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Sanap AS, Davile MD, Kamath AA, Mundle SR. Frozen in Time: Intraoperative Diagnosis and Management of Malignant Transformation in Mature Cystic Teratoma. J Midlife Health 2024; 15:115-118. [PMID: 39145267 PMCID: PMC11321514 DOI: 10.4103/jmh.jmh_253_23] [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: 12/23/2023] [Revised: 02/28/2024] [Accepted: 03/11/2024] [Indexed: 08/16/2024] Open
Abstract
Malignant transformation (MCT) of ovary is rare complications affecting elderly, squamous cell carcinoma being the most common. The prognosis worsens with extraovarian spread. We present two cases of MCT-derived SCC. Patients exhibited abdominal lump, pain, bowel symptoms, sometimes with weight loss; imaging revealed MCT. Age (51-60), postmenopausal status, large size (>20 cm), bilaterality, and complex ovarian lesions raised suspicion of malignancy. Elevated tumor markers (e.g., cancer antigen-125 and lactate dehydrogenase) were noted in one case. Intraoperative frozen section confirmed malignancy, guiding staging laparotomy. One case was advanced stage on histopathology. Intraoperative frozen section aids optimal staging.
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Affiliation(s)
| | - Medha D. Davile
- Department of Obstetrics and Gynecology, AIIMS, Nagpur, Maharashtra, India
| | - Anusha A. Kamath
- Department of Obstetrics and Gynecology, AIIMS, Nagpur, Maharashtra, India
| | - Shuchita R. Mundle
- Department of Obstetrics and Gynecology, AIIMS, Nagpur, Maharashtra, India
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2
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Atwi D, Kamal M, Quinton M, Hassell LA. Malignant transformation of mature cystic teratoma of the ovary. J Obstet Gynaecol Res 2022; 48:3068-3076. [PMID: 36053141 DOI: 10.1111/jog.15409] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 07/08/2022] [Accepted: 08/11/2022] [Indexed: 11/29/2022]
Abstract
Mature cystic teratoma is the most common ovarian germ cell neoplasm. Malignant transformation is a rare occurrence, accounting for 1.5%-2% of cases. Malignant changes can arise from any constituent tissue of a teratoma; however, squamous cell carcinoma is the most common histologic type seen, followed by adenocarcinoma and sarcoma respectively. Tumor marker concentration levels, age, and the tumor maximum diameter are predictive indicators for malignant transformation. Proper diagnosis includes recognizing the possibility of malignant transformation versus excluding other differential options, such as metastasis. Primary cytoreductive surgery, adjuvant chemotherapy, and radiotherapy are the current treatment methods. The aim of the review is to discuss the clinical and pathologic features of malignant transformation within mature cystic teratomas, while reviewing the reported malignant types, differential diagnoses, and treatment options. Data sources include review of pertinent peer-reviewed literature on malignant transformation of mature cystic teratoma and cases seen in authors' institutional practice. Mature cystic teratomas are a commonly encountered benign ovarian tumor. However, the possibility of malignant transformation should remain in consideration, especially with given clinical or pathologic features: increased patient age, tumor size, or tumor marker levels. Thorough sampling of solid tumor foci can help identify malignant components. Awareness and proper diagnosis, along with early detection and clinical management, shows improved patient outcomes.
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Affiliation(s)
- Doaa Atwi
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria Kamal
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Quinton
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lewis A Hassell
- Department of Pathology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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3
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Rowe JS, Makar G, Holdbrook T, Germaine P. Squamous cell carcinoma arising in a partially ruptured giant mature cystic teratoma: A case report. Radiol Case Rep 2018; 14:97-102. [PMID: 30386447 PMCID: PMC6204922 DOI: 10.1016/j.radcr.2018.09.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Revised: 09/01/2018] [Accepted: 09/29/2018] [Indexed: 11/19/2022] Open
Abstract
Mature cystic teratomas are the most common ovarian germ cell tumors and represent 70% of the benign ovarian tumors occurring in women under age 30. In less than 2% of cases, these tumors can transform into malignancies. Squamous cell carcinoma arises most frequently from these tumors (in 80% of cases). Intra-peritoneal rupture accounts for approximately 1%-2% of cystic teratoma complications with most ruptures occurring either intraoperatively during laparoscopic surgery or due to trauma. This case report describes the common presentation, imaging, and pathologic findings of a mature cystic teratoma with 2 uncommon associated complications.
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Affiliation(s)
- Jean Sebastien Rowe
- Cooper University Hospital, Department of Diagnostic Radiology, One Cooper Plaza, Camden, NJ 08103, USA
| | - Gabriel Makar
- Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103 USA
| | - Thomas Holdbrook
- Cooper University Hospital, Department of Pathology, One Cooper Plaza, Camden, NJ 08103, USA
| | - Pauline Germaine
- Cooper University Hospital, Department of Diagnostic Radiology, One Cooper Plaza, Camden, NJ 08103, USA
- Corresponding author.
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4
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Chiang AJ, Chen MY, Weng CS, Lin H, Lu CH, Wang PH, Huang YF, Chiang YC, Yu MH, Chang CL. Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: a Taiwanese Gynecologic Oncology Group (TGOG) study. J Gynecol Oncol 2017; 28:e69. [PMID: 28657230 PMCID: PMC5540728 DOI: 10.3802/jgo.2017.28.e69] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Revised: 05/13/2017] [Accepted: 06/02/2017] [Indexed: 02/06/2023] Open
Abstract
Objective The malignant transformation (MT) of ovarian mature cystic teratoma (MCT) to squamous cell carcinoma (SCC) is very rare. This study analyzed cases from multiple medical centers in Taiwan to investigate the clinicopathologic characteristics, treatment, and prognostic factors of this disease and reviewed related literature. Methods Pathological reports of 16,001 patients with primary ovarian cancer who were treated at Taiwan medical centers from 1990 to 2011 were reviewed. In total, 52 patients with MT of MCT to SCC were identified. Results Among all ovarian MCTs, the incidence of MT to SCC is 0.2%. The median age of patients was 52 years (range, 29–89 years), and the mean tumor size was 10.5 cm (range, 1–40 cm). We analyzed the patients in our study and those in the literature and determined that early identification and complete surgical resection of the tumor are essential for long-term survival. In addition, adjuvant chemotherapy or concurrent chemoradiotherapy can be used to treat this malignancy. Old age, large tumor size (≥15.0 cm), and solid components in MCTs are suitable indicators predicting the risk of MT of MCT to SCC. Conclusion Similar to general epithelial ovarian cancers, the early detection of MT of MCT to SCC is critical to long-term survival. Therefore, older patients with a large tumor or those with a tumor containing a solid component in a clinically diagnosed MCT should be evaluated to exclude potential MT to SCC.
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Affiliation(s)
- An Jen Chiang
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.,Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Min Yu Chen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Department of Obstetrics and Gynecology, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chia Sui Weng
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan
| | - Hao Lin
- Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien Hsing Lu
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Peng Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan.,Division of Gynecology, Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu Fang Huang
- Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ying Cheng Chiang
- Department of Obstetrics and Gynecology, College of Medicine, National Taiwan University, Taipei, Taiwan.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Mu Hsien Yu
- Department of Obstetrics and Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih Long Chang
- Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
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5
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Tazo Y, Yoshimura Y, Shoda T, Kyushima N, Okada T, Yamazaki H. Relevance of frozen sections and serum markers in invasive squamous cell carcinoma arising from ovarian mature cystic teratoma: two case reports. J Med Case Rep 2016; 10:20. [PMID: 26801904 PMCID: PMC4724162 DOI: 10.1186/s13256-015-0783-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 12/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ovarian mature cystic teratoma (MCT) is a common neoplasm in women. While malignant transformation of MCT is relatively rare, squamous cell carcinoma is the most frequent malignant neoplasm arising from MCT. Some tumor markers have been reported to be useful for prediction of MCT malignant transformation prior to operation. However, widely accepted use of these markers remains to be established. In the present study, we report the usefulness of frozen section assessment during operation, as well as preoperative measurement of tumor marker levels. CASE PRESENTATION We present two cases of squamous cell carcinoma arising from ovarian MCT. The first case was a 45-year-old Asian woman referred to our hospital after her periodical company medical checkup, due to possible ovarian tumor. Image analysis suggested a dermoid cyst, and left salpingo-oophorectomy was performed. Because the cyst was histologically diagnosed as an invasive squamous cell carcinoma arising from an MCT, our patient underwent an additional preventative operation. The TNM classification and FIGO stage were T1aNXM0 and Ia, respectively. The second case was a 53 -year-old Asian woman who visited our hospital due to complaints of abdominal pain and urinary retention. Image analysis and laboratory data showing high serum levels of SCC antigen (normal range: < 1.5 ng/mL) and CA19-9 (normal range: < 37 U/mL), which strongly suggested malignant transformation of MCT. Frozen sections obtained during the operation were histologically analyzed to confirm malignancy, and our patient underwent an additional operation. The TNM classification and FIGO stage were T1aNXM0 and Ia, respectively. CONCLUSIONS We report the usefulness of frozen section assessment during operation, as well as preoperative measurement of tumor marker levels.
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Affiliation(s)
- Yuki Tazo
- Department of Gynecology and Obstetrics, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan. .,Department of Pathology, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
| | - Yoshihiro Yoshimura
- Department of Gynecology and Obstetrics, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
| | - Takashi Shoda
- Department of Gynecology and Obstetrics, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
| | - Noriyuki Kyushima
- Department of Gynecology and Obstetrics, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
| | - Takemichi Okada
- Department of Radiology, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
| | - Hitoshi Yamazaki
- Department of Pathology, Kitasato University, 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, Japan.
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6
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The usefulness of 18F-FDG-PET/CT in discriminating benign from malignant ovarian teratomas. Int J Clin Oncol 2015; 20:960-6. [DOI: 10.1007/s10147-015-0800-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 02/02/2015] [Indexed: 10/24/2022]
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Deffieux X, Thubert T, Huchon C, Demoulin G, Rivain AL, Faivre E, Trichot C. [Complications of presumed benign ovarian tumors]. ACTA ACUST UNITED AC 2013; 42:816-32. [PMID: 24210240 DOI: 10.1016/j.jgyn.2013.09.036] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The main risk factor of adnexal torsion is a previous adnexal torsion (LE3). There is no clinical, biological or radiological sign that may exclude the diagnosis of adnexal torsion (LE3). The presence of flow at color Doppler imaging does not allow exclusion of the diagnosis (LE2). An emergent laparoscopy is recommended for adnexal untwisting (Grade B), except in postmenopausal women where oophorectomy is recommended (grade C). A persistent black color of the adnexa after untwisting is not an indication for systematic oophorectomy (grade C), since a functional recovery is possible (LE3). Ovariopexy is not routinely recommended following adnexal untwisting (grade C). The clinical signs of intra-cystic hemorrhage and those of rupture of the corpus luteum are not specific (LE4). MRI is not recommended to confirm the diagnosis of intra-cystic hemorrhage (grade C). Malignant transformation of an ovarian cyst is very rare. The presence of a benign ovarian cyst is not associated with an increased risk of ovarian cancer at long-term follow-up (LE2). For these women, an ultrasound follow-up is not recommended (grade C). Dermoid ovarian cyst containing nerve tissue can trigger the production of pathogenic auto-antibody-anti-NMDA, leading to encephalitis. A high proportion of thyroid tissue in a mature teratoma (struma ovarii) may cause hyperthyroidism.
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Affiliation(s)
- X Deffieux
- Service de gynécologie-obstétrique et médecine de la reproduction, hôpital Antoine-Béclère, AP-HP, 157, rue de la Porte-de-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud, 91405 Orsay, France.
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8
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Kahraman K, Cetinkaya SE, Kankaya D, Dünder I, Söylemez F. Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma. J Obstet Gynaecol Res 2010; 37:146-50. [PMID: 21083842 DOI: 10.1111/j.1447-0756.2010.01323.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Squamous cell carcinoma arising from a mature cystic teratoma of the ovary is a rare event representing only 1-2% of all mature cystic teratomas. Furthermore, the synchronous occurrence of a second malignancy in this setting is extremely rare. A 63-year-old woman presented with a pelvic mass which was diagnosed as a left ovarian mature cystic teratoma preoperatively by ultrasonography. The frozen section of the mass revealed a left ovarian mature cystic teratoma with a focus of squamous cell carcinoma. Subsequently surgical staging procedure for ovarian cancer was performed. The final pathologic diagnosis was squamous cell carcinoma in mature cystic teratoma of the ovary, and synchronous endometrial adenocarcinoma with a mixture of endometrioid and mucinous subtypes as an incidental finding. The combination of these two synchronous cancers is unique and to the best of our knowledge, this has not been previously reported in the English language literature.
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Affiliation(s)
- Korhan Kahraman
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, Ankara, Turkey.
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9
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Hackethal A, Brueggmann D, Bohlmann MK, Franke FE, Tinneberg HR, Münstedt K. Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data. Lancet Oncol 2008; 9:1173-80. [PMID: 19038764 DOI: 10.1016/s1470-2045(08)70306-1] [Citation(s) in RCA: 178] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Up to a quarter of ovarian masses originate from germ cells, and many of these are mature cystic teratomas. The secondary development of malignancy is a rare but well-known phenomenon in patients with ovarian teratomas. Squamous-cell carcinoma accounts for 80% of secondary malignant transformations of ovarian teratomas. We aimed to do an up-to-date systematic review of this rare malignant transformation. 64 suitable studies provided information on 277 patients. Squamous-cell carcinoma in mature cystic teratoma was mainly found in women aged more than 50 years, with high concentrations of squamous-cell-carcinoma antigen and cancer antigen CA125, and with ovarian tumours more than 100 mm in size. Patients with FIGO stage Ia tumours had better survival than those with more advanced disease. Complete resection together with hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy for patients with advanced disease, followed by adjuvant chemotherapy with an alkylating drug was associated with higher survival, radiotherapy was not. We make proposals for investigation and treatment of this rare disorder.
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Affiliation(s)
- Andreas Hackethal
- Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Giessen, Germany
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10
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Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Malignant transformation of mature cystic teratoma of the ovary: experience at a single institution. Eur J Obstet Gynecol Reprod Biol 2008; 141:173-8. [PMID: 18823690 DOI: 10.1016/j.ejogrb.2008.07.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2008] [Revised: 07/01/2008] [Accepted: 07/22/2008] [Indexed: 01/20/2023]
Abstract
OBJECTIVES Malignant transformation of mature cystic teratoma (MCT) of ovary is very rare. Therefore, the clinicopathologic characteristics, treatment and prognostic factors are not yet well established. The aim of this study was to review our experience with this malignancy and previously published reports in the literature. STUDY DESIGN A review of pathologic reports for 2019 patients with ovarian MCT and 937 patients with primary ovarian cancer who were treated at the Asan Medical Center, Korea, from 1989 to 2007 identified 16 patients with malignant transformation from MCT. A retrospective chart review of these patients and a review of the literature were performed. RESULTS The incidence rate of malignant transformation was 0.8% of all ovarian MCT. It accounted for 1.7% of all primary ovarian cancer. Squamous cell carcinoma was the most common histologic type, comprising 75%. The median age of the 16 patients was 50 years (range, 29-75 years). Mean tumor size was 14.5 cm (range, 5-26 cm). Twelve patients had some solid portions in the cyst containing fat fluid, hair, and/or calcification. According to the review of the patients in our study and of the literature, early detection and complete surgical resection are important for long-term survival. It seems that adjuvant chemotherapy or concurrent chemoradiation therapy have roles in treating this malignancy. CONCLUSIONS Early detection is important for long-term survival. Old age, large tumor size, and solid portion in mature cystic teratoma seem to predict the malignant transformation of mature cystic teratoma.
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Affiliation(s)
- Jeong-Yeol Park
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Ulsan, College of Medicine, Asan Medical Center, #388-1 Poongnap-dong, Songpa-Ku, Seoul 138-736, Republic of Korea
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11
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[Degeneration of dermoid cysts: a case study of malignant transformation]. ACTA ACUST UNITED AC 2007; 35:1005-8. [PMID: 17916437 DOI: 10.1016/j.gyobfe.2007.03.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2006] [Accepted: 03/06/2007] [Indexed: 01/09/2023]
Abstract
Malignant transformation of ovarian dermoid cyst (mature cystic teratoma) is rare and most often established in postmenopausal women after surgery by sample anatomopathological analysis. We report the case of a 58-year-old woman showing abdominal pain associated with constipation episodes. The diagnosis of dermoid cyst was established upon ultrasonographic and tomodensitometric criteria. Its histopathological analysis confirmed the presence of a well differentiated epidermoid carcinoma. In line with the literature, our study highlights the importance of the age of the patient, the size of dermoid cyst and its growth rate as well as squamous cell carcinoma (SCC) antigen serum level. These date are collected in order to establish a correct diagnosis and provide an appropriate cure. When a cyst is discovered these data must pathological event, mostly observed in menopaused women. Certainty diagnosis is collected in order to establish a correct diagnosis and provide an appropriate cure.
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12
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Bal A, Mohan H, Singh SB, Sehgal A. Malignant transformation in mature cystic teratoma of the ovary: report of five cases and review of the literature. Arch Gynecol Obstet 2006; 275:179-82. [PMID: 16957908 DOI: 10.1007/s00404-006-0244-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Accepted: 08/17/2006] [Indexed: 10/24/2022]
Abstract
The incidence of malignant transformation in mature cystic teratoma (MCT) of the ovary is less than 2% as reported in gynaecological and pathological literature. Here we present a series of five patients, who developed malignant transformation in MCT of the ovary, over a 6-year period (1999-2004). The morphological and clinico-pathological features of malignant transformation in MCT of the ovary are discussed.
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Affiliation(s)
- Amanjit Bal
- Department of Pathology, Government Medical College and Hospital, Sarai Building, Chandigarh, 160030, India
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13
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Sanghera P, El Modir A, Simon J. Malignant transformation within a dermoid cyst: a case report and literature review. Arch Gynecol Obstet 2006; 274:178-80. [PMID: 16525791 DOI: 10.1007/s00404-006-0139-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Accepted: 01/11/2006] [Indexed: 10/24/2022]
Abstract
Malignant transformation within a dermoid cyst is a rare event. The most common transformation is to squamous cell carcinoma. Patients are often elderly and present with advanced disease. The prognosis tends to be very poor. We present a case of locally invasive squamous cell carcinoma arising from a dermoid cyst in a 48-year-old lady. She underwent debulking surgery with no gross residual disease remaining. Within 2 months of the surgery she had recurrent disease and this was resistant to single agent carboplatin chemotherapy. She died 4 months after her initial surgery. We discuss the difficulties in diagnosing such tumours, the poor prognosis and review the various adjuvant treatment strategies that have been used in attempt to improve the outcome.
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Affiliation(s)
- P Sanghera
- SpR Clinical Oncology (West Midlands Rotation), Cancer Centre, Queen Elizabeth Hospital, B15 2TH, Birmingham, UK.
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14
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Tangjitgamol S, Manusirivithaya S, Sheanakul C, Leelahakorn S, Thawaramara T, Jesadapatarakul S. Squamous cell carcinoma arising from dermoid cyst: Case reports and review of literature. Int J Gynecol Cancer 2003; 13:558-63. [PMID: 12911740 DOI: 10.1046/j.1525-1438.2003.13312.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Malignant transformation of a dermoid cyst is rare, with squamous cell carcinoma (SCC) being the most common type. During a 10-year period in our institution, we encountered only four cases of SCC out of 425 cases of dermoid cyst, an incidence of 0.94%. Two were of old age, in menopausal status (63 and 74 y), while the other two were in their early forties. Three cases presented with pelvic masses while the other one had nonspecific wasting symptoms and later diarrhea. Three were in early stage and have survived to date without evidence of disease at 8, 12, and 116 months after diagnosis. The other case, in stage III, had suboptimal surgery and responded partially to chemotherapy, subsequently progressed after cessation of the drug, and finally died within a year after diagnosis.
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Affiliation(s)
- S Tangjitgamol
- Gynecologic Oncology Unit, Department of Obstetrics and Gynecology and Department of Pathology, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok, Thailand.
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15
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Suzuki M, Tamura N, Kobayashi H, Ohwada M, Terao T, Sato I. Clinical significance of combined use of macrophage colony-stimulating factor and squamous cell carcinoma antigen as a selective diagnostic marker for squamous cell carcinoma arising in mature cystic teratoma of the ovary. Gynecol Oncol 2000; 77:405-9. [PMID: 10831350 DOI: 10.1006/gyno.2000.5784] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Mature cystic teratoma of the ovary transforms into malignant tumors, mostly squamous cell carcinomas, at an incidence of approximately 2%. Preoperative diagnosis of squamous cell carcinoma arising in mature cystic teratoma of the ovary is a difficult task. The present study aims to assess whether combined use of two serum tumor markers, macrophage colony-stimulating factor (M-CSF) and squamous cell carcinoma antigen (SCC), is effective in preoperatively diagnosing squamous cell carcinoma arising in mature cystic teratoma of the ovary, distinguishing it from mature cystic teratoma without malignant transformation. METHODS Serum levels of M-CSF and SCC were assayed using blood samples collected preoperatively from 31 patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary and 133 patients with mature cystic teratoma of the ovary without malignant transformation. RESULTS In 22 of the 31 (71.0%) patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary, the serum M-CSF levels exceeded the upper limit of the normal level (1056 U/ml). This positive incidence of the elevated serum M-CSF levels was significantly higher compared with that (13.5%, 18/133) observed in patients with benign cystic teratoma of the ovary (P < 0.0001). Regarding the serum levels of SCC, 13 of 31 (41.9%) patients with malignant tumors showed positive values exceeding the cutoff value of 2.0 ng/ml. Again, this incidence of positive cases was significantly higher compared with that (15.0%, 20/133) observed in patients with benign tumors (P < 0.01). There was no correlation between the serum levels of M-CSF and SCC among patients with squamous cell carcinoma arising in mature cystic teratoma of the ovary. Patients with malignant tumors testing positive for elevated M-CSF did not necessarily test positive for SCC. Patients with positive values for excess M-CSF and/or SCC constituted 87.1% of the total (27/31). Even when patients were restricted to those with stage I tumors, a value as high as 83.3% (15/18) was still obtained for those testing positive for elevated M-CSF and/or SCC. CONCLUSION Serum M-CSF was proven to be useful as a tumor marker for detecting squamous cell carcinoma arising in mature cystic teratoma of the ovary. Combined use of serum M-CSF and SCC as a marker seemed to be useful in the selective diagnosis of mature cystic teratoma of the ovary harboring malignant squamous carcinoma, discriminating it from that without malignant carcinoma.
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Affiliation(s)
- M Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, 3311 Yakushiji, Minamikawachi, Kawachi, Tochigi, 329-0498, Japan
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16
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Emoto M, Obama H, Horiuchi S, Miyakawa T, Kawarabayashi T. Transvaginal color Doppler ultrasonic characterization of benign and malignant ovarian cystic teratomas and comparison with serum squamous cell carcinoma antigen. Cancer 2000; 88:2298-304. [PMID: 10820352 DOI: 10.1002/(sici)1097-0142(20000515)88:10<2298::aid-cncr14>3.0.co;2-s] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The preoperative diagnosis of squamous cell carcinoma (SCC) arising in mature cystic teratoma of the ovary remains difficult. The purpose of this study is to examine the usefulness of transvaginal color Doppler ultrasound (TV-CDU) in differentiating malignant (SCC) from benign cystic teratoma of the ovary. METHODS Eighty-eight patients with an ovarian tumor showing gray scale sonographic appearances of mature cystic teratoma were preoperatively evaluated for the presence or absence of intratumoral blood flow by TV-CDU. The blood flow characteristics of the tumor vessels were analyzed using the resistance index (RI), pulsatility index (PI), and peak systolic velocity (PSV). The serum levels of SCC antigen were also randomly examined preoperatively in 50 patients. RESULTS Intratumoral blood flow was significantly detected in malignant teratomas (SCCs) (80.0%; 4 of 5) compared with benign teratomas (20.5%; 17 of 83) (P < 0.01). All malignant teratomas with intratumoral blood flow showed both RI less than 0.4 and PI less than 0.6, whereas no benign teratomas showed any such value except for 1 case with struma ovarii. In addition, both the mean RI and the mean PI values in the tumor vessels were significantly lower in the malignant teratomas (RI: 0.31 +/- 0.07; PI: 0.40 +/- 0.16) than in the benign teratomas (RI: 0.62 +/- 0.13; PI: 1.06 +/- 0.44) (P < 0.001). However, the mean PSV value of the malignant teratomas (PSV: 20.6 +/- 8.33) was not significantly different from the benign teratomas (PSV: 18.1 +/- 9.9). Elevation of serum SCC was found in 4 of 5 patients (80%) with malignant teratomas, whereas the elevation was found in 11 of 45 patients (24.4%) with benign teratomas (P < 0.05). The diagnostic accuracy using the RI (cutoff value 0.4) as well as the PI (cutoff value 0.6) was thus 95.2%, which was significantly superior to that obtained by using the serum SCC (76%) (cutoff value, 1.5 ng/mL). CONCLUSIONS Evaluating the presence or absence of intratumoral blood flow, together with blood flow resistance, in tumor vessels using TV-CDU thus may be more useful to differentiate malignant (SCC) from benign cystic teratomas of the ovary than by measuring serum SCC levels.
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Affiliation(s)
- M Emoto
- Department of Obstetrics and Gynecology, Fukuoka University School of Medicine, Japan
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Lee YC, Abulafia O, Montalto N, Holcomb K, Matthews R, Golub RW. Malignant transformation of an ovarian mature cystic teratoma presenting as a rectal mass. Gynecol Oncol 1999; 75:499-503. [PMID: 10600316 DOI: 10.1006/gyno.1999.5602] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Squamous cell carcinoma arising from malignant degeneration of a mature cystic teratoma is rare with a reported incidence of approximately 1-3%. The most common presenting symptoms are lower abdominal pain and increasing abdominal girth of several months' duration. Approximately 50% of the patients present with FIGO stage I while 35-38% present with stage III diseases. CASE The case described herein represents an unusual presentation and initial diagnostic dilemma of locally aggressive squamous cell carcinoma arising in an ovarian dermoid cyst, with invasion into the distal rectum and anal canal causing rectal bleeding similar to the presentation of anal squamous cell carcinoma. Despite aggressive surgical management with posterior exenteration and optimal tumor debulking followed by 5040-cGy pelvic radiation utilizing 25-MV photons, the patient developed pelvic recurrence at the vaginal cuff 6 weeks after completion of her adjuvant radiotherapy. She subsequently failed cis-platinum single-agent chemotherapy and died 9 months after her initial surgery and diagnosis. CONCLUSION Squamous cell carcinoma in the anal canal, diagnosed by colonoscopy or proctoscopy, could be an unusual presentation of that arising from malignant degeneration of an ovarian dermoid cyst. This tumor may behave in a locally aggressive manner and be resistant to pelvic radiation or single-agent chemotherapy of cis-platinum. The current experience of adjuvant treatment after comprehensive staging and cytoreductive surgery reported in the world literature is limited, and the optimal management of the malignancy remains unclear.
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Affiliation(s)
- Y C Lee
- Department of Obstetrics and Gynecology, Section of Colorectal Surgery, Brooklyn, New York 11203, USA
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18
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Shiono S, Sato T, Abiko M. [Mediastinal mature teratoma with elevated serum SCC levels--a report of 2 cases]. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 1998; 46:743-6. [PMID: 9785874 DOI: 10.1007/bf03217813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This is a report of two cases of mature mediastinal teratoma associated with elevated serum SCC levels. The first patient was a 17-year-old female admitted to our hospital for severe left chest pain. Chest x-ray film and CT scan showed a mediastinal tumor. The preoperative serum SCC level was elevated. Resection was performed and the pathological diagnosis was mature teratoma. The second patient was a 32-year-old male admitted to our hospital for severe anterior chest pain. A chest CT scan showed a mediastinal tumor. The preoperative serum SCC level was high. Surgery was performed and the pathological diagnosis was mature teratoma. The cause of the high serum SCC levels was unclear, but we suspect that the pulmonary atelectasis may have caused it.
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Affiliation(s)
- S Shiono
- Department of Surgery, Yamagata Prefectural Central Hospital, Japan
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19
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Kikkawa F, Nawa A, Tamakoshi K, Ishikawa H, Kuzuya K, Suganuma N, Hattori S, Furui K, Kawai M, Arii Y. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer 1998; 82:2249-55. [PMID: 9610706 DOI: 10.1002/(sici)1097-0142(19980601)82:11<2249::aid-cncr21>3.0.co;2-t] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND The prognoses of patients with squamous cell carcinoma of the ovary are quite poor. However, preoperative diagnosis is difficult due to the rarity of this tumor and its similarity to mature cystic teratoma (MCT). The objective of this study was to assess the value of tumor markers and clinical characteristics in making a differential diagnosis between MCT and squamous cell carcinoma arising from MCT. METHODS Between September 1979 and June 1996, 37 patients with ovarian squamous cell carcinoma arising from MCT were treated by the Tokai Ovarian Tumor Study Group. The authors evaluated tumor markers, tumor size, and age as parameters for differentiation between MCT and squamous cell carcinoma arising from MCT. Diagnostic efficiency was calculated as the sensitivity multiplied by the specificity. RESULTS There were significant differences (P < or = 0.0002) in age, tumor size, and levels of squamous cell carcinoma antigen (SCC), CA125, and CEA, as well as a significant difference (P < or = 0.0396) in the CA19-9 level between MCT and squamous cell carcinoma arising from MCT. Diagnostic efficiency was highest for SCC (63.0%), followed by CA125 (50.7%). Receiver operating characteristic (ROC) curves demonstrated that CEA was the best screening marker for squamous cell carcinoma arising from MCT, whereas age and tumor size were better markers than CA125 or CA19-9. The optimal cutoff values for age and tumor size were 45 years and 99 mm, respectively, according to ROC analysis. CONCLUSIONS These findings demonstrate that age and tumor size are important factors in making a differential diagnosis. In addition, SCC and CEA levels should be measured in patients age 45 years or older who have an MCT-like ovarian tumor larger than 99 mm in greatest dimension.
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Affiliation(s)
- F Kikkawa
- Department of Obstetrics and Gynecology, Nagoya University School of Medicine, Japan
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20
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Saito Y, Mitsuhashi N, Hayakawa K, Nakayama Y, Kazumoto T, Furuta M, Yamakawa M, Akimoto T, Sakurai H, Takahashi T, Niibe H. Prognostic value of pretreatment serum carcinoembryonic antigen and squamous cell carcinoma antigen levels for patients with stage I–III non-small cell lung cancer treated with radiation therapy alone. Int J Clin Oncol 1998. [DOI: 10.1007/bf02490098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Suzuki M, Kobayashi H, Ohwada M, Terao T, Sato I. Macrophage colony-stimulating factor as a marker for malignant germ cell tumors of the ovary. Gynecol Oncol 1998; 68:35-7. [PMID: 9454657 DOI: 10.1006/gyno.1997.4897] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
We assessed the usefulness of macrophage colony-stimulating factor (M-CSF) as a serum marker for malignant germ cell tumors of the ovary. Serum levels of M-CSF were measured in 49 patients with malignant germ cell tumors and in 64 patients with mature benign cystic teratoma by an enzyme-linked immunosorbent assay. CA125 was measured by radioimmunoassay. The serum level of M-CSF was above normal (>1056 U/ml) in 44 (90%) of 49 patients with malignant germ cell tumors; the CA125 level was above the cutoff value (35 U/ml) in 34 patients (69%) (P < 0.05). The serum level of M-CSF was elevated in 20 (87%) of 23 patients with stage I disease and in all 16 patients with dysgerminoma. Only 7 (11%) of 64 patients with mature benign cystic teratoma had elevated levels of M-CSF. These results suggest that M-CSF is highly sensitive and specific for malignant germ cell tumors of the ovary, especially for dysgerminoma.
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Affiliation(s)
- M Suzuki
- Department of Obstetrics and Gynecology, Jichi Medical School, 3311 Yakushiji, Minamikawachi, Kawachi, Tochigi 329-04
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