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Overin en yaygın germ hücreli tümörü ve tüm ovaryen neoplazmalarının yaklaşık %10-20'sini oluşturan matur kistik teratom (MCT) sıklıkla genç kadınlarda görülür. Menopoz sonrası nadiren izlenirler ve ileri yaş popülasyonunda malign transformasyon riski artmaktadır. Vakamızda 80 yaşında postmenopozal kadın hasta son 1 aydır devam eden şişkinlik ve hafif karın ağrısı şikayeti ile kliniğimize başvuran bir hastayı irdeledik. Yapılan tetkiklerinde uterus ve mesanenin sağ arka ve üst kadranında boyutları 9 x 11,5 cm çapında olan bir lezyon saptandı. Ayrıca kitlenin yarattığı basıncı nedeniyle üreterin net olarak izlendiği belirtildi. Tümör belirteçlerinden insan koryonik gonadotropininin (betahCG) (10,4 mIU/mL) arttığı, diğer belirteçlerin ise negatif olduğu görüldü. Hastaya total abdominal histerektomi + bilateral ooferektomi operasyonu yapıldı. Yapılan frozen inceleme sonucunda malignite alanları olmayan matür kistik teratom olarak rapor edildi. Sonrasında kesin histopatolojik inceleme benign matür kistik teratom olarak rapor edildi. Matür kistik teratom olgularında tümör belirteçlerinden en çok CA 125 ve CA 19-9'da artış görülmektedir. Postmenopozal kadınlarda matür kistik teratom ile ilgili literatür sınırlıdır. Bu vakalarda olası malignite riskinden dolayı cerrahi ve tedavi planlanmasında dikkatli olmak gerekmektedir., Mature cystic teratoma (MCT) is the most common germ cell tumor of the ovary and accounts for approximately 10-20% of all ovarian neoplasms. They are rarely observed after menopause and the risk of malignant transformation increases in the elderly population. In our case, we examined an 80-year-old postmenopausal female patient who applied to our clinic with complaints of bloating and mild abdominal pain for the last 1 month. A lesion measuring 9 x 11.5 cm in diameter was detected in the right posterior and upper quadrant of the uterus and bladder. In addition, it was stated that the ureter was clearly observed due to the pressure created by the mass. It was observed that human chorionic gonadotropin (betahCG) (10.4 mIU/mL), one of the tumor markers increased, while other markers were negative. Total abdominal hysterectomy + bilateral oophorectomy operation was performed on the patient. As a result of frozen examination, it was reported as mature cystic teratoma without areas of malignancy. Afterwards, definitive histopathological examination was reported as benign mature cystic teratoma. Among the tumor markers, CA 125 and CA 19-9 are mostly increased in mature cystic teratoma cases. There is limited literature on mature cystic teratoma in postmenopausal women. In these cases, it is necessary to be careful in the planning of surgery and treatment due to the possible risk of malignancy.

We report the case of a 16-year-old female with a huge mass (40 × 30 × 40 cm) on the left ovary, causing mild bilateral hydronephrosis. Ultrasonography and computed tomography allowed us to diagnose this condition and showed an associated uretero-hydronephrosis. A unilateral salpingo-oophorectomy was performed on the left ovary, and final pathology revealed a mature cystic teratoma. The patient did not experience any problems in the follow-up six months later, and her hydronephrotic appearance disappeared.

The aim of the study was to report the elevated liver function test levels in torsion of ovarian mature cystic teratoma (MCT). A retrospective review was performed of 116 patients with MCT who underwent surgery in our hospital between 2010 and 2017. Eleven of 116 patients were with torsion of MCT. Of the 11 torsion of MCT cases, 6 of those showed abnormal elevated levels of aspartate transaminase (AST)/alanine aminotransferase (ALT). After operation, AST/ALT levels recovered to normal ranges. Elevated liver function levels require attention to complications associated with anaesthesia and emergency operation. However, the current report shows that emergency surgery should not be delayed to assess other causes of elevated liver function tests.Impact statement

Highlights • Metastatic SCC arising from the ovary is rare, and the optimal treatment is unknown. • Pembrolizumab successfully treated a patient with metastatic SCC. • Patients on pembrolizumab should be monitored for immune-related adverse events.

Mature cystic teratoma (MCT) is a common neoplasm of the ovary that typically contains mature tissues of ectodermal, mesodermal, and endodermal origin. This tumor tends to affect younger women, its presentation ranges from pure cystic mass to complex solid cystic mass, and the detection of intratumoral fat component is the key diagnostic imaging feature. MCT can be associated with various complications and it demonstrates a wide spectrum of imaging findings. Associated complications include rupture, torsion, malignant transformation, and gliomatosis peritonei. MCT may also have unusual imaging features that can lead to misdiagnosis. These features may expand the differential diagnosis to include immature teratoma, monodermal teratoma, mature cystic teratoma with minimal or no fat, and collision tumor. The aim of this article was to highlight and describe the imaging features of unusual ovarian MCT lesions, and the complications associated with ovarian MCT.

Pure primary squamous cell carcinoma (SCC) of the ovary is extremely rare. SCC can also arise in a mature cystic teratoma or dermoid cyst, in an ovarian endometrioma or in a brenner’s tumor, but such malignant transformations are also quite rare. Development of SCC in a mature cystic teratoma (MCT) has been reported sporadically in less than 2% cases only. Here in our present study, we are reporting such a rare case of 65 years old postmenopausal woman who was diagnosed as having squamous cell carcinoma developed in a mature cystic teratoma of the ovary at our institute. This diagnosis was given on the basis of clinical (patient’s history and examination), radiological (CT scan) and pathological (histopathology report) findings. We are also going to discuss other similar cases with review of literature. The only aim of this present study is to share our experience of such rare diagnosis with others.

Most adnexal masses found in pregnancy are simple benign cysts less than 5 cm in diameter. On the other hand, the majority of persistent adnexal masses 5 cm or greater in diameter are mature teratomas. Malignant transformation occurs in 0.2 to 2 percent of mature teratomas, and squamous cell carcinoma arising from ectoderm is the most common secondary neoplasm. The mucinous cystadenocarcinoma transformation is very rare. We presented a 38-year-old G2Ab1 woman at 32 weeks of gestation with a huge, rapid growth adnexal mass who came to our emergency department due to severe preeclampsia, stage 1 of IUGR, and borderline AFI. After 48 hours of expectant management, a cesarean section associated with unilateral salpingooophorectomy was done, and the histopathology of the cyst revealed mature teratoma that was focally involved with mucinous cystadenocarcinoma. The complete surgical staging was done, and due to the stage of disease (1C1), she received adjuvant chemotherapy, and she has remained disease-free in her last follow up after one year.

Ovarian mature cystic teratomas are the commonest germ cell tumors of the ovary. Malignant transformation in them is a rare event and is difcult to diagnose preoperatively. Clinicians, pathologists and radiologists should always suspect this if the patient is elderly or when the cyst is large or in presence of a solid foci. Here, we discuss two cases of squamous cell carcinoma arising from a mature cystic teratoma

Os teratomas ovarianos císticos maduros ocorrem com maior frequência em pacientes com idades entre 20 e 40 anos, correspondendo a 20% das neoplasias ovarianas. Na maioria das vezes são assintomáticos sendo diagnosticados por achados incidentais. Os sintomas mais comuns incluem alterações no ciclo menstrual, dor pélvica e sensação de massa na pelve. No caso apresentado, a paciente iniciou quadro com queixas urinárias, apresentação incomum desta patologia, ocasionando um mascaramento dos sintomas isquêmicos provocados pela torção vascular, levando a um retardo no diagnóstico. Após o diagnóstico aventado por exames de imagem (ultrassonografia e tomografia de abdome), foi realizada laparotomia exploradora para a exérese de massa ovariana torcida. O material obtido foi enviado para exame anátomo-patológico, o qual confirmou se tratar de teratoma cístico maduro do ovário esquerdo.

The incidence of bilateral mature cystic teratoma of the ovary is only 10%. Ovarian mature cystic teratomas are common, benign, pelvic tumours and can be easily detected by ultrasonography. Recurrent ovarian teratomas are very rare, and cases of bilateral teratomas are even rarer. So, it is advisable to routinely check the ovary contralaterally during the surgical procedure along with careful pelvic sonographic examination of both the ovaries. Inadvertent extensive surgery should be avoided in this benign condition that might further compromise the fertility of young patients. We report a rare case of bilateral mature cystic teratoma of the ovary in a 28-year-old female, who presented to the gynaecologic outpatient department with complaints of intermittent dull aching, diffuse lower abdominal pain and dysmenorrhea for three months. Transvaginal ultrasonography revealed bilateral complex ovarian masses that raised suspicion of dermoid cysts with hypoechoic endometrial collections. Her Cancer Antigen 125 (CA-125) was normal. A bilateral ovarian cystectomy was performed and histopathology confirmed the diagnosis. This case highlights a rare occurrence of bilateral ovarian mature cystic teratoma, where cystectomy was performed to preserve the fertility in a young female.

Background Ovarian mature cystic teratomas comprise tissues derived from all three germ layers. In rare incidences, malignant tumors may arise from ovarian mature cystic teratoma, which occurs in 0.2–1.8% of cases. A variety of tumors can arise within mature cystic teratoma, among which malignant melanoma is exceedingly rare. Case presentation A 42-year-old woman presented with abdominal pain. Transvaginal ultrasonography showed mixed echogenic cystic masses in both ovaries. Her serum cancer antigen (CA19–9) level was elevated at 29,770 U/ml. Surgical excision was performed. Histologic examination showed infiltrating nests of pleomorphic cells with prominent nucleoli and black pigments in the background of a mature cystic teratoma. These pleomorphic cells showed strong immunoreactivity for Melan-A and HMB-45. The patient was re-evaluated and the possibility of a melanoma at any other site was ruled out. Based on these findings, we concluded that the malignant melanoma originated from the ovarian mature cystic teratoma. Conclusion We report a rare case of primary malignant melanoma derived from an ovarian mature cystic teratoma.

Adrenal leiomyoma is a rare neoplasm and usually associated with adrenal vein or its tributaries. These are benign in nature and are composed of smooth muscle cells. A sixty years Normotensive, non-HIV lady presented with right adnexal mass diagnosed as Mature Cystic Teratoma along with adrenal incidentalomas for which laparoscopic adrenalectomy was done and histopathology diagnosis was Leiomyoma. These are more common in immunocompromised patients especially HIV and or EBV infection. Adrenal incidentalomas can have a hormone secreting functions or they can be malignant tumors hence a proper evaluation and treatment should be performed.

DOI: https://doi.org/10.3126/jpn.v9i1.23383 Mature cystic teratomas are frequently encountered neoplasms of the ovary that comprise of tissues derived from all three germ layers. They are benign neoplasms with malignant transformation noted rarely in around 0.1 to 3% cases. Among the various transformations, malignant melanoma is one of the least commonly encountered. Here, we report a case of 41 years old female with malignant melanoma arising within mature cystic teratoma. Keywords: Dermoid cyst; Malignant melanoma; Mature cystic teratoma; Ovarian melanoma

Introduction: Ovarian tumors in the pediatric population are a rare occurrence, with an incidence of 2.6 cases per 100,000 girls per year.1 Ovarian teratomas are germ cell tumors further c...

The most common malignant transformation of mature cystic teratoma of the ovary (MCTO) is squamous cell carcinoma, whereas, carcinoid tumor and papillary thyroid carcinoma are extremely extraordinary. This paper presents two rare cases of malignant transformation from MCTO. First, in a 33 year old, nulligravid, who underwent oophorocystectomy for a dermoid cyst. Histopathologic and Immunohistochemical studies revealed a carcinoid tumor arising from a mature cystic teratoma. Second, in a 52 year old who underwent, total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian new growth, with a final histopathologic and immunohistochemical analysis showed follicular variant of papillary carcinoma arising from mature cystic teratoma. Preoperative diagnosis of MCTO can be made through physical examination and imaging however not the concealed malignancy. Thorough extensive sampling and histopathologic examination of a dermoid cyst is necessary to detect malignant transformation. The optimal management of the disease is uncertain because of its rarity, but complete excision of tumor renders excellent prognosis.

Objective To evaluate the clinical significance of CA19-9 in patients with ovarian mature cystic teratoma (MCT). Materials and methods A retrospective study was performed on 65 patients with pathologically-confirmed MCT and 80 patients with benign epithelial ovarian tumors. Serum tumor markers for all patients and tissue CA19-9 for MCTs were measured. The relationships between clinical characteris- tics of MCTs and CA19-9, as well as the correlation between serum and tissue level of CA19-9 in MCTs, were evaluated. Results The mean serum level of CA19-9 in MCTs was significantly higher than that in benign ovarian epithelial tumors (49.9 ± 73.4 IU/ml vs. 17.08 ± 24.8 IU/ml). CA19-9 was the only tumor marker with a mean serum level above the cut-off value and the elevation rate was 30.76% in MCTs. The positive tissue expression rate of CA19-9 in MCT patients were 50.9% and were higher than that of preoperative serum levels (50.9% vs. 32.7%). Conclusion Serum CA19-9 has the highest positivity rate among other tumor markers in MCT. Elevated serum CA19-9 is not an uncommon finding MCT and could be used as a marker in the differential diagnosis of MCT in patients with pelvic mass.

Objective: To compare the intraoperative and postoperative outcomes of laparoendoscopic single-site surgery (LESS) versus conventional laparoscopic surgery in women with ovarian mature cystic teratoma. Methods: A retrospective review of 303 women who underwent LESS (n=139) or conventional laparoscopic surgery (n=164) due to ovarian mature cystic teratoma was performed. Intra- and postoperative outcomes were compared between the two groups. Results: There was no intergroup difference in age, body weight, height, body mass index, comorbidities, tumor size, bilaterality of tumor, or the type of surgery. However, more patients in the LESS group had a history of previous abdominal surgery (19.4% vs. 6.7%, P=0.001). Surgical outcomes including operating time (89 vs. 87.8 minutes, P=0.734), estimated blood loss (69.4 vs. 68.4 mL, P=0.842), transfusion requirement (2.2% vs. 0.6%, P=0.336), perioperative hemoglobin level change (1.3 vs. 1.2 g/dL, P=0.593), postoperative hospital stay (2.0 vs. 2.1 days, P=0.119), and complication rate (1.4% vs. 1.8%, P=0.999) did not differ between LESS and conventional groups. Postoperative pain scores measured using a visual analogue scale were significantly lower in the LESS group at 8 hours (P=0.021), 16 hours (P=0.034), and 32 hours (P=0.004) after surgery, and 32 of 139 patients (23%) in the LESS group and 78 of 164 patients (47.6%) in the conventional group required at least one additional analgesic (P

The occurrence of malignant transformation in mature cystic teratoma of the ovary is rare, with squamous cell carcinoma being the most common histologic type. Sarcomatous transformation has been rarely described in the literature. We present a case of leiomyosarcoma with a minor component of squamous cell carcinoma arising in mature cystic teratoma of ovary in a 65-year-old woman. The malignant tumor showed two distinct components of sarcomatous and invasive epithelial elements, which were confirmed by immunostaining. To our knowledge, only four cases of leiomyosarcoma in ovarian mature cystic teratoma have been reported and this is a unique case report of leiomyosarcoma and squamous cell carcinoma arising in a mature cystic teratoma of ovary.

Background Plasmablastic lymphoma (PBL) is relatively new clinical entity described as a distinct subtype of diffuse large B-cell lymphoma (DLBCL). It is characterized by its aggressive nature and proliferation of large neoplastic cells resembling immunoblasts including cells with more obvious plasmacytic differentiation. In this case report, we describe an unexpected finding of PBL associated with a mature cystic teratoma of the ovary in a young immune competent woman. Case presentation A 19-year old woman was admitted to the hospital with generalized lymphadenopathy, a pelvic tumor mass measuring 35 × 30 cm and a 4 cm lump in her right breast. She underwent a right salpingo-oophorectomy, lymphadenectomy, splenectomy, omentectomy, and a right breast lumpectomy. On macroscopic examination the right ovary was replaced by a thick-walled multilocular cystic tumor. Upon incision, the cysts were filled with thick, greasy sebaceous material and hair and there were several solid nodules within the cyst walls. Histological examination revealed a mature cystic teratoma and malignant non-Hodgkin lymphoma (NHL) within the solid nodules. Tumor tissue from the right breast, spleen and lymph nodes, all had the same histological, NHL morphology. After extensive immunostaining, a diagnosis of PBL was made. Following surgery, the patient was treated with different chemotherapy regimens, without any significant regression of the disease, and died of multiple organ failure. Conclusions Primary NHL of the ovary is relatively rare occurrence while secondary involvement by lymphoma is much more common. PBL is a rare lymphoma, primarily reported in the jaw and oral mucosa, but also documented in extra-oral sites. To the best of our knowledge, this is the first case described in a mature ovarian cystic teratoma. Although the patient was HIV-negative and immune competent, she had progressive disease and died despite aggressive chemotherapy 11 months after the initial diagnosis. Electronic supplementary material The online version of this article (10.1186/s13000-017-0672-x) contains supplementary material, which is available to authorized users.

Granular cell tumors involving the female reproductive tract are rare, with only a small number of cases described. Of the reported cases, none are documented within an ovarian mature cystic teratoma (MCT). This report documents a case of a granular cell tumor, incidentally discovered within an ovarian MCT in a 50-yr-old woman undergoing a supracervical hysterectomy and left salpingo-oophorectomy. Although malignant transformation and other secondary ovarian neoplasms in MCT have been well documented, synchronous nonovarian benign neoplasms are reported much less frequently. The histogenesis of secondary tumors arising in MCT is incompletely understood, and the current case provides additional insight, especially pertaining to schwannian and neuroectodermal tumors arising in this setting. The current case, to the best of our knowledge, represents the first report of a granular cell tumor involving a mature teratoma of any site, with the diagnosis being supported by morphologic and immunohistochemical staining characteristics.

Background Ovarian mature cystic teratomas (MCTs) rarely transform to primary primitive neuroectodermal tumors. This case report offers evidence that MCTs might have undetected microfoci of malignant neural tumors. Case We describe the case of a 12-year-old girl who presented with right-sided abdominal pain and distention. Intraoperative findings revealed a right ovarian MCT. However, pathology showed a 0.5-cm focus of malignant neural tumor within the 11-cm MCT. Summary and Conclusion This patient will need close follow-up with a multidisciplinary team because the clinical implications of this transformation has yet to be defined.

Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases.

Background: Plasmablastic lymphoma (PBL) is relatively new clinical entity described as a distinct subtype of diffuse large B-cell lymphoma (DLBCL), characterized by its aggressive nature and proliferation of large neoplastic cells resembling immunoblasts to cells with more obvious plasmacytic differentiation. Principals/Methodology: To describe an unexpected finding of PBL associated with mature cystic teratoma of the ovary in the young immunocompetent women. Results: A 19-vear old woman was admitted to the hospital with generalized lymphadenopathy, pelvic tumour mass measuring 35x30 cm and with 4cm lump in her right breast. The patient underwent right salpingo-oophorectomy, lymphadenectomy, removal of omentum, splenectomy and right breast lumpadenectomy. At macroscopic examination the right ovary was replaced by thick-walled multilocular cystic tumor. On incision, cysts were filled with thick, greasy sebaceous material and hair while within cysts walls there were several solid, greyish nodules. Histological examination revealed a mature cystic teratoma while solid nodules were malignant non-Hodgkin lymphoma (NHL). Tumour tissue from the right breast, spleen and lymph nodes, all had the same histological NHL morphology. After extensive immunostaining, a diagnosis of PBL was made. In the past year the patient was treated with IV cycles of EPOCH chemotherapy, I cycle of salvage DHAP chemotherapy and III cycles of CODOX-M/IVAC alternating chemotherapy but without any significant regression of the disease, as shown by the most recent PET-CT scan. Conclusion: PBL remains a diagnostic challenge given its peculiar morphology and immunohistochemical profile which is similar to anaplastic or plasmablastic plasma cell myeloma (PCM). Furthermore, PBL represents therapeutic challenge, with very aggressive clinical course and with majority of the patients dying in the first year after diagnosis.

We describe an unexpected finding of diffuse large B-cell lymphoma associated with mature cystic teratoma of the ovary. A 68-yr-old woman with a complex left ovarian cystic mass on imaging underwent bilateral salpingo-oophorectomy, lymphadenectomy, appendicectomy, and omentectomy. Histopathologic examination revealed nodules of malignant non-Hodgkin lymphoma within the teratoma. A diagnosis of diffuse large B-cell lymphoma, germinal center cell subtype by Hans criteria was made after immunostaining and molecular studies. The patient was treated with R-CHOP chemotherapy and remains disease-free at 14-mo follow-up.

Mature cystic teratomas, also known as dermoid cysts, are composed of a mixture of tissues derived from all three germ layers and constitute about 20% of all ovarian neoplasms. However, malignant transformation in a mature cystic teratoma is an uncommon event occurring only in about 1.8% cases. A variety of tumours can arise within a mature cystic teratoma (most common being squamous cell carcinoma), with malignant melanoma being extremely rare among such tumors. While most authors believe that primary ovarian melanoma almost always arises within a mature cystic teratoma, the primary nature of an ovarian malignant melanoma can be ascertained only once metastasis from a cutaneous melanoma is ruled out. The first case of malignant melanoma arising in an ovarian mature cystic teratoma was reported in 1901 and only about 45 additional cases have been reported till date. We present another case of a primary malignant melanoma arising within a mature cystic teratoma.

Objective: To investigate the incidence of malignant transformation and P53 and P16 expression in teratomatous skin of ovarian mature cystic teratoma. Materials and Methods: Data on ovarian teratoma specimens in nearly 10 years were reviewed. P53 and P16 expression were detected by immunohistochemistry in 25 cases of teratomatous skin of ovarian mature cystic teratoma, 20 cases of squamous cell carcinoma and 2 cases of squamous cell carcinoma originated from teratomatous skin. Results: Of 1913 cases of ovarian mature cystic teratoma in nearly 10 years, only two cases of squamous cell carcinoma were found in teratomatous skin, with malignant transformation rate of 0.1045%. P53 expression was detected in 2 cases squamous cell carcinoma originated from teratomatous skin and P16 overexpression in one. There were no expressions of P53 and P16 in 25 cases of teratomatous skin of ovarian mature cystic teratoma. Of 20 cases of squamous cell carcinoma P53 overexpression (positive rate of 55%) was detected in 11 cases, P16 overexpression (positive rate of 35%) in 7 cases. The positive rates of P53 and P16 expression in squamous cell carcinomas were significantly higher than that in the teratomatous skins (p< 0.001, p= 0.002). Conclusions: There was low risk of malignant transformation in teratomatous skin of ovarian mature cystic teratoma which can be explained by lower P53 and P16 expressionin teratomas than that in squamous cell carcinoma.