Immature Teratoma with Extra-Ovarian Deposits of Mature Teratoma–Case Report and Review of the Literature

Special Article - Gynecologic Oncology Case Reports

Austin J Med Oncol.2016; 3(1): 1026.

Immature Teratoma with Extra-Ovarian Deposits of Mature Teratoma–Case Report and Review of the Literature

Haran G¹*, Pomerantz M¹, Ganor-Paz Y¹, Kravtsov V², Kidron D¹, Fishman A¹ and Bruchim I¹

¹Department of Obstetrics & Gynecology, Meir Medical Center, Israel

²Department of Pathology, Meir Medical Center, Israel

*Corresponding author: Haran G, Division of Gynecologic Oncology, Meir Medical Center, Israel

Received: May 02, 2016; Accepted: May 30, 2016; Published: May 31, 2016

Abstract

Mature teratoma is the most common type of germ cell tumor of the ovary, consisting of 10-20% of ovarian neoplasms. Mature teratoma can occur at any age, but is more common in the child-bearing years. Transformation to a malignant, immature teratoma is reported in 0.17%-2% of cases. Deposits of mature teratoma in the omentum are even rarer, with only 32 cases described in literature. Only 4 cases of co-existing omental and ovarian teratoma have been described. The current case report presents a 42-year-old female who was admitted to the Emergency Department at Meir Medical Center, Kfar Saba, Israel with abdominal pain. Trans-vaginal ultrasound revealed an enlarged, complex, left ovarian mass, 120x105x132 mm with low resistance index. On exploratory laparotomy, a large ovarian mass was identified, with enlarged lymph nodes in the retroperitoneum. Unilateral salpingo-ophorectomy was performed. Pathology was consistent with an immature teratoma in the left ovary, co-existent with implants of mature teratoma in the omentum and Douglas` pouch. We hereby present a unique case of immature teratoma with mature extra-ovarian deposits.

Keywords: Mature teratoma; Immature teratoma; Omental deposits

Introduction

Mature teratoma is the most common histologic type among the ovarian germ cell tumors. About 10-20% of ovarian neoplasms are of this origin [1]. Mature teratoma can appear at any age, but is more common in the reproductive age group. It can contain all three germ cell layers- endoderm, ectoderm and mesoderm. Only 10% to 17% are bilateral and most cystic tumors are unilateral [1].The incidence of malignant transformation of mature teratomas is 0.17% to 2% of reported cases [1]. Deposits of mature teratoma in the omentum are even rarer, with only 32 cases previously reported in literature and only 4 cases of co-existing omental and ovarian teratoma have been described [2]. The first omental mature teratoma was described by Lebert in 1734 [3], but to the best of our knowledge, no case of ovarian immature teratoma, with distant mature deposits has been reported.

Case Presentation

A 42-year-old female presented to the emergency room at Meir Medical Center, Kfar Saba, Israel with a history of abdominal pain for the last month, escalating in the days before admission. Abdominal tenderness was noted on admission and gynecological exam revealed a non-tender mobile mass in the Douglas pouch. Trans-vaginal ultrasound revealed an enlarged, complex, left ovarian mass, 120x105x132 mm with low Resistance Index (RI) of 0.41 and classical sonographic signs of left adnexal torsion. Following a detailed explanation regarding the working diagnosis of ovarian tumor, the patient signed an informed consent for cystectomy/ salpingoophorectomy and possible hysterectomy and staging procedures. Onexploratory laparotomy, a largeovarian mass was identified with enlarged retroperitoneal lymph nodes. The tumor ruptured during mobilization of the left adnexa and unilateral salpingo-ophorectomy was performed. Frozen section was consistent with an ovarian,immature teratoma. Therefore, total abdominal hysterectomy, pelvic and para-aortic lymphnode dissection and infracoloic omentectomy were performed. Alphafetoprotein taken before surgery was elevated to 219.5 ng/ml, while other ovarian tumor markers were normal.

Final histopathologic examination found a large ovarian cyst with a smooth surface consisting of hair and solid components. Microscopically, the findings were consistent with immature cystic teratoma composed of numerous wide areas of embryonic-appearing neuroectodermal elements, grade 2-3 (Figure 1). The left parametrium and Douglas space contained foci of mature glial tissue (Figure 2).The right parametrium had no significant changes. No metastasis was seen in 14 lymph nodes. There was a fibroid uterus and the fallopian tubes had no significant changes. The omentum contained a few mature glial implants (Figure 3). The cytology of the ascitic fluid contained numerous, reactive, mesothelial cells, lymphocytes and macrophages.