion is a rare problem in the pediatric age group that must be included in the differential diagnosis of any girl with abdominal pain or a pelvic or abdominal mass. Clinical presentation is nonspecific, and diagnosis is based on a high index of suspicion. Ultrasound scan remains the most useful investigation, but blood flow on Doppler examination does not exclude ovarian torsion. Current recommendations of treatment strongly support ovary conservation, and macroscopic appearance of the ovary is not a reliable indicator of the degree of necrosis and potential for ovary recovery. For children with ovarian torsion, laparoscopic detorsion should be performed with strong consideration of oophoropexy. An underlying ovary lesion such as mature teratoma or functional cyst is found in most cases; however, the risk of cancer in these patients is extremely low. If there is concern of a mass or underlying pathology, then follow-up ultrasound, resolution of edema and interval laparoscopic treatment may be required.