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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

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.

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.

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 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.

This is the first reported case of a sebaceous adenoma arising within an ovarian mature cystic teratoma in a patient with Muir-Torre syndrome. The pathologic findings and a literature review are presented, including the importance and possible benefits of an early diagnosis of Muir-Torre syndrome. It is proposed that the presence of a sebaceous adenoma in an ovarian cystic teratoma may serve as a useful trigger to consider further history and investigations, with the goal of identifying an important genetic cancer predisposition syndrome.

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.

Aim: The aim of this study was to evaluate the correlation between clinicopathological characteristics and serum levels of tumor markers in patients with ovarian endometrioma (OE) and ovarian mature cystic teratoma (MCT). Material and Methods: Values of CA125, CA19-9, and sialyl Tn antigen (STN) were retrospectively investigated in 321 patients with OE. CA125, CA19-9, STN, and squamous cell carcinoma antigen (SCC) were examined in 435 patients with MCT. Results: Mean values of CA125, CA19-9, and STN were 105.3 U/mL, 58.0 U/mL, and 31.1 U/mL in OE, while the values were 26.8 U/mL, 246.8 U/mL, and 24.7 U/mL in MCT. Abnormal elevation of CA125, CA19-9, and STN was observed in 53.3%, 38.9, and 13.5 of OE, and in 12.9, 50.6, and 4.6% of MCT, respectively. CA125 level was significantly higher in bilaterally occurring OE and premenopausal patients with MCT, while the value of CA19-9 was significantly higher in cases of bilaterally occurring MCT. Furthermore, the levels of CA125 and CA19-9 showed significant correlations with tumor diameter, while the levels of STN and SCC showed no significant correlations with tumor diameter. The highest CA125 level (9513 U/mL) was observed in OE and the highest CA19-9 level (25 590 U/mL) was observed in MCT. Conclusion: Although abnormal increases in the levels of CA125 and CA19-9 were often observed, the levels of STN were not influenced by clinicopathologic factors in OE and MCT. Further studies of the clinical usefulness of STN for detecting malignant tumors in OE and MCT are needed.

The purpose of this study was to evaluate the clinical value of serum tumor markers in patients with ovarian mature cystic teratoma (MCT). We retrospectively evaluated 163 women who underwent surgery for MCT of the ovary between March 2003 and August 2007 and who provided preoperative blood samples for the measurement of CA 19-9 and CA 125. The rates of elevated serum CA 19-9 and CA 125 levels were 31.9% (52/163) and 13.5% (22/163), respectively. The rate of ovarian torsion was 12.9% (21/163). There were significant differences between the elevated CA 19-9 group and the normal CA 19-9 group in the diameters of the tumors and the rates of ovarian torsion. Elevated serum CA 19-9 levels correlated with larger tumor diameters and higher torsion rates. CA 19-9 may be a useful tool for the diagnosis of ovarian MCT. Elevated CA 19-9 levels appear to correlate with larger tumor diameters and higher rates of ovarian torsion.

The question of whether patients with pure stage I squamous cell carcinoma in a mature cystic teratoma (MCT) should undergo conservative surgery, or postoperative adjuvant treatment remains unresolved.A 33-year-old woman with a left ovarian cyst underwent laparoscopic cystectomy at 16 weeks of gestation. Histological examination confirmed squamous cell carcinoma arising in an MCT. At 18 weeks of gestation, she underwent left salpingo-oophorectomy, and was diagnosed as having stage Ic malignant transformation of the MCT, and was observed closely without postoperative adjuvant chemotherapy. She delivered a healthy baby at 41 weeks of gestation. No evidence of recurrence was observed 14 months after the initial laparoscopic surgery.Although a thorough staging procedure , histopathologic evaluation, and long-term follow-up are indispensable, patients with early stage I squamous cell carcinoma in MCT may safely undergo conservative surgery.

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.

Malignant transformation of mature cystic teratomas is uncommon but present in clinical practice. Especially in postmenopausal women, the clinical manifestation of a mature teratoma with undiagnosed malignant transformation as acute abdomen is extremely rare. In these cases, total hysterectomy with bilateral salpingo-oophorectomy is the treatment choice since the chance of malignancy is high. The prognosis is good if the cyst is not ruptured, is completely excised and the cancer does not extend beyond the capsule. In any other case, the prognosis is unfavorable since recurrence is common and the tumor is chemoresistant.

► This is a case of central PNET arising from a mature teratoma in the ovary in pregnancy. ► Fertility sparing surgery can be considered for early stage PNET of the ovary.

The occurrence of a malignant neuroectodermal tumor in a mature cystic teratoma is extremely rare. Five cases of ovarian primitive neuroectodermal tumors (PNET) or neuroepitheliomas have been reported. In two, the tumor was adjacent to foci of a mature teratomatous element. We present the immunohistochemical profile and electron microscopic study of an ovarian mature cystic teratoma with PNET or malignant neuroepithelioma. The transition between the mature neural elements and the malignant PNET presents a model for monodermic neuroepithelial differentiation and explains the histogenesis of this unusual tumor.

Introduction.Mature cystic teratoma is the benign tumor of the ovary. CA19-9 levels, although a marker of pancreatic malignancy, have been found to be raised in large ovarian mature cystic teratomas.Case Report.We report a case of a young female who had unusually high levels of CA19-9 in the blood associated with large ovarian mature cystic teratoma. The levels returned to normal 12 weeks after cystectomy was performed.Conclusion. This case highlights the fact that although raised tumor marker may be associated with a benign pathology thorough evaluation to rule out malignancy still must be done.

We report a case of mucinous adenocarcinoma arising from mature cystic teratoma (MCT) of the ovary ascertained incidentally during pregnancy. An ovarian adnexal mass was seen in a 38-year-old pregnant woman during cesarean section. Oophorectomy revealed a mucinous adenocarcinoma arising from MCT with additional capsule invasion. Following this, staging procedures were applied. The patient was staged as IC and adjuvant chemotherapy was applied. She has remained disease-free for over 24 months. To our knowledge, this is a case of mucinous adenocarcinoma arising from MCT and the third case of malignant transformation from MCT in pregnancy in English literature.

An ovarian mature cystic teratoma featuring florid vascular proliferation and Wagner-Meissner—like corpuscles is presented. The vascular proliferation is analogous to that seen in other tumors having a prominent neural component. The Wagner-Meissner—like corpuscles are viewed as evidence of a specialized type of differentiation of this neural component. To the best of our knowledge, they had not been previously reported in this setting.

Objective To determine the validity of sonographic pattern recognition in the diagnosis of mature cystic teratoma. Methods Consecutive patients scheduled for elective surgery for adnexal masses were included in the study. All patients underwent transabdominal ultrasound with color extended-flow mapping within 24 hours prior to surgery. Examinations were performed by the same sonographer to identify benign cystic teratoma. The final diagnoses were based on histopathologic findings. Results A total of 329 consecutive patients were recruited; 23 were excluded because the masses were not adnexal masses. Of the remaining 306 patients, 36 masses were found to be mature cystic teratomas and 270 were nonteratomas. Sonographic pattern recognition showed a sensitivity of 94.4% and a specificity of 98.2%. Conclusion Sonographic pattern recognition using transabdominal ultrasound with color extended-flow mapping can accurately diagnose mature cystic teratoma.

Retroperitoneal benign lipomas are extremely rare and represent about 2.9% of all primary retroperitoneal tumors. About 80% of the tumors in the retroperitoneal cavities are malignant neoplasms. We experienced a case of a retroperitoneal lipoma simulating an ovarian mature cystic teratoma. A diagnosis was correctly made by magnetic resonance imaging (MRI) prior to surgery, and a total tumorectomy was performed. The retroperitoneal lipoma was recognized to have arisen from the urinary bladder. Histological sections revealed a tumor consisting of typical adipose cells without atypia. These types of lipomas should be carefully followed-up because they often recur and undergo malignant transformations.

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.

A 77-year-old woman presented with an abdominal swelling and underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy and omentectomy for a left ovarian tumor. This was an ovarian mature cystic teratoma in which had developed a sebaceous cell carcinoma. This is a rare form of ovarian malignancy whose behavior is poorly documented. The treatment and follow-up of this case are discussed.

Primary malignant melanoma arising from the ovarian mature cystic teratoma is extremely rare, with only 31 cases have been desc ribed in the literature. It is one of the rarest forms of malignant transformation of ovarian mature cystic teratoma and usually develops unilaterally after menopause. Recently, we experienced a case of primary malignant melanoma arising from ovarian mature cystic teratoma in 71-year-old woman. The diagnosis was confirmed by positive immunohistochemical results of S-100 protein and HMB 45. Here we report the rare case with review of literature.

Carcinoid tumors are peripheral endocrine system, which produce biologic amines and various polypeptides. Primary carcinoid tumors of the ovary are devided into insular, trabecular, strumal types. The primary insular carcinoid should be distinguished from carcinoid metastatic to the ovary, which is nearly always bilateral, is usually associated with the presence of peritoneal metastases. The age incidence of patients with ovarian carcinoids show a wide range but most patients are postmenopausal. Most primary insular carcinoids of the ovary have been components of teratomas, but some have occurred in apparently pure form. We experienced a case of primary insular carcinoid tumor of the ovary and report it with a brief review of concerned literature.

The development of cancer in mature cystic teratomas of the ovary is rare and sometimes difficult to detect because of sampling errors. Six cases of squamous cell carcinoma arising in ovarian mature cystic teratomas were studied, five of which showed an elevated level of a squamous cell carcinoma-associated antigen, TA-4, in the sera obtained preoperatively; the preoperative determination was not performed in the sixth case. However, no elevated TA-4 level was detected in the sera of 28 patients with mature cystic teratomas of the ovary. Moreover, serial determination of the serum TA-4 level showed a good correlation between the clinical course and the serum TA-4 level. Interestingly, an abnormal TA-4 level preceded the clinical detection of recurrence by 2 months in two patients. Thus, determination of the serum TA-4 concentration may be useful for diagnosing and monitoring patients with squamous cell carcinoma arising in mature cystic teratomas of the ovary.

Malignant transformation of mature cystic teratoma of the ovary is rare. A wide variety of malignant tumors may arise within benign mature cystic teratoma. The most common form of malignant transformation of a mature cystic teratoma is squamous cell carcinoma. We report a series of three cases that developed squamous cell carcinoma in a benign ovarian cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 51-year-old (case # 2) and 60 year-old (case # 3). The first case occurred in a 33-year-old woman. Histologically, all three cases were moderately differentiated squamous cell carcinomas and were confined to the ovaries. The aim of this study was to review our experience with this disease and to review the literature. DOI: http://dx.doi.org/10.3126/jpn.v2i3.6032 JPN 2012; 2(3): 248-250