Mature Ovarian Teratoma: Neurological Implications in a Young Woman

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

A previously fit and healthy 39-year-old woman was admitted to our tertiary referral hospital with coexisting autoimmune encephalopathy and ovarian tumor. Due to the presence of anti-N-methyl-d-aspartate receptor (anti-NMDAR) in the cerebrospinal fluid, a diagnosis of anti-NMDAR encephalitis was first suggested after ruling out other etiologies. Thus, a laparoscopy was promptly performed to remove the ovarian tumor. The histological endpoint revealed an ovarian teratoma. Consequently, the patient recovered completely in good health condition after 2 months in a coma status. Herein, we report an uncommon case of anti-NMDAR encephalitis associated with ovarian teratoma at our hospital, thus raising awareness of physicians.

Mature ovarian teratoma-associated encephalitis

Introduction. Autoimmune encephalitis associated with ovarian teratoma is a serious and potentially fatal pathology. While this clinical entity is known to neurologists, the available literature rarely mentions the role of a gynecologist in diagnostic imagining and treatment. Although several months have passed from the appearance of the symptoms to surgical treatment, this case shows that even then a complete recovery is possible. Case presentation. The patient was a 28-year-old female, brought to the hospital because a sudden onset of unusual behavior - an acute psychosis with suicidal thoughts and auditory hallucinations. Soon after the admission she became delirious, uncooperative and agitated. Blood check, neurological assessment and cranial computed tomography yielded normal results. Therefore, a psychiatric disorder was suspected. Electroencephalogram revealed a diffuse encephalitic insufficiency. As cerebrospinal fluid was negative for infections, the autoimmune etiology of the disease was suspected. Abdominal computer tomography showed a complex right ovarian mass measuring 50 x 40 x 30 mm, confirmed by vaginal ultrasound. Laparoscopy with right adnexectomy was performed. The pathohistological finding showed a mature teratoma. In the meantime, the result of the cerebrospinal fluid test came positive for anti NMDAR antibodies. Six months after surgery, the patient was in a good mental and neurological status without symptoms. Conclusion. Gynecologists should be aware of the presence of ovarian tumors in encephalitis cases. A timely diagnosis of the underlying gynecological cause of a neurological condition, allows for prompt treatment and can remarkably improve clinical conditions and, thus, be lifesaving.