Dermoid cysts of the ovary with malignant transformation: MR appearance

Size threshold as a risk for malignant transformation in typical ovarian dermoid lesions: a scoping review

PURPOSE

The O-RADS malignancy risk stratification of typical ovarian dermoid cysts by using a 10 cm threshold is based on expert consensus rather than analysis of objective clinical data. This comprehensive scoping review consolidated all currently available studies evaluating typical benign ovarian dermoid cyst size and risk for malignant transformation.

METHODS

A systematic review of MEDLINE, Embase, Scopus and the Cochrane library was performed from inception to January 14, 2024, using PRISMA-ScR guidelines. A grey literature search and forward searching of reference lists from included studies were performed. Case reports and case series evaluating dermoid cyst size and malignant transformation as defined by a pathological reference standard were included. Data synthesis was provided as a qualitative review of the existing literature.

RESULTS

Twenty-five studies were included in qualitative synthesis comprising 6 case reports and 19 retrospective studies with a total of 15,295 dermoid cysts. Of these, 215 lesions demonstrated malignant transformation. Studies reporting dermoid size with malignant transformation ranged from 1 to 32 cm with 46/173 (27%) total malignant transformation lesions measuring < 10 cm. Solid enhancing components were infrequently reported but all measured > 1 cm when described.

CONCLUSION

More than 25% of dermoid cysts with malignant transformation may be classified as "almost certainly benign" with the current 10 cm O-RADS malignancy risk threshold. Although surveillance of O-RADS 2 dermoid cysts may improve sensitivity, modifying a caveat recommendation for MRI O-RADS +/- gyn-oncologist referral when potentially solid components are present in otherwise typically benign dermoid cysts may be appropriate.

MRI features of ovarian teratomas with somatic-type malignancy and mature cystic teratomas

PURPOSE

We evaluated the magnetic resonance imaging (MRI) features of ovarian teratomas with somatic-type malignancy (TSMs) and benign ovarian mature cystic teratomas (MCTs) to determine the diagnostic contribution of the MRI findings for differentiating these two teratomas.

METHODS

We compared the MRI findings between ovarian TSMs (n = 10) and MCTs (n = 193), and we conducted a receiver operating characteristic (ROC) analysis to determine the MRI findings' contribution to the differentiation of TSMs from MCTs.

RESULTS

The maximum diameters of whole lesion and the largest solid component in the TSMs were larger than those of the MCTs (p = 0.0001 and p < 0.0001, respectively). Fat tissue in solid components was seen in 73/116 (62.9%) MCTs but in none of the TSMs (p = 0.0001). Ring-like enhancement in solid components was seen in 60/116 (51.7%) MCTs and none of the TSMs (p = 0.0031). On dynamic contrast-enhanced MRI (DCE MRI), all of the solid components in the TSMs showed a high- or intermediate-risk time intensity curve (TIC), and those in 113 of the 116 (97.4%) MCTs showed a low-risk TIC (p < 0.0001). The area under the curve of the ROC analysis using the high-/intermediate-risk TIC on DCE MRI was the highest (0.99) for differentiating TSMs from MCTs: sensitivity 100%, specificity 97.4%, positive predictive value 75.0%, negative predictive value 100%, and accuracy, 97.6%.

CONCLUSION

Compared to ovarian MCTs, ovarian TSMs are larger and have larger solid components with high- or intermediate-risk TICs on DCE MRI. Ovarian MCTs frequently show small solid components with fat tissue, ring-like enhancement, and a low-risk TIC on DCE MRI.

MRI findings of malignant transformation arising from mature cystic teratoma of the ovary: comparison with benign mature cystic teratoma

OBJECTIVE

This study aimed to evaluate the efficacy of MRI findings to differentiate malignant transformation arising from mature cystic teratoma (MT-MCT) of the ovary from benign mature cystic teratoma (BMCT).

MATERIALS AND METHODS

This study included 11 patients with histopathologically proven MT-MCT and 50 with BMCT. Overall, 7 patients with MT-MCT and all 50 with BMCT underwent unenhanced and contrast-enhanced MRIs and 4 with MT-MCT only underwent unenhanced MRIs. The MRI findings were evaluated and compared between the two diseases.

RESULTS

The median age (55 vs. 38 years, p < 0.01) and maximum diameter (109 vs. 65 mm, p < 0.01) were higher in MT-MCT than in BMCT. Fat component occupancy was lower in MT-MCT than in BMCT (median, 5% vs. 63%, p < 0.01). Only MT-MCT exhibited irregular tumor margins (64%), peritoneal dissemination (18%), and abnormal ascites (27%). The solid components were more commonly observed in MT-MCT than in BMCT (100% vs. 32%, p < 0.01) on contrast-enhanced images. The maximum diameter of solid components in MT-MCT was larger than that in BMCT (median, 61 mm vs. 14 mm, p < 0.01). In MT-MCT, the common configuration of solid components was endophytic or exophytic sessile (85%), whereas in BMCT, it was endophytic papillary (88%).

CONCLUSION

Compared with BMCT, MT-MCT demonstrated a larger maximum diameter, lower occupancy rate of fat components, and sessile solid components. The characteristic configuration of solid components was endophytic or exophytic sessile in MT-MCT and endophytic papillary in BMCT.

A case of pelvic squamous cell carcinoma of unknown primary origin that responded well to radiotherapy and nivolumab

Squamous cell carcinoma of unknown primary origin in the pelvis is rare. We report a case of a 64-year-old woman with a large osteolytic squamous cell carcinoma of unknown primary origin in the pelvis that presented with p16 expression. The patient presented with leg pain and swelling and was admitted to our hospital. Computed tomography scans of the pelvis revealed a large osteolytic tumor. A computed tomography-guided needle biopsy was performed, and pathological examination revealed neoplastic cells with metastatic squamous cell carcinoma presenting with p16 expression. Despite a whole-body examination, tumor origin remained undetected. The patient was treated for this metastatic squamous cell carcinoma of unknown primary using palliative radiotherapy for hip pain and nivolumab. Remarkable reduction in the tumor marker levels and tumor size were obtained after therapy. Finally, partial remission and progression-free survival for more than 7 months were achieved. In conclusion, we experienced a rare case with a large p16-positive squamous cell carcinoma of unknown primary in pelvis, which responded well to radiotherapy and nivolumab.

MR diagnosis of SCC arising within ovarian cystic teratomas: analysis of mural nodule characteristics

PURPOSE

This study aims to evaluate and identify magnetic resonance (MR) findings of mural nodules to detect squamous cell carcinoma arising from ovarian mature cystic teratoma (SCC-MCT).

METHODS

This retrospective study examined 135 patients (SCC-MCTs, n = 12; and benign MCTs, n = 123) with confirmed diagnoses across five different institutions between January 2010 and June 2022. Preoperative MR images for each patient were independently assessed by two experienced radiologists and analyzed following previously reported findings (PRFs): age, tumor size, presence of mural nodules, size of mural nodule, and the angle between mural nodule and cyst wall (acute or obtuse). Furthermore, this study evaluated four mural nodule features-diffusion restriction, fat intensity, Palm tree appearance, and calcification-and the presence of transmural extension.

RESULTS

There were significant differences between the SCC-MCT and benign MCT groups in terms of all PRFs and all mural nodule findings (p < 0.01). Among the PRFs, "tumor size" demonstrated the highest diagnostic performance, with a sensitivity of 83.3% and a specificity of 88.6%. A combination of the aforementioned four mural nodule findings showed a sensitivity and specificity of 83.3% and 97.6%, respectively, for the diagnosis of SCC-MCT. Regarding diagnosis based on a combination of four mural nodule findings, the specificity was significantly higher than the diagnosis based on tumor size (p = 0.021). Based on these mural nodule findings, three SCC-MCT patients without transmural invasion could be diagnosed.

CONCLUSION

Mural nodule MR findings had a higher diagnostic performance than PRFs for SCC-MCT and can potentially allow early detection of SCC-MCTs.

Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation

ABSTRACT

The purpose of this article is to provide a comprehensive review of the imaging findings along with histopathologic correlation of mature (benign) teratomas and malignant ovarian teratomas, which include both immature teratomas and malignant degeneration of mature teratomas. The radiologist's ability to provide an accurate diagnosis plays an essential role in guiding the interdisciplinary care of patients with malignant teratomas and improving their outcomes.

Colorectal Adenocarcinoma Derived From Mature Cystic Teratomas: A Case Report With Review of the Literature

Mature cystic teratomas (MCTs) are the most common benign ovarian germ cell neoplasms in women of reproductive age. Rarely, somatic malignancies arise from MCTs, the most common being squamous cell carcinoma. Adenocarcinomas are less common and colorectal adenocarcinomas are extremely rare. We present a case of somatic adenocarcinoma of colorectal type which may pose challenges in diagnosis and treatment. A middle-aged female presented to the Emergency Department with lower abdominal pain. CT scan revealed an 11 cm sharply demarcated left pelvic mass. Laparoscopy showed a left ovarian mass with torsion, a smooth external surface, and thick brownish contents. An intraoperative evaluation was consistent with an adenocarcinoma. Permanent histopathology revealed adenocarcinoma of colorectal phenotype with necrosis. Additional evaluation of the cyst showed benign colonic epithelial lining. The immunohistochemistry (IHC) profile of positive CDX2 and CK20 and negative PAX8, CK7, ER, and PR suggested a colorectal-type somatic adenocarcinoma arising from the MCT and was staged as IA, after negative endoscopic findings. Due to their rarity and atypical symptoms, distinguishing metastatic tumors from MCT-derived somatic malignancies is a challenging process. CT scan and serum tumor markers can be helpful but are not definite. Thorough clinical evaluation and proper staging are necessary after pathologic evaluation. Extensive sampling and IHC can further characterize the origin of the tumor. Diligent sampling and a high index of suspicion in this case clinched the correct diagnosis and clinical management. The patient is being treated for stage IA ovarian cancer as opposed to stage IV metastatic colorectal cancer.

Manifestations of Ovarian Cancer in Relation to Other Pelvic Diseases by MRI

Imaging plays a pivotal role in the diagnostic approach of women with suspected ovarian cancer. MRI is widely used for preoperative characterization and risk stratification of adnexal masses. While epithelial ovarian cancer (EOC) has typical findings on MRI; there are several benign and malignant pelvic conditions that may mimic its appearance on imaging. Knowledge of the origin and imaging characteristics of a pelvic mass will help radiologists diagnose ovarian cancer promptly and accurately. Finally, in special subgroups, including adolescents and gravid population, the prevalence of various ovarian tumors differs from that of the general population and there are conditions which uniquely manifest during these periods of life.

Mature Cystic Teratoma: An Integrated Review

Ovarian dermoid cysts, also called mature cystic teratomas (MCTs), account for 69% of ovarian germ cell tumors in young women. The tumors are formed by tissues derived from three germ layers, and sebaceous materials are most commonly seen. The origin of MCTs is widely considered to be the germ cell origin, which completes meiosis I. The clinical symptoms vary widely, but 20% of tumors could be asymptomatic. The diagnosis of MCTs is usually made without difficulty by ultrasound and confirmed by histopathology post-operatively. The imaging findings have a high diagnostic value. The typical characteristics present in the sonographic images, including a dermoid plug or Rokitansky nodule, are considered strong evidence for a teratoma. Although the malignant transformation of MCTs is rare, it can occur in some cases, especially in women of advanced age. The treatment of MCTs depends on the risk of malignancy, the age of the patient, and the patient's fertility reserve requirement. In this article, we review the epidemiology, clinical symptoms, diagnosis criteria, cellular origin, and treatment of mature cystic teratomas.

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.

Fat-containing adnexal masses on MRI: solid tissue volume and fat distribution as a guide for O-RADS Score assignment

PURPOSE

To explore ways to improve O-RADS MRI scoring for fat-containing adnexal masses, by investigating methods for quantifying solid tissue volume and fat distribution and evaluating their associations with malignancy.

METHODS

This retrospective, single-center study included patients with fat-containing adnexal masses on MRI during 2008-2021. Two radiologists independently reviewed overall size (Sizeoverall), size of any solid tissue (Sizeanysolid), size of solid tissue that was not Rokitansky nodule (Sizenon-Rokitansky), and fat distribution. Wilcoxon test, Fisher-exact test, and ROC curve analysis were performed. Reference standard was pathology or follow-up > 24 months.

RESULTS

188 women (median age 35 years) with 163 benign and 25 malignant lesions were included. Sizeoverall (R1, 9.9 cm vs 5.9 cm; R2, 12.4 cm vs 6.0 cm), Sizeanysolid (R1, 5.1 cm vs 1.2 cm; R2, 3.2 cm vs 0.0 cm), Sizenon-Rokitansky (R1, 5.1 cm vs 0.0 cm; R2, 3.1 cm vs 0.0 cm), and fat distribution differed significantly between malignant and benign lesions (p < 0.01). Area under ROC curve was greatest using Sizenon-Rokitansky (R1, 0.83; R2, 0.86) vs Sizeoverall (R1, 0.78; R2, 0.81) or Sizeanysolid (R1, 0.79; R2, 0.81), though differences were non-significant (p = 0.48-0.93). Cutoffs for Sizenon-Rokitansky (R1, ≥ 1.2 cm; R2, ≥ 1.0 cm) yielded sensitivity and specificity of 0.72 and 0.93 (R1) and 0.76 and 0.95 (R2). Among immature teratomas, 85.7% displayed scattered fat.

CONCLUSION

Overall size, size of (any or non-Rokitansky-nodule) solid tissue, and fat distribution differed between benign and malignant fat-containing adnexal masses. Incorporating these would constitute simple and practical approaches to refining O-RADS MRI scoring.

Ruptured mature ovarian teratoma: A case report

INTRODUCTION

Dermoid cysts, or also known as mature cystic teratomas, are one of the most common benign ovarian tumors. Spontaneous rupture of this tumor is rare and can be suspected on imaging.

CASE REPORT

we report a case of ruptured mature ovarian teratoma. A 21 years old previously healthy woman presented with recurrent pelvic pain, the diagnostic of rupture was made by imaging. The patient underwent surgery with a good follow up.

DISCUSSION

Dermoid cysts are the most common benign ovarian neoplasm and its rupture is rare due to its thick capsule. Imaging has a major role in the diagnosis of dermoid cyst and in the detection of its rupture. CT scan is the most requested modality imaging especially in acute abdominal pains. MRI can performed for further characterization.

CONCLUSION

the aim of the study is to report a new case of ruptured mature ovarian teratoma and to describe the imaging signs suggesting dermoid cysts rupture.

Magnetic resonance imaging findings of cystic ovarian tumors: major differential diagnoses in five types frequently encountered in daily clinical practice

There are many types of ovarian tumors, and these different types often form cystic masses with a similar appearance, which can make their differentiation difficult. However, with the exclusion of rare ovarian tumors, the number of ovarian tumors encountered in daily practice is somewhat fixed. It goes without saying that magnetic resonance imaging (MRI) is useful for differentiating ovarian tumors. In this review, we summarize the differential diagnoses for each of the five types of MRI findings commonly encountered in daily practice. First, unilocular cystic masses without mural nodules/solid components include benign lesions such as serous cystadenoma, functional cysts, surface epithelial inclusion cysts, paratubal cysts, and endometriosis. Second, multilocular cystic ovarian lesions include mucinous tumors and ovarian metastases. It should be noted that mucinous tumors may be diagnosed as borderline or carcinoma, even if no solid component is observed. Third, cystic lesions with mural nodules that are unrelated to endometriosis include serous borderline tumor and serous carcinoma. Cystic lesions with solid components are more likely to be malignant, but some may be diagnosed as benign. Fourth, ovarian tumors deriving from endometriosis include seromucinous borderline tumors, endometrioid carcinoma, and clear cell carcinoma. These tumors sometimes need to be differentiated from serous tumors. Finally, cystic lesions with lipid contents include teratoma-related tumors. In mature cystic teratoma, mural nodules (called "Rokitansky protuberance" or "dermoid nipple") are sometimes seen, but they do not suggest malignancy. Some of these lesions can be diagnosed accurately by considering their characteristic imaging findings, their changes over time, MRI findings other than those of the primary lesion, and information from other modalities such as tumor markers. To ensure the optimal treatment for ovarian tumors, it is important to estimate the histological type as well as to diagnose whether a lesion is benign or malignant.

Imaging in a Patient with Recent Cesarean Section and Acute Right Lower Quadrant Pain Due to Torsion OF Ovarian Teratoma – Diagnostic Challenges

Introduction: Ovarian teratomas are common pathology, manifested by various clinical and imaging findings, as well as different complications. The differential diagnosis can be challenging in cases with acute right lower quadrant (ARLQ) pain.

Aim: to present typical imaging findings in this pathology and possible pitfalls in their interpretation, focusing on a case with torsion of ovarian teratoma.

Methods: We describe a case of a 41-yearold female patient with a recent Cesarean section and a history of kidney stones and previous appendectomy, who presented with acute right lower quadrant pain. Her pregnancy was uneventful. The plain abdominal X-ray, ultrasound and computer tomography images revealed air-fluid levels, a fecaloma in the ascending colon and a pelvic mass of unclear origin, misinterpreted as a foreign body or postoperative complication.

Results: The patient underwent a surgical procedure that revealed an ovarian teratoma torsion. A right adnexectomy was performed. The diagnosis was confirmed by histological examination.

Conclusion: An excellent knowledge of the imaging findings in the diseases presented with ARLQ pain is of vital importance, however patient’s co-morbidities and recent surgical procedures may hinder the correct interpretation.

O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee

MRI plays an important role as a secondary test or problem-solving modality in the evaluation of adnexal lesions depicted at US. MRI has increased specificity compared with US, decreasing the number of false-positive diagnoses for malignancy and thereby avoiding unnecessary or over-extensive surgery in patients with benign lesions or borderline tumors, while women with possible malignancies can be expeditiously referred for oncologic surgical evaluation. The Ovarian-Adnexal Reporting and Data System (O-RADS) MRI Committee is an international collaborative effort formed under the direction of the American College of Radiology and includes a diverse group of experts on adnexal imaging and management who developed the O-RADS MRI risk stratification system. This scoring system assigns a probability of malignancy based on the MRI features of an adnexal lesion and provides information to facilitate optimal patient management. The widespread implementation of a codified reporting system will lead to improved interpretation agreement and standardized communication between radiologists and referring physicians. In addition, it will allow for high-quality multi-institutional collaborations-an important unmet need that has hampered the performance of high-quality research in this area in the past. This article provides guidelines on using the O-RADS MRI risk stratification system in clinical practice, as well as in the educational and research settings.

A Rare Urothelial Malignant Transformation in a Mature Cystic Teratoma of the Ovary

Approximately 0.17-2% of mature cystic teratomas undergo malignant transformation, of which squamous cell carcinoma (SCC) is the most common, accounting for 80% of these cases. Urothelial malignant transformation is extremely rare. The present study involves a 58-year-old patient who visited the hospital with discomfort in the lower abdomen. USG and pelvic MRI showed a left ovarian mature cystic teratoma. Left salpingo-oophorectomy was performed, and pathological examination revealed urothelial carcinoma transformation of the mature cystic teratoma morphologically and immunohistochemically. No metastasis to other organs was identified by CT after the surgery. Additional surgery, including total hysterectomy, right salpingo-oophorectomy, omentectomy, and dissection of pelvic and para-aortic lymph nodes, was performed without complications. No tumors were identified elsewhere, and the patient's stage was confirmed as IA. She had an uneventful postoperative course and was discharged 10 days later. CT showed no metastasis or recurrence six months later.

Ovarian teratomas: clinical features, imaging findings and management

Ovarian teratomas are the most common type of germ cell tumors. There are three major subtypes of ovarian teratomas including mature, immature, and monodermal teratomas. Ultrasound, computed tomography and magnetic resonance imaging can demonstrate specific imaging findings for mature teratoma. Imaging features of immature and monodermal teratomas are less specific, but a combination of clinical features and imaging findings can help in the diagnosis. Imaging is also very helpful in guiding management. In this article, we review the epidemiology, histopathology, clinical presentation, imaging features and management of ovarian teratomas.

Ovarian and non-ovarian teratomas: a wide spectrum of features

Teratoma is a germ cell tumor (GCT) derived from stem cells of the early embryo and the germ line. Teratoma is the most common neoplasm of the ovaries and is usually diagnosed easily using imagings by detecting fat components. However, there are various histopathological types and the imaging findings differ according to the type. Teratoma usually occurs in the gonads or in the midline due to migration of primordial germ cells during development. The clinical course of teratomas depends on the age of the patient, histological type, and anatomical site. Sometimes teratomas show unusual manifestations, such as mature teratoma without demonstrable fat components, torsion, rupture, growing teratoma syndrome, anti-N-methyl-D-aspartate receptor encephalitis, and autoimmune hemolytic anemia. For all of these reasons, teratomas demonstrate a wide spectrum of imaging features and radiologists should be familiar with these variabilities. The present article aims to introduce a model encompassing types of GCTs based on their developmental potential, and to review several histopathological types in various anatomical sites and unusual manifestations of teratomas, with representative imaging findings.

Squamous Cell Carcinoma from Abscessed, Mature Cystic Ovarian Teratoma - A Case Report and Literature Review

BACKGROUND/AIM

Malignant transformation of mature cystic ovarian teratoma is a scarce eventuality, only rare cases being reported so far. Furthermore, development of this transformation in the setting of an abscessed tumor is even scarcer. The aim of this study was to report the case of a 47-year-old patient submitted to surgery for such a lesion.

CASE REPORT

The patient was investigated for diffuse pelvic pain and diagnosed with a 10×7×8 cm mass at the level of the left adnexa with imaging findings suggesting the presence of an ovarian teratoma. The patient was submitted to surgery involving a total hysterectomy with bilateral adnexectomy, lymphadenectomy and peritoneal biopsies. The histopathological examination demonstrated the presence of squamous cell carcinoma areas transformation in association with areas of abscess. Postoperatively the patient was submitted to six cycles of platinum-based chemotherapy and concurrent external radiotherapy. At one-year follow-up she is free of recurrent disease.

CONCLUSION

Although malignisation of mature cystic ovarian teratoma is a rare event, it should not be omitted when mature ovarian teratoma is suspected; however, association between malignant transformation and abscess is a scarcer eventuality.

Malignant transformation arising from mature cystic teratoma of the ovary presenting as ovarian torsion: a case report and literature review

Objective: Ovarian torsion is an acute gynecological condition. Torsion is more likely to occur with benign rather than malignant tumors. Mature cystic teratoma of the ovary (MCTO) is frequent in women of reproductive age; however, the incidence of malignant transformation is approximately 2%. We report a case of malignant transformation of MCTO presenting as ovarian tumor torsion.

Case report: A 51-year-old premenopausal woman was diagnosed with mature cystic teratoma in the left ovary 7 years ago. The patient visited our hospital because she had been experiencing of pain in left lower abdomen for the past two days. She was diagnosed with ovarian tumor torsion and underwent emergency surgery. The left ovarian tumor was twisted, and left salpingo-oophorectomy was performed. Histopathological examination revealed squamous cell carcinoma arising from the MCTO. We carefully followed the patients without performing staging laparotomy. On postoperative day 112, multiple lymph node metastases in the pelvic and para-aortic areas were found by positron-emission tomography and computed tomography. After referral to a university hospital, total hysterectomy, right salpingo-oophorectomy, partial omentectomy, and pelvic and paraaortic lymphadenectomy were performed. Metastases of squamous cell carcinoma were confirmed in the pelvic and para-aortic lymph nodes. Six courses of adjuvant chemotherapy with paclitaxel and carboplatin were given following radical surgery to prevent the recurrence of malignant transformation of MCTO. No recurrence of the disease has been observed during 2 years of follow-up.

Conclusion: When physicians diagnose large ovarian tumor torsion cases, preoperative examinations should be performed, with the possibility of malignancy in mind.

Mature Ovarian Teratoma: Atypical Imaging

The incidence of a mature ovarian teratoma ranged from 20% to 30% of pediatric ovarian tumors (Sabaa et al., 2009), which is composed of well-differentiated tissues that derive from all three germ cell layers (ectoderm, mesoderm, and endoderm); it is one of the most common benign ovarian neoplasms. In this case report, we discuss a 9-year-old female patient who presented with abdominal pain and distended abdomen, for which she had an abdominal ultrasound and magnetic resonance imaging. The histopathological exam, after a laparotomy, showed a mature ovarian teratoma.

Mature cystic ovarian teratoma without intracystic fat: Case report with the "fat within the wall" sign

Mature cystic teratoma is the most common ovarian neoplasm among young females. Diagnosed through radiological imaging as it exhibits typical radiological features; typically, fat. However, complete cystic teratoma without visible fat is a very rare and challenging diagnosis. It is difficult to distinguish it from malignant neoplasm, due to the presence of enhancing components, for example, Rokitansky nodule and the presence of diffusion restriction from keratinized products. We present a case of an incidental mature cystic teratoma without visible intracystic fat, where the correct diagnosis based on imaging was failed. Mature cystic teratoma was then confirmed upon histologic examination.

Comparison of International Ovarian Tumor Analysis Simple Rules to Society of Radiologists in Ultrasound Guidelines for Detection of Malignancy in Adnexal Cysts

OBJECTIVE. The purpose of this study was to evaluate the International Ovarian Tumor Analysis (IOTA) simple rules and the Society of Radiologists in Ultrasound (SRU) guidelines for detecting ovarian malignancy in a general population of women presenting to radiology departments with adnexal cystic lesions. MATERIALS AND METHODS. A retrospective multicenter study of ultrasound-detected adnexal cystic lesions with appropriate follow-up was conducted. Lesions were classified into benign, indeterminate, or malignant categories according to criteria based on the IOTA simple rules and the SRU guidelines. The prevalence of nonneoplastic cysts, neoplasms, and malignant tumors was calculated. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy were calculated, and ROC analysis for the diagnosis of malignancy was performed. RESULTS. A total of 697 women with 764 cystic lesions were included; 85.2% (651/764) of the lesions were nonneoplastic, 12.2% (93/764) were benign neoplasms, and 2.6% (20/764) were malignant neoplasms. Nearly all malignancies were classified into indeterminate and malignant categories. The prevalence of malignancy in the indeterminate category was 4.8% (7/145) (SRU) to 10.7% (7/65) (IOTA) and in the malignant category was 18.1% (13/72) (SRU) to 34.3% (12/35) (IOTA). Only one malignancy was misclassified as benign by the IOTA simple rules. The sensitivity of the IOTA simple rules for malignancy was 90.0%; specificity, 96.5%; PPV, 29.0%; NPV, 99.8%; and accuracy, 96.4%. The corresponding values for the SRU guidelines were 100%, 89.6%, 14.9%, 100%, and 89.8%. In ROC analysis, the IOTA simple rules were slightly more accurate than the SRU guidelines (AUC, 0.9805 versus 0.9713; p = 0.0003). CONCLUSION. Both imaging characterization methods were sensitive for identifying ovarian malignancies, but the PPV was low among women presenting to radiology departments, and the indeterminate classification harbored one-third of the total malignancies. Exploration of varied clinical settings and inclusion of secondary tests may help to refine these systems.

Live birth following laparoscopic fertility-sparing surgery for papillary thyroid carcinoma arising from mature ovarian cystic teratoma: A case report

Papillary thyroid carcinoma arising from ovarian mature cystic teratoma is clinically rare. We herein present a case of live birth following two laparoscopic surgeries for papillary thyroid carcinoma arising in a mature ovarian cystic teratoma. A 30-year-old female patient, gravida 1 para 1, was treated by laparoscopic bilateral ovarian cystectomy for suspicion of bilateral mature cystic teratoma. The diagnosis of papillary thyroid carcinoma arising from right ovarian mature cystic teratoma was established based on postoperative pathological examination of the tumor. Such rare neoplasms may be difficult to diagnose preoperatively based on radiological examinations alone. The patient underwent laparoscopic fertility-preserving unilateral (right) salpingo-oophorectomy. Following an extensive discussion with the patient and her family, appropriate informed consent was obtained for the treatment option and the patient and her family chose to preserve her fertility. She could have a baby following the treatment and no evidence of disease for 6 years. Gynecologists should be aware of the possibility of such rare cases, and the available surgical interventions should be fully discussed with patients who wish to preserve their fertility. Laparoscopic fertility-sparing surgery may be a feasible option when encountering such a rare condition.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary: A challenging question for gynecologic oncologists

Mature cystic teratomas of the ovary have an incidence of 1.2-14.2 cases per 100.000 people per year. Malignant transformation occurs in approximately 2% of the cases, and usually consists of squamous cell carcinoma. The preoperative detection is difficult and the diagnostic accuracy of ultrasound, magnetic resonance imaging, and computed tomography is debated. The diagnosis is frequently made in the operating room or on final histological examination. Standard treatment consists of bilateral salpingo-oophorectomy, total hysterectomy and comprehensive surgical staging in early disease and optimal cytoreductive surgery in advanced disease. Paclitaxel/carboplatin- based chemotherapy is the most used adjuvant treatment, whereas more aggressive regimens can be adopted in patients with high tumor burden or recurrent disease. The efficacy of radiotherapy is still unproven. The prognosis is poor when the tumor has spread beyond the ovary. There are few information to provide commonly accepted guidelines for this malignancy.

Adnexal lesions: Imaging strategies for ultrasound and MR imaging

Adnexal lesions are routinely encountered in general practice. Ultrasound is the first line of investigation in determining the benign or malignant potential of an adnexal lesion. In the cases of classic simple cysts, hemorrhagic cysts, endometriomas, dermoids and obviously malignant lesions, ultrasound may be sufficient for management recommendations. In cases where there is an isolated adnexal lesion, without peritoneal disease or serum CA-125 elevation, and in lesions considered indeterminate on ultrasound, MR imaging with incorporation of the ADNEx MR score can increase the specificity for the diagnosis of benignity or malignancy. This article will review the imaging evaluation of adnexal lesions and how to incorporate the ADNEx MR score to help guide clinical management.

A Rare Malignant Transformation of an Ovarian Cystic Teratoma: A Case Report

Mature cystic teratoma (MCT) is the commonest germ cell neoplasm of the ovary but malignant transformation is a rare occurrence (1-2%). Of these malignancies documented in literature the commonest are squamous cell carcinoma and adenocarcinoma. Urothelial carcinomas arising in an MCT are a rare occurrence and only 7 cases have been reported in literature. We report a case of an MCT which was complicated by the presence of urothelial carcinoma confirmed on histopathological examination.

Squamous Cell Carcinoma Arising in Mature Teratoma of the Ovary Masquerading as Abdominal Tuberculosis

Pure squamous cell carcinoma (SCC) of the ovary is rare. SCC can arise in a mature teratoma (MT), ovarian endometriosis or in a Brenner tumor. SCC is the most common malignant transformation arising in MT and comprises 80% of all cases. Such neoplastic transformations are extremely difficult either to predict or detect early. The mechanism of malignant transformation has not been completely understood. Due to the rarity and the aggressive course, diagnosis and treatment constitute a big challenge. We report a case of SCC arising in MT presenting with a huge abdominopelvic mass and abundant peritoneal collections clinically masquerading as abdominal tuberculosis. A review of literature with special emphasis on prognosis and treatment modalities is also presented.

Indeterminate Adnexal Cysts at US: Prevalence and Characteristics of Ovarian Cancer

Purpose To assess the prevalence of indeterminate adnexal cysts in women presenting to academic medical centers for pelvic ultrasonography (US), determine the incidence of malignancy, and identify cyst and patient characteristics that are predictive of malignancy. Materials and Methods A multicenter study of US-detected adnexal cysts with appropriate follow-up (surgical pathologic examination, imaging and/or clinical examination) was conducted from January 2008 to June 2012. Indeterminate cysts were classified as category 1 (typical benign appearing cysts >5 cm) or category 2 (cysts with avascular solid components) on the basis of a combination of definitions in the existing literature. The incidence of neoplasms and malignant tumors was calculated. Patient and cyst characteristics associated with neoplasm and malignant tumors were evaluated with the χ² test or Fisher exact test for categorical variables and the t test for continuous variables. A backward stepwise logistic regression model was performed for two outcomes: (a) the presence of any neoplasm (benign or malignant) and (b) the presence of a malignant tumor. Results There were 1637 women with an adnexal cyst at US; 391 (mean age = 41.8 years ± 13.5.1; range = 17-91 years) had an indeterminate adnexal cyst at US. The prevalence of indeterminate adnexal cysts was 23.9% (391 of 1637; 95% confidence interval [CI]: 0.22, 0.26). Three hundred three indeterminate cysts in 280 women (mean age = 42.9 years ± 14.1; range = 17-88 years) had adequate follow-up. The incidence of ovarian neoplasms (benign and malignant) was 24.8% (75 of 303 cysts; 95% CI: 0.20, 0.30), and the incidence of malignant tumors was 3.6% (11 of 303 cysts; 95% CI: 0.02, 0.06). The proportion of ovarian neoplasms differed between category 1 and category 2 cysts (17.5% [25 of 143 cysts; 95% CI: 0.12, 0.25] vs 31.3% [50 of 160 cysts; 95% CI: 0.24, 0.39], respectively; P = .001). The proportion of malignant tumors differed between categories 1 and 2 cysts (0% [0 of 143 cysts] vs 6.9% [11 of 160 cysts; 95% CI: 0.03, 0.12]; P < .001). The presence of an avascular nodular component was a significant predictor of malignancy at stepwise logistic regression analysis (odds ratio = 2.83; P ≤ .0001; 95% CI: 1.69, 4.70). Conclusion The presence of an avascular nodular component was the most significant predictor of the presence of malignancy in indeterminate adnexal cysts. The risk of malignancy is higher with category 2 cysts than with category 1 cysts. ^© RSNA, 2018.

The Driver Mutational Landscape of Ovarian Squamous Cell Carcinomas Arising in Mature Cystic Teratoma

Purpose: We sought to identify the genomic abnormalities in squamous cell carcinomas (SCC) arising in ovarian mature cystic teratoma (MCT), a rare gynecological malignancy of poor prognosis.Experimental design: We performed copy number, mutational state, and zygosity analysis of 151 genes in SCC arising in MCT (n = 25) using next-generation sequencing. The presence of high-/intermediate-risk HPV genotypes was assessed by quantitative PCR. Genomic events were correlated with clinical features and outcome.Results: MCT had a low mutation burden with a mean of only one mutation per case. Zygosity analyses of MCT indicated four separate patterns, suggesting that MCT can arise from errors at various stages of oogenesis. A total of 244 abnormalities were identified in 79 genes in MCT-associated SCC, and the overall mutational burden was high (mean 10.2 mutations per megabase). No SCC was positive for HPV. The most frequently altered genes in SCC were TP53 (20/25 cases, 80%), PIK3CA (13/25 cases, 52%), and CDKN2A (11/25 cases, 44%). Mutation in TP53 was associated with improved overall survival. In 8 of 20 cases with TP53 mutations, two or more variants were identified, which were bi-allelic.Conclusions: Ovarian SCC arising in MCT has a high mutational burden, with TP53 mutation the most common abnormality. The presence of TP53 mutation is a good prognostic factor. SCC arising in MCT share similar mutation profiles to other SCC. Given their rarity, they should be included in basket studies that recruit patients with SCC of other organs. Clin Cancer Res; 23(24); 7633-40. ©2017 AACR.

Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: a Taiwanese Gynecologic Oncology Group (TGOG) study

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.

Benign enhancing components of mature ovarian teratoma: magnetic resonance imaging features and pathologic correlation

The purpose of this work was to evaluate cases of benign ovarian mature teratoma (MT) with enhancing solid components on pelvic magnetic resonance imaging (MRI) and to correlate the MRI findings with the pathology reports. We retrospectively reviewed MRI findings and pathologic reports of 126 patients with pathologically confirmed ovarian MT. Enhancing solid components were observed in 24 (18.8%) of 128 benign MTs. The largest diameter ranged from 5.9 to 42.2 mm. The appearance was variable. Of 24 tumors, 19 (79.2%) had regular borders. On pathologic analysis, solid components of benign MTs were identified as glial tissue, thyroid tissue, fibrous stroma, or vessels.

An Evaluation of the Incidence of Right-Sided Ovarian Cystic Teratoma Visualized on Sonograms

This study set out to determine the incidence of right-sided ovarian cystic teratoma. The author examined 270 cases of ovarian cystic teratoma. In this series, ovarian dermoids were more frequently found on the right ovary than the left ovary. The primary data were obtained over two decades and include both retrospective and prospective review. The data included the clinical history of each patient, pelvic sonography examination, and microscopic and/or surgical findings reports. Data used were limited to proven cases of ovarian cystic teratoma shown by sonography and confirmed by histology. Results demonstrate that 195 dermoids (72.22%) were located on the right ovary, 47 dermoids were found on the left side (17.41%), and 28 dermoids were found bilaterally (10.37%). The results indicate that the incidence of unilateral dermoids occurs more often on the right side.

A series of malignant ovarian cancers arising from within a mature cystic teratoma: a single institution experience

BACKGROUND

Mature cystic teratoma (MCT) is the most common germ cell tumor. It accounts for 10% to 20% of all ovarian masses. The likelihood of malignancy arising from within an MCT is low, and prognosis is poor.

METHODS

A single-institution retrospective chart review was completed of all cases of MCT from 2004 to 2012. Multiple variables were examined including procedure performed, residual disease after surgery, surgical stage, histologic type, site of primary disease, date of recurrence, whether or not adjuvant chemotherapy was given, and whether or not there was death secondary to disease.

RESULTS

During the study period, 1.2% of MCTs exhibited malignant transformation. The average age at presentation was 53.7 years. Mean follow-up time was 23 months. The most common presenting symptoms were bloating and abdominal pain. The average tumor size was 18 cm. Of note, 33% of cases were at least surgical stage IIIC at the time of presentation, whereas the remainder were stage IC or lower. Four (44.4%) of the 9 cases were identified as mucinous adenocarcinoma in addition to 1 case each of malignant melanoma, squamous cell carcinoma, and poorly differentiated adenocarcinoma. Only 1 patient experienced recurrence. One patient had a known MCT that was being managed expectantly and exhibited malignant transformation to a mucinous adenocarcinoma.

CONCLUSIONS

A large ovarian mass that is suspected to be a mature teratoma should be managed more aggressively in older patients. Our data suggest that although malignancy arising from mature teratomas is rare, it is more likely when patients are older than 40 years, the mass is greater than 18 cm, and there is any suspicion for a mucinous tumor. Like most ovarian tumors, these tumors most often present at later stages and, thus, can be difficult to treat. It is unclear what role chemotherapy or radiation plays in the management of these tumors.

Unexpected Malignant Diagnosis in Colonic Biopsies: Malignant Transformation of Ovarian Mature Teratomas-Two Case Reports and Review of the Literature

Colorectal adenocarcinoma is the second cause of cancer-related deaths in the United States. The occurrence of squamous cell carcinoma in the colorectum is extremely unusual. Malignant transformation from mature cystic teratoma of the ovary is a rare event. The most common transformation is squamous cell carcinoma, followed by adenocarcinoma. It occurs more often in elderly patients, who usually present with advance disease. We report two unusual cases of postmenopausal women diagnosed with squamous cell carcinoma in colon biopsies. After surgical resections, the carcinoma was proven to be the result of malignant transformation of ovarian mature cystic teratomas. Since squamous cell carcinoma of the colorectum is extremely rare, the presence of squamous cell carcinoma in a colonic biopsy in a female patient should alert the clinicians to other possible primary sites, as seen in these cases.

Urothelial carcinoma arising from an ovarian mature cystic teratoma

OBJECTIVE

Ovarian mature cystic teratomas with malignant transformation are rare, and squamous cell carcinoma is the most common pathological entity. Among these malignant transformations, urothelial cell carcinoma is rare.

CASE REPORT

We report a woman presenting with a huge pelvic cystic mass, favoring a right ovarian mature cystic teratoma with malignant transformation, based on magnetic resonance imaging, who was successfully treated with surgery.

CONCLUSION

The final pathology confirmed concomitant malignant transformation of urothelial carcinoma.

Squamous cell carcinoma arising in mature cystic teratoma of ovary

Squamous cell carcinoma of the ovary is a rare condition and usually arises in mature cystic teratoma (MCT) or dermoid cyst of the ovary. The reported incidence of malignant transformation in MCT is approximately 2%. A case of squamous cell carcinoma arising in a dermoid cyst of the ovary presenting at an early stage is presented here. A 53-year-old postmenopausal lady, presented with the complaint of pain in right lower abdomen since one month and a large complex abdomino-pelvic mass on examination and investigations. Final histopathology was reported as squamous cell carcinoma of left ovary arising from dermoid cyst and a benign dermoid cyst in the right ovary. The patient was assigned to squamous cell carcinoma of the ovary arising in a mature cystic teratoma, surgical stage Ic2. In view of the poor prognosis, adjuvant chemotherapy was started.

Gynecologic Cancer InterGroup (GCIG) consensus review for squamous cell carcinoma of the ovary

Squamous cell carcinoma of the ovary is a rare complication of mature cystic teratoma. The epidemiology, pathology, diagnosis, and management of this rare tumor are reviewed. Clinical characteristics, preoperative imaging, and tumor markers may help to predict malignancy preoperatively. Complete cytoreduction should be the aim of surgery. The prognosis for stage 1A disease is good, but for women with advanced or recurrent disease, it is very poor and has not improved in recent years. At present, there are insufficient data to provide clear guidance on the optimal management strategy for advanced disease, and there is a need to gain an understanding of the biology and to develop novel effective therapies. This will require coordinated international collaboration.

MRI features of ovarian cystic lesions

The purpose of this article is to present the clinical and imaging features for the spectrum of ovarian cystic lesions, from benign to malignant and from tumorous to nontumorous. We review the imaging modalities for evaluating ovarian cystic lesions, especially magnetic resonance imaging (MRI) techniques. We present clinical and imaging features that can be used to help with the differential diagnosis of the spectrum of ovarian cystic lesions. We discuss the relevance of imaging features for distinguishing between benign and malignant ovarian cystic lesions. The characteristic clinical and imaging features of ovarian cystic lesions can provide criteria for making a diagnosis or substantially narrowing the differential diagnosis. Therefore, a careful assessment of ovarian cystic lesions is warranted.

Characteristics and treatment outcomes of patients with malignant transformation arising from mature cystic teratoma of the ovary: experience at a single institution

BACKGROUND

Malignant transformation arising in mature cystic teratoma (MCT) is one of the most serious complications of MCT. Squamous cell carcinoma is the most common malignant change. Some clinical findings such as advanced age group and large tumor size are significant risk factors of malignant transformation. This study was conducted in order to evaluate characteristics, cell types, treatment and outcome of malignant transformation arising from dermoid cysts in our institution.

MATERIALS AND METHODS

A retrospective chart review was performed. General characteristics, operative data, procedure, operative finding and operative outcome were analyzed. Statistical assessment was performed with SPSS version 17.0, using mean, mode, median and percentage to describe those data.

RESULTS

During the 10 years period, 11 cases of malignant transformation from a total of 753 cases (1.46% incidence) of MCT were reviewed. Mean age of the patients was 41.2 years (SD 4.34, range 24-70). The most common presenting symptom was a palpable mass (8 cases; 72.7%). Primary surgical staging was performed in 4 patients (36.4%). Re-staging was conducted in the other 4. Complete cytoreduction was obtained in 45.5% (5 cases) and optimal surgical resection was obtained in 36.4% (4 cases). Mean tumor size was 14.1 cm. (SD 1.55, range 6-20). Squamous cell carcinoma was found in 36.4% (4 cases) and mucinous cancer in the other 4. More than half of them were stage Ia (54.5%, 6 cases). All patients whose stage more than Ia received chemotherapy (45.5%). Mean disease free survival was 5.53 years (1.32, 0.3-10).

CONCLUSION

According to our study, the incidence of malignant transformation was consistent with previous studies. The common malignant transformation histologic types are both squamous and mucinous carcinoma which differed from previous reports. Early detection for early stage disease and optimal surgery are important for long term survival.

Conservative treatment of a young patient with thyroid carcinoma in adult ovarian teratoma - case report

The cystic mature teratomas, including dermoid cysts, are one of the most frequently occurring benign ovarian tumors diagnosed in female patients. The process of neoplastic transformation in mature dermoid cysts is applicable only to 1-2% of cases. In our article, we present a rare case of thyroid carcinoma development in adult teratoma in 21-year-old patient. The young age, certain pathomorphological features and clinical data (small size of neoplastic lesion, correct values of tumour markers, unilateral character, regular levels of thyreoglobulin and absence of any significant deviations in imaging examinations), were the basis for attempting to apply the conservative treatment both in the scope of gynecological surgery and in the supplemental endocrinological therapy. In the patient, the one-sided adnexectomy was performed, considering pathological lesions on the adnexa, as well as the other ovary dermoid cyst was enucleated, without the hysteroctomy procedure. Considering the lack of any morphological lesions and functional changes relating to thyroid gland, the treatment was not radicalised in this scope, either. At present, one year after the primary operation treatment, the patient does not manifest any disease symptoms, whereas the other ovary, in the follow-up ultrasound examinations, shows normal size and echostructure. The thyroid-stimulating hormone (TSH) suppression keeps being applied.

[Complications of presumed benign ovarian tumors]

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.

Fractalkine receptor is expressed in mature ovarian teratomas and required for epidermal lineage differentiation

Background

The goal of this study was to determine a predominant cell type expressing fractalkine receptor (CX₃CR1) in mature ovarian teratomas and to establish functional significance of its expression in cell differentiation.

Methods

Specimens of ovarian teratoma and human fetal tissues were analyzed by immunohistochemistry for CX₃CR1expression. Ovarian teratocarcinoma cell line PA-1 was used as a model for cell differentiation.

Results

We found that the majority of the specimens contained CX₃CR1-positive cells of epidermal lineage. Skin keratinocytes in fetal tissues were also CX₃CR1- positive. PA-1 cells with downregulated CX₃CR1 failed to express a skin keratinocyte marker cytokeratin 14 when cultured on Matrigel in the presence of a morphogen, bone morphogenic protein 4 (BMP-4), as compared to those expressing scrambled shRNA.

Conclusions

Here we demonstrate that CX₃CR1 is expressed in both normally (fetal skin) and abnormally (ovarian teratoma) differentiated keratinocytes and is required for cell differentiation into epidermal lineage.

A case of sebaceous carcinoma arising in a benign cystic teratoma of the ovary and review of the literature

Objective:

To present an extremely rare case of sebaceous carcinoma arising in a mature cystic teratoma of the ovary.

Clinical presentation and intervention:

A 66-year-old woman presented with abdominal discomfort and a pelvic mass. Abdominal and pelvic ultrasound, as well as CT scan, revealed a 27 cm complex right pelvic mass, which was diagnosed histologically as a sebaceous carcinoma arising in a mature cystic teratoma. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal washings, appendicectomy and infracolic omentectomy.

Conclusion:

This case adds to the rare reports in the literature of sebaceous carcinoma occurring in a mature cystic teratoma. The clinical behaviour and optimal management of this entity are not well established. The patient has been well for 32 months following surgery with no evidence of recurrent disease clinically.

Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy

Mature cystic teratomas of the ovary (MCT) are usually observed in women of reproductive age with the most dreadful complication being malignant transformation which occurs in approximately 1% to 3% of MCTs. In this case report, we present a patient with squamous cell carcinoma which developed from a MCT during pregnancy. The patient was treated conservatively without adjuvant chemotherapy and was followed without evidence of disease for more than 60 months using conventional tools as well as positron emission tomography-computed tomography following the initial surgery. We report this case along with the review of literature.