Squamous cell carcinoma arising in mature cystic teratoma of the ovary

Squamous cell carcinoma malignant transformation in mature cystic teratoma of the ovary: a case report and review of the literature

BACKGROUND

Mature cystic teratoma of the ovary is classified among the benign ovarian germ cell neoplasms, and its malignant transformation occurs very rarely (in about 2%). As a result of nonspecific signs and symptoms, preoperative diagnosis of theses malignancies is a challenge to clinicians, resulting in delayed diagnosis (in advanced stages) and poor outcomes.

CASE PRESENTATION

We report the case of a 43-year-old Iranian woman with progressive distension of the abdomen and hypogastric pain, who was diagnosed with squamous cell carcinoma transformation in a mature cystic teratoma of the ovary confirmed by histopathology examination. Total abdominal hysterectomy, bilateral salpingooophorectomy, and comprehensive staging surgery were performed for the patient, and she was scheduled for chemotherapy after the surgery. She responded well to the treatment and is currently continuing her chemotherapy process.

CONCLUSION

There are a great number of reports in the literature regarding mature cystic teratoma of the ovary transformation into malignancy, so these neoplasms must be considered as a possible differential diagnosis and should be evaluated in older individuals with abdominal pain and palpable mass, or those with considerable tumor diameter and raised serum tumor markers.

Mature Cystic Teratoma of the Ovary Transforms into Squamous Cell Carcinoma: A Case Report

Mature cystic teratomas (MCTs) are benign ovarian tumors known to undergo malignant transformation in 1%-2% of cases. Most of these cases lead to squamous cell carcinomas (SCC), and the prognosis is often poor, particularly in advanced-stage disease. A 50-year-old postmenopausal woman presented with a large pelvic mass. The patient initially underwent suboptimal primary surgery and was later diagnosed with stage IIIA SCC arising from MCT. Following the first cycle of chemotherapy with carboplatin and paclitaxel, a computed tomography scan showed a rapidly growing large mass in the pelvic cavity after 4 weeks of primary surgery, leading to a second debulking surgery. However, the patient underwent only one cycle of chemotherapy after secondary debulking surgery because of her poor performance status. Subsequently, after 4 months of secondary debulking surgery, the patient developed rapidly progressive disease, leading to her death approximately after 8 months of diagnosis. While an appropriate multimodal treatment strategy has yet to be established, optimal cytoreductive surgery and adjuvant chemotherapy should be considered for treatment of advanced-stage diseases to improve survival outcomes.

Recurrent squamous cell carcinoma arising in ovary mature cystic teratoma: A case report

RATIONALE

Malignant transformation of mature cystic teratoma is very rare, of which squamous cell carcinoma (SCC) is the most common type. Prognosis of SCC arising in mature cystic teratoma of the ovary is very poor. Our experience may provide new ideas for the treatment of this disease.

PATIENT CONCERNS

The patient was a 56-year-old woman and was admitted for a lower abdominal pain. She underwent a laparoscopic surgery with 4 cycles of chemotherapy and had achieved a complete response; 10 months after the completion of initial treatment, her cancer relapsed. She underwent a cytoreductive surgery with concurrent chemoradiotherapy and has achieved a complete response again.

DIAGNOSES

This patient was initially diagnosed with ovarian cancer (stage IIIB) arising from malignant transformation of mature teratoma; 10 months after the completion of initial treatment, she was diagnosed with recurrent ovarian cancer.

INTERVENTIONS

This patient was initially treated with laparoscopic bilateral salpingo-oophorectomy. After histopathological confirmation that she had ovarian cancer, she underwent laparoscopic total hysterectomy and omentectomy with 4 cycles of chemotherapy. After her ovarian cancer recurred, she underwent open cytoreductive surgery and concurrent chemoradiotherapy.

OUTCOMES

The patient achieved complete response after both initial and relapsed treatment.

LESSONS

Optimal cytoreduction and concurrent chemoradiotherapy may be an option to improve the prognosis of patients with recurrent SCC arising in ovary mature cystic teratoma.

Malignant transformation of primary mature teratoma of colon: A case report

BACKGROUND

Mature teratoma is a common benign ovarian germ cell tumor, accounting for about 20% of ovarian tumors. The malignant transformation of this tumor is less than 2%. The most common type is squamous cell carcinoma, followed by adenocarcinoma. Malignant transformation of colonic mature teratoma is extremely rare. We here report a case of malignant transformation of primary mature teratoma of the colon. The type of malignant transformation was adenocarcinoma.

CASE SUMMARY

A 63-year-old woman was admitted to our hospital due to persistent pain in her right lower abdomen for 1 mo, and she had no nausea, vomiting, blood in the stools, or other symptoms. Preoperative colonoscopy showed uplift of the sigmoid colon mucosa and submucosa. The biopsy showed squamous epithelium. However, contrast-enhanced computed tomography of abdomen and pelvis showed a localized thickening of the sigmoid wall, suggesting colon cancer. Endoscopic ultrasonography (EUS) revealed that the structure of the intestinal wall at the base of the lesion was destroyed, and the boundary between the lesion and the surroundings was unclear. According to the findings of the EUS, the patient did not undergo endoscopic submucosal dissection, but underwent radical resection of the tumor. Histologically, squamous epithelium was seen on the mucosal surface of the colon wall, cartilage and glands were seen under the epithelium, and adenocarcinoma was seen on the muscular layer and serous surface. The final pathological diagnosis was malignant teratoma of the colon. We have followed up the patient for 2 mo since the operation, and the patient recovered well.

CONCLUSION

This case suggests the possibility of mature teratoma in the colon and recognition of malignant types, and it should not be considered as an exclusively ovarian tumor.

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 ovarian cystic teratoma: A case series

Malignant transformation arising in mature cystic teratoma (MT-MCT) is a rare neoplasm of the ovary. Herein, we aimed to evaluate the clinicopathological features and treatment outcome of the Han Chinese women with MT-MCT.In this retrospective study, the clinical data of patients who had been surgically treated from January 2000 to November 2019 and in whom the diagnosis of MCT was confirmed based on the pathology were included. Fourteen patients with MT-MCT from a total of 569 cases (2.46% incidence) of MCT were reviewed.The mean age of patients with MT-MCT was 51.3 (range, 31-71) years, while the mean age of patients with MCT was 45.3 (range, 17-62) years. Upon gross examination, the mean size of MT-MCT was 14.0 (range, 11-25) cm, whereas the mean size of MCT was 7.5 (range, 4-10) cm. Primary surgical staging was performed in all cases. Complete cytoreduction and suboptimal surgical resection were performed in 12 (85.7%) and 2 (14.3%) cases, respectively. Thirteen patients with malignant transformation of squamous cell carcinoma (SCC) whose Federation International of Gynecology and Obstetrics stage was >1 received chemotherapy, comprising carboplatin and paclitaxel. Response to the chemotherapy regimen was complete in 12 patients; 1/12 patients died within the median follow-up period of 16.5 months. The 5-year overall survival rate and disease-free survival rates were 31.2% and 31.6%, respectively.From the data generated, we conclude that the rate of MT-MCT increases with age. The MT-MCT was much higher in women of postmenopausal age than in younger women. We described our experience of successfully treating patients with malignant transformation of SCC with primary surgical staging and adjuvant chemotherapy (cisplatin, paclitaxel, bleomycin, and etoposide) that might improve survival in patients with advanced-stage disease.

Single-cell transcriptional profiling identifies a cluster of potential metastasis-associated UBE2C+ cells in immature ovarian teratoma

To dissect the disease heterogeneity and identify the underlying cellular and molecular events related to metastasis of immature ovarian teratoma in children, single-cell RNA sequencing was performed for a 2-year-old patient with liver metastases from immature ovarian teratoma. A total of 5976 cells were obtained for further analysis, with a median unique molecular identifier count of 6011 per cell and a median number of 1741 genes detected per cell. Fourteen clusters were recognized, with the main lineages comprising epithelial cells, macrophages, fibroblasts, glial cells, and dendritic cells. Ten subclusters of epithelial cells were further defined, originating from the urinary tract, esophagus, bronchus, lung, skin, and gastrointestinal tract. An undefined UBE2C + population in an active state of proliferation was also identified and its biological processes were related to meiosis and maturation of oocytes. Pseudotime analysis revealed different distributions of epithelial cells in the development trajectory. In conclusion, a cluster of UBE2C + epithelial cells in an active state of proliferation was identified in an immature ovarian teratoma in a child, and may contribute to metastasis by regulating epithelial-mesenchymal transition. These findings help toward understanding the origin of the malignant behaviors, offer a potential biomarker for early determination of the tumor nature, and provide new ideas for the therapy of immature ovarian teratoma in children.

Mature cystic teratoma of ovary with squamous cell carcinoma arising from it

Clinicians, pathologists, and radiologists should be aware of rare malignant ovarian tumors arising in mature cystic teratoma (MCT). Suspicion should be raised if the patient is elderly, the tumor is huge, and the tumor has large solid foci. However, malignant transformations in MCTs in younger women have been reported.

Squamous cell carcinoma transformation in mature cystic teratoma of the ovary: a systematic review

BACKGROUND

0.17-2% of mature cystic teratoma of the ovary (MCTO) undergo malignant transformation, of which 80% are squamous cell carcinoma (SCC) transformation in MCTO. We aim to investigate the clinical characteristics and treatment of SCC transformation in MCTO METHODS: We systematically searched PubMed database and individual patient data about SCC transformation in MCTO were extracted. The published cases were combined with 6 cases of SCC transformation in MCTO from Qilu Hospital, Shandong University.

RESULTS

The incidence of SCC transformation in MCTO was 0.3%. A total of 435 cases of SCC transformation in MCTO were enrolled in the analysis. The mean age of diagnosis was 53.5 (range 19-87) years old. The most common clinical manifestations were abdominal pain (47.3%) and abdominal mass (26.0%). StageI,II, III and IV accounted for 50.0, 18.8, 26.8 and 4.4% of all cases, respectively. Patients with stage I had significantly better prognosis than stage II, III and IV patients (P < 0.01). Hysterectomy can improve overall survival (P < 0.01). For patients younger than 45 years old with stageIA orIC, there was no difference in mortality between fertility-sparing and radical surgery (P = 1.00). Adjuvant chemotherapy can improve survival in patients with advanced stage (P = 0.02), and chemotherapy with platinum was related to better prognosis (P = 0.02).

CONCLUSION

SCC transformation in MCTO is a rare malignancy mainly occurs in older age. FIGO stage is an independent prognostic factor. Hysterectomy and platinum-based chemotherapy are associated with better survival. Fertility-sparing surgery is feasible for young patients with early stage.

Squamous cell carcinoma arising in a partially ruptured giant mature cystic teratoma: A case report

Mature cystic teratomas are the most common ovarian germ cell tumors and represent 70% of the benign ovarian tumors occurring in women under age 30. In less than 2% of cases, these tumors can transform into malignancies. Squamous cell carcinoma arises most frequently from these tumors (in 80% of cases). Intra-peritoneal rupture accounts for approximately 1%-2% of cystic teratoma complications with most ruptures occurring either intraoperatively during laparoscopic surgery or due to trauma. This case report describes the common presentation, imaging, and pathologic findings of a mature cystic teratoma with 2 uncommon associated complications.

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.

Fertility-sparing surgery of malignant transformation arising from mature cystic teratoma of the ovary

Background

The purpose of this study was to evaluate the long-term clinical outcome of young women with malignant transformation arising from mature cystic teratoma of the ovary (MT-MCT) by comparing radical surgery and fertility-sparing surgery (FSS).

Patients and methods

All patients treated with radical surgery or FSS for MT-MCT in multiple institutions were registered in this analysis. Univariate and multivariate analyses were performed to evaluate clinical outcome, including overall survival (OS) and disease-free survival (DFS).

Results

From 1986 to 2016, 62 patients with MT-MCT were treated in our group. The median follow-up period was 38.0 (2.0-227.9) months, and the median age was 54 (17-82) years old. Multivariate analysis revealed that only advanced stage was significantly correlated with poorer prognosis of patients [hazard ratio (HR) for death: 6.58, 95% confidence interval (CI): 1.82–24.78, P = 0.0048; HR for recurrence: 5.59, 95% CI: 1.52–21.83, P = 0.01]. Of a total of 13 women with stage I-II disease at less than 45 years old, 7 were treated with FSS, and there was no recurrence except for in one woman with stage II MT-MCT. There was no significant difference in long-term oncological outcome between radical surgery and FSS.

Conclusion

FSS may be indicated for patients with stage I MT-MCT, who hope to preserve fertility, as no relapse was found after FSS.

An Ovarian Mucinous Adenocarcinoma Arising from Mature Cystic Teratoma Associated with Respiratory Type Tissue: A Case Report

Mature cystic teratoma (dermoid cyst) is the most common benign germ cell tumor of the ovary, accounting for approximately 30% of all ovarian tumors. Malignant transformation is rare; the most frequent transformation reported is to squamous-cell carcinoma in 80% of cases, whereas transformation to adenocarcinoma is described in about 7% of cases. We report a case of malignant transformation to mucinous adenocarcinoma arising from respiratory-like epithelium in a mature teratoma of the ovary.

[Malignant teratoma: about a case and a review of the literature]

Parmi les tumeurs germinales de l’ovaire, on retrouve les kystes dermoïde dans 10 à 20% des cas. Dans 1 à 2 % des cas, une transformation maligne en kyste dermoïde cancérisé a été décrite(KDC). Le traitement, est un véritable sujet à controverse, Chez la femme en âge de procréer et pour les stades débutants, une annexectomie unilatérale sans traitement adjuvant est préconisée. Quant aux cas où il s’agit d’une femme ménopausée, certaines équipes réalisent une chirurgie élargie et ceci quelques soit le stade. Nous rapportons le cas KDC chez une patiente ménopausée traitée chirurgicalement et dont l’évolution a été favorable.

Pure Primary Squamous Cell Carcinoma of Ovary - A Rare Case Report

Primary Squamous Cell Carcinoma (SCC) is a rare tumour which arises in a mature cystic teratoma, endometrioma or Brenner tumour. The pure variety arises from metaplasia of surface epithelium of ovary and it is the rarest type. For optimal management no definitive treatment protocol is available till date. Also, there is no agreement concerning the postoperative therapy-chemotherapy or radiotherapy. We present a rare case of pure primary SCC of ovary which was managed by aggressive cytoreductive surgery followed by chemotherapy.

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.

An ovarian mature cystic teratoma evolving in squamous cell carcinoma: A case report and review of the literature

Mature cystic teratomas (MCT), also known as dermoid cysts, are the most common ovarian germ cell tumors and the most common ovarian neoplasms in patients younger than 20 years. Malignant transformation (MT) is a rare complication of MCTs which may occur in 1–2% of the cases. Squamous cell carcinoma (SCC) is the most frequent histology arising from MCTs and its appearance depends on diverse risk factors such as patient's age, the size of the tumor and levels of serum tumor markers. Diagnosis and treatment constitute a big challenge due to the rarity and the aggressive course of this entity. Adjuvant chemotherapy has a leading role in the treatment of MCT-arising SCC, while the use of radiotherapy or chemoradiation is still under consideration. Herein, we report a case of a post-menopausal woman, presenting with mild symptoms and a large pelvic mass deriving from the left ovary occurring as dermoid cyst. Simultaneously, we review the literature stressing out the prognostic factors and the treatment options for MCT arising SCC according to traditional and new therapy-strategies.

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Malignant transformation is a rare complication of Mature Cystic Teratomas(MCTs).

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We report a case of a woman with invasive squamous cell carcinoma arising an MCT.

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We review the literature stressing out the prognostic factors and treatment options.

Advanced squamous cell carcinomas arising from mature cystic teratoma of the ovary: a retrospective case series at the Tohoku Gynecologic Cancer Unit

We retrospectively evaluated the clinical characteristics of a rare clinical condition of International Federation of Gynecology and Obstetrics (FIGO) stage III and IV squamous cell carcinomas arising from mature cystic teratoma of the ovary between October 1999 and September 2010 at member institutions of the Tohoku Gynecologic Cancer Unit. A total of nine cases (eight FIGO stage III and one FIGO stage IV) were included in this survey. The patients' median age was 56 years (range 46-74 years), and the median tumor diameter was 140 mm (range 95-250 mm). Five of eight patients were positive for cancer antigen (CA)-125, six of eight were positive for CA19-9, four of seven were positive for the carcinoembryonic antigen, and eight of nine were positive for squamous cell carcinoma antigen. Eight patients received postoperative therapy (five underwent chemotherapy, two underwent concurrent chemoradiotherapy, and one underwent radiation therapy alone). Two patients who received complete surgery and concurrent chemo radiotherapy achieved disease-free survival. The median overall survival was 8.9 months. Univariate analysis showed that both the patients' age (<50 years or ≥50 years) and maximum diameter of the residual tumor (<1 cm or ≥1 cm and none or persistent) did not predict the patients' prognosis. These results suggest that complete surgery should be performed because disease-free survival was observed only in patients with no residual tumor, similar to the previous findings of large number retrospective study.

Radiotherapy for persistent malignant transformation from mature cystic teratoma of the ovary

Malignant transformations of mature cystic teratomas (MCT) are extremely rare and most of them are squamous cell carcinomas (SCC). Therefore no effective postoperative treatment has been established. In this article, we report two cases in which radiotherapy was effective for SCC arising from MCT. Case 1 was a 64-year-old woman with stage IIA of this tumor. After primary surgery, chemotherapy and interval debulking surgery were performed. She received radiotherapy for relapsed tumors, and has been well for 36 months since the initial diagnosis. Case 2 was a 37-year-old woman with stage IIB of this tumor. After primary debulking surgery, she received chemoradiotherapy for a residual tumor and has been well for 27 months since the surgery. Although there is no established therapy, radiotherapy or concurrent chemoradiotherapy might have beneficial effects on this tumor, similarly to those on SCC from other tissue.

Risk factors for malignant transformation of mature cystic teratoma

Objective

The aim of this study was to investigate the preoperative characteristics of benign mature cystic teratoma (MCT) and struma ovarii and their risk factors associated malignancies, and determine the appropriate treatment options for these tumors.

Methods

This was a retrospective study on 248 patients who were pathologically diagnosed with ovarian MCT, struma ovarii, or malignant transformations of these tumors at Inje University Haeundae Paik Hospital from March 2010 to January 2015. Routinely evaluated results of adnexal masses before surgery were compared.

Results

A total of six patients (2.4%) were confirmed to have malignant tumors. Of the struma ovarii patients, two out of five patients (40%) were confirmed to have malignancy. The mean age at the diagnosis of patients with malignant transformation of teratomas was 43.0 years (range, 27 to 67 years), which was higher than that of patients with benign teratomas (36.5 years). The mean diameter of the tumor before surgery in the malignant tumor group was 11.4 cm and larger than 6.5 cm of benign group (P=0.003). The mean CA-125 level in the malignant tumor group was higher than that in the benign tumor group (P=0.01).

Conclusion

Risk factors for malignant transformation of MCT include elevated CA-125 levels, older age, large tumor masses, and postmenopausal status.

Squamous carcinoma of the ovary

Squamous ovarian cancer (SOC) represents a (very) rare subtype of ovarian cancer. The lack of evidence on which to base management presents significant challenges. The small number of patients prohibits randomised studies to establish level 1 evidence, and no non-randomised studies or prospective series have been reported. Here, we present a review of the available literature on squamous ovarian cancer and explore some lessons learnt from squamous cancers originating from other primary sites to see if these can be applied to SOC.

Squamous cell carcinoma arising in a mature cystic teratoma invading the sigmoid colon: a rare presentation

We discuss a rare presentation of malignant teratoma in a 63-year-old woman who was admitted to accident and emergency with abdominal distension, bloody diarrhoea and peritonitis. CT of the abdomen and pelvis showed free air in the abdomen and a gas-fluid filled cavity measuring 12×6 cm in the mid-pelvis with possible fistulation that was suspicious for malignancy. A 10×12 cm ruptured dermoid cyst was found intraoperatively, which was adherent to the bowel wall. Bulky lymph nodes were also appreciated. The surgeon suspected a metastatic malignant teratoma, and a Hartmann's procedure, total abdominal hysterectomy and bilateral salpingoopherectomy were performed with clearance of the para-aortic lymph nodes. Subsequent histological analysis revealed a squamous cell carcinoma arising from an ovarian malignant teratoma. The patient went on to have carboplatin and paclitaxel chemotherapy and is alive at 6 months follow-up.

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.

Clinical experience in ovarian squamous cell carcinoma arising from mature cystic teratoma: A rare entity

OBJECTIVE

We sought to investigate the clinicopathologic features of ovarian squamous cell carcinomas arising from mature cystic teratomas (MCT) and to report our clinical experience and lessons learned.

METHODS

From January 1993 to November 2012, a total of 6,260 women with ovarian MCT were surgically treated at Cheil General Hospital and Women's Healthcare Center. Among them, the cases with malignant transformation to squamous cell carcinoma were included in this analysis. Patient demographic characteristics, surgical findings, and prognosis were evaluated retrospectively.

RESULTS

Of the 6,260 ovarian MCT patients, four (0.06%) had ovarian squamous cell carcinoma arising from MCT. The mean patient age was 43 years (range, 35-51 years), and the mean tumor size was 12 cm (range, 9-16 cm), with two patients in the International Federation of Gynecology and Obstetrics stage I and the other two in stage III. Upon preoperative imaging, all cases were expected to be benign ovarian tumors, but the preoperative squamous cell carcinoma antigen level was elevated from 1.5 ng/mL in stage Ia to 11.3 ng/mL in stage IIIc, suggesting malignancy, while the CA-125 level was normal in two of the three patients who received the test. Optimal debulking surgery was performed and adjuvant chemotherapy was used in all patients, but death from the recurrence of disease occurred in one patient, whose overall survival was 10 months.

CONCLUSION

Ovarian squamous cell carcinoma arising from MCT is extremely rare, and it is rarely diagnosed preoperatively on imaging workups. Measuring the squamous cell carcinoma antigen level might be a useful diagnostic clue, and it might also be predictive of the tumor stage. An adequate staging surgery should be included in the standard treatment, but multicenter studies are needed to confirm this.

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.

[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.

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.

Squamous cell carcinoma arising within a mature cystic teratoma with invasion into the adjacent small intestine: a case report

Malignant transformation in a mature cystic teratoma (MCT) is rare, with a reported incidence of approximately 1% to 3%. To our knowledge, no case has been reported previously with the invasion of malignant tumor of MCT into the adjacent small intestine. We report a case of squamous cell carcinoma arising within a MCT and invading into the adjacent small bowel. The patient is a 73-yr-old African American woman who noted the presence of a relatively asymptomatic abdominal mass over the past 40 yr. The mass had become more symptomatic over the past several months, with right-sided abdominal pain and constipation. She underwent an exploratory laparatomy, which demonstrated a cystic abdominal mass measuring 24 cm in diameter and weighing 8 kg. The mass contained necrotic debris, a cloudy fluid, hair, and cartilage. It was adherent to the small intestine in an area associated with focal thickening of the cystic wall of the mass. Histologically, the mass demonstrated a MCT within which arose a well-differentiated squamous cell carcinoma. At the point of attachment to the small intestine, histologic sections demonstrated a transmural invasion of the squamous cell carcinoma into the attached segment of the small intestine through the muscularis propria and the submucosa reaching the mucosal surface. Thirteen regional lymph nodes were isolated near the portion of the small intestine involved with the tumor; however, none of them exhibited metastatic carcinoma.

Early diagnosis of malignant-transformed ovarian mature cystic teratoma: fat-suppressed MRI findings

The most common form of malignant transformation developing from a mature cystic teratoma is squamous cell carcinoma, representing 80% of malignant transformations, while adenocarcinoma accounts for approximately 5%. Because of this rarity, few reports exist of preoperative diagnosis of this tumor by magnetic resonance imaging, in particular with fat suppression techniques. Here, we report magnetic resonance imaging findings and clinical features of a 79-year-old woman with mucinous adenocarcinoma arising from a mature cystic teratoma (measuring 5×6 cm), classified as surgical stage IA. Because of the poor prognosis of malignant transformation, when mature cystic teratomas are detected (even smaller than 5 cm tumor size) in postmenopausal women, serum tumor marker carcinoembryonic antigen levels and fat-suppressed magnetic resonance imaging may be potential indicators of malignant transformation.

Malignant transformation arising from mature cystic teratoma of the ovary: a report of six cases

AIM

Malignant transformation of mature cystic teratoma (MCT) is an uncommon complication. Preoperative diagnosis is difficult because of the lack of specific symptoms and signs indicating malignancy. Thus, we retrospectively analyzed the clinical characteristics of patients and the role of surgery in their management.

MATERIAL AND METHODS

During a 9-year period (2002-2010), six patients with malignant transformation arising from ovarian MCT were treated at the Gynecologic Oncology Unit of Bakirkoy Woman and Children's Training and Research Hospital. A retrospective chart review and analysis of the patients' data were conducted.

RESULTS

Malignant transformation arising from ovarian MCT accounted for 1.9% of all ovarian MCT (6/321). Three cases were stage IA and the other three were stage IC. Histologically, three of six cases had squamous cell carcinoma (50%), two had a carcinoid tumor (33%), and one had mucinous adenocarcinoma (17%). All patients underwent comprehensive surgical staging. Two patients received adjuvant chemotherapy and one received adjuvant chemoradiation. Five of six patients were observed for 16-104 months and no recurrence was detected. One patient with a carcinoid tumor in stage IC died of disease within 34 months following the surgery.

CONCLUSION

Early detection of malignant transformation arising from MCT is mandatory for treating patients, but in most patients malignancy was detected intraoperatively. Surgical cytoreduction with a complete staging procedure and adjuvant treatment may be reasonable for stage IC. Additionally, prognosis is better when the tumor is completely excised and does not extend beyond the capsule.

Carbon ion radiotherapy for recurrent malignant transformation from mature cystic teratoma of the ovary

Mature cystic teratoma (MCT) is the most common tumor of the ovary; malignant transformation (MT) of squamous cell carcinoma is a rare disorder. A 78-year-old woman with stage IIc MT-MCT (squamous cell carcinoma [SCC]) underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy; there was residual tumor in the pelvis. The patient was treated with six courses of paclitaxel and carboplatin, but the recurrent tumor grew. The patient was then treated with carbon ion radiotherapy (CIRT). The recurrent tumor shrank and the patient has been free of clinical disease for 53 months. CIRT can be considered as a treatment for recurrent MT-MCT.

Squamous cell carcinoma arising from mature cystic teratoma of the ovary

OBJECTIVE

Squamous cell carcinoma (SCC) is the most common type of malignant transformation in mature cystic teratoma (MCT) of the ovary. The SCC is difficult to preoperatively diagnose. We conducted a retrospective study to seek the possible risk/prognostic factors and treatments for SCC arising from MCT of the ovary.

METHODS

Using an institutional database, we identified 3 women treated for SCC arising from an MCT of the ovary at the Kaohsiung Veteran General Hospital. A retrospective chart review was conducted, with information obtained from radiographs, operative reports, pathology reports, and radiation oncology records.

RESULTS

A total of 1551 cases of MCT were diagnosed at Kaohsiung Veteran General Hospital from 1990 to 2009, of which, malignant teratoma SCC type was noted in 3 cases (0.19%). The median age of the subjects was 39 years. Abdominal fullness was the most common symptom (3/3 cases). The mean diameter of the ovarian tumor was 17.3 cm, ranging from 16 to 18 cm. All 3 patients received simple right salpingo-oophorectomy or debulking surgery. Two of the patients reached stage IIIC and died.

CONCLUSIONS

: With our review as basis, we recommend being cautious of the following risk factors: patient age, tumor size, ultrasound characteristics, sonar tumor vessel wave form, computed tomography, and levels of SCC and CA125 tumor markers. We suggest that patients have regular ovarian ultrasound examination. Based on our literature review, stage IA patients who undergo standardized operational procedures do well without adjuvant treatment, but such patients must be confirmed accurately with complete surgical staging to be in stage IA before undergoing conservative management. The optimal approach to the management of patients with advanced stage and recurrent disease is unclear. Surgical cytoreduction with proper staging, adjuvant therapy with platinum-based or paclitaxel-based chemotherapy, and concurrent whole pelvic radiation have been recommended as possible methods of treatment.

Squamous cell carcinoma in situ arising in mature cystic teratoma of the ovary: a case report

Introduction

Malignant transformation is a rare complication of mature cystic teratoma with squamous cell carcinoma being the most common type. We report a new case of squamous cell carcinoma in situ.

Case presentation

A 62 year old woman was admitted for an abdomino-pelvic mass and she underwent a left salpingo-oophorectomy. The histopathologic analysis revealed a squamous cell carcinoma in situ arising in mature cystic teratoma of the ovary. Then, she underwent a total hysterectomy, contralateral salpingo-oophorectomy and omentectomy without adjuvant treatment.

Conclusion

Optimal cytoreduction has been associated with a statistically significant improvement in survival for malignant transformation of mature cystic teratoma.

[Malignant degeneration of benign cystic teratoma of the ovary]

Malignant transformation of mature cystic teratoma of the ovary is a rare complication occurring preferentially during peri- and post-menopausal period. No clinical nor radiological, nor biological signs are specific to malignant transformation. The treatment is surgical and similar to that of epithelial tumors of the ovary. We report an observation of a squamous cell carcinoma developed on a mature cystic teratoma of the ovary, in a patient aged 46 years.

Malignant Transformation Arising From Mature Cystic Teratoma of the Ovary: A Retrospective Study of 20 Cases

Objectives:

Mature cystic teratoma (MCT) of the ovary rarely undergoes malignant transformation (MT). Malignant transformation carries a significantly worse prognosis than epithelial ovarian cancer, regardless of whether postoperative chemotherapy or radiotherapy is applied. The rarity of this tumor has posed a significant challenge to developing standardized postoperative management protocols. The aim of this study was to review our experience with MT and to describe our current treatment practices.

Methods:

A retrospective chart review of these patients was performed that identified 20 women treated for MT of MCT at our centers between 1988 and 2008.

Results:

The median age was 52.5 (range, 29-77) years. Fifteen patients had squamous cell carcinoma (SCC), and 5 patients had other histological subtypes. The International Federation of Gynecology and Obstetrics stage distribution was as follows: 11 were stage I, 4 were stage II, 4 were stage III, and 1 was stage IV. All patients underwent an initial laparotomy. Eleven patients received adjuvant treatment: 8 were treated with chemotherapy, 2 with concurrent chemoradiation therapy, and 1 with radiation therapy. Platinum-based chemotherapy was the first-line regimen. The overall 1-year survival rate was 70%. Significant correlations between overall survival and age, stage, and residual tumor were presented (P = 0.044, P = 0.0107, P < 0.0001, respectively). Eight patients with advanced stage died of their disease. Four patients, however, were treated with adjuvant chemotherapy or concurrent chemoradiation therapy and survived more than 1 year. One stage III patient had a disease-free interval of 2 years. Two cases of SCC treated with combination platinum/taxane chemotherapy temporarily responded. In the other 2 cases of SCC, concurrent chemoradiation therapy with nedaplatin also resulted in tumor regression.

Conclusions:

The prognosis of MT is highly dependent on age, stage, and optimal cytoreduction. Adjuvant treatment has not been standardized, although our experience supports the use of combination platinum/taxane chemotherapy.

Malignant transformation within ovarian dermoid cysts: an audit of treatment received and patient outcomes. an Australia New Zealand gynaecological oncology group (ANZGOG) and gynaecologic cancer intergroup (GCIG) study

INTRODUCTION

Malignant transformation in an ovarian dermoid cyst occurs in 1% to 2% of cases. Our knowledge about this tumor type is limited and largely based on case reports. We aimed to collate and analyze the cumulative experience of how these patients have been managed in an effort to identify the most appropriate treatment strategies.

METHODS

A survey was sent to the members of the Gynaecologic Cancer Intergroup. Data collected included age, symptoms, stage, extent of surgery, chemotherapy and radiotherapy details, response to treatment, progression, survival, and salvage therapy.

RESULTS

Data on 33 patients whose conditions were diagnosed between 1979 and 2007 were received from 10 centers in Australia, Canada, Germany, and Austria. The mean age was 49 years. All 15 patients with stage I disease and most of the patients with stages II and III were optimally debulked. Four patients with stage I disease had fertility-sparing surgery with good outcomes. Chemotherapy was not routinely given after surgery and did not seem to be effective. Platinum-based regimens were most commonly used. At relapse, 2 patients had a sustained remission after secondary surgery for relapsed disease. Second-line chemotherapy and radiotherapy were infrequently prescribed. Patients with stage I disease had a good outcome, with all but 2 alive and well at a minimum of 12 months of follow-up.

CONCLUSIONS

Most patients undergo optimal debulking surgery. Fertility-sparing surgery may be a reasonable option in selected patients. Stage I patients have a good prognosis. There is no standard adjuvant treatment, but platinum-based regimens are most commonly used. However, regardless of treatment received, patients with advanced disease do poorly.

Squamous cell carcinoma arising in a dermoid cyst of the ovary in pregnancy

BACKGROUND

A rare complication of mature cystic teratoma of the ovary is malignant transformation, mostly being squamous cell carcinoma (SCC). Due to small case series, there are no established standard surgical and postoperative procedures.

CASE

A 41-year-old pregnant woman presented with a right ovarian tumour. At 14 weeks of gestation, laparotomy with oophorectomy was performed. Histology revealed a pT1a poorly differentiated SCC with lymphovascular invasion. She delivered a healthy infant at 39 weeks of gestation. Nine weeks after delivery, she underwent complete surgical resection and was staged pT1a, pN0 (0/40) pMx, G0. No further treatment was given and 37 months later she is still free of disease.

CONCLUSION

For this rare entity complete surgical resection seems to be a safe treatment.

Disease confined within the ovary and smaller amount of ascites are good prognostic factors for survival of patients with squamous cell carcinoma arising from mature cystic teratoma of the ovary: a case series in Korea and review of the published reports

AIM

To identify clinical prognostic factors for survival of patients with squamous cell carcinoma (SqCC) arising from mature cystic teratoma (MCT) of the ovary with review of the published reports.

METHODS

Clinical data of 55 patients with SqCC arising from MCT of the ovary who were reported in the Korean Journal of Obstetrics and Gynecology and the Korean Journal of Gynecologic Oncology and Colposcopy between 1992 and 2006 were reviewed. Clinical factors were analyzed to identify their association with disease-free survival and overall survival (OS), which were evaluated using the Kaplan-Meier analysis with the log-rank test. Clinical prognostic factors were identified using Cox's proportional hazard analysis.

RESULTS

Patients with disease confined within the ovary (n = 31) or ascites <500 mL (n = 15) had the benefit of a higher mean OS than those with advanced disease (n = 8) (116 vs 21 months, P = 0.004) and ascites > or =500 mL (n = 7) (106 vs 8 months, P = 0.005), respectively. Disease confined within the ovary and ascites <500 mL were good prognostic factors by univariate but not multivariate Cox's proportional hazard analyses (HR = 0.123 and 0.139, 95% confidence interval = 0.022-0.670 and 0.027-0.722, respectively).

CONCLUSIONS

Disease confined within the ovary and a smaller amount of ascites may be good prognostic factors for the OS of patients with SqCC arising from MCT of the ovary.

Prognosis and treatment of squamous cell carcinoma from a mature cystic teratoma of the ovary

BACKGROUND/PURPOSE

Squamous cell carcinoma (SCC) arising from a mature cystic teratoma of the ovary is rare and only reported sporadically. Clinical information on the disease is limited. This study assesses the clinical characteristics, treatment, outcome and prognostic factors of reported cases.

METHODS

Two hundred and twenty cases from 1976 through to 2005 in MEDLINE were analyzed for patient age, clinical and laboratory data, extent of disease, tumor markers, treatment and survival rates. Only the 188 cases with surgical staging were included in the survival analysis.

RESULTS

The disease occurred most often in elderly women (mean, 55.0 +/- 14.4 years) and cysts were large (mean, 13.7 +/- 5.7 cm). Abdominal pain (71.6%) was the most common symptom. Preoperative serum SCC antigen level had a high positive rate (81.3%). Overall 5-year survival rate for all stages was 48.4%. For Stage I, the 5-year survival rate was 75.7%; stage II, 33.8%; stage III, 20.6%; and stage IV, 0% (p < 0.0001). Univariate analysis revealed that tumor stage, patient age, tumor size, preoperative SCC antigen and CA125 levels, and optimal debulking were significant prognostic factors. Further investigation into treatments for all stages revealed that postoperative adjuvant chemotherapy may produce a better survival rate for both stage III and stage IV cases. However, postoperative radiotherapy did not show a similar effect. Multivariate analysis indicated that stage and optimal debulking were significant factors that influenced survival.

CONCLUSION

A mature cystic teratoma should be treated as early as possible. Tumor stage and optimal debulking are critical to survival. Unlike SCCs of the uterine cervix, postoperative adjuvant chemotherapy may produce a better result than adjuvant radiotherapy for advanced-stage cases.

Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data

Up to a quarter of ovarian masses originate from germ cells, and many of these are mature cystic teratomas. The secondary development of malignancy is a rare but well-known phenomenon in patients with ovarian teratomas. Squamous-cell carcinoma accounts for 80% of secondary malignant transformations of ovarian teratomas. We aimed to do an up-to-date systematic review of this rare malignant transformation. 64 suitable studies provided information on 277 patients. Squamous-cell carcinoma in mature cystic teratoma was mainly found in women aged more than 50 years, with high concentrations of squamous-cell-carcinoma antigen and cancer antigen CA125, and with ovarian tumours more than 100 mm in size. Patients with FIGO stage Ia tumours had better survival than those with more advanced disease. Complete resection together with hysterectomy, bilateral salpingo-oophorectomy and lymphadenectomy for patients with advanced disease, followed by adjuvant chemotherapy with an alkylating drug was associated with higher survival, radiotherapy was not. We make proposals for investigation and treatment of this rare disorder.

Malignant transformation of mature cystic teratoma of the ovary: experience at a single institution

OBJECTIVES

Malignant transformation of mature cystic teratoma (MCT) of ovary is very rare. Therefore, the clinicopathologic characteristics, treatment and prognostic factors are not yet well established. The aim of this study was to review our experience with this malignancy and previously published reports in the literature.

STUDY DESIGN

A review of pathologic reports for 2019 patients with ovarian MCT and 937 patients with primary ovarian cancer who were treated at the Asan Medical Center, Korea, from 1989 to 2007 identified 16 patients with malignant transformation from MCT. A retrospective chart review of these patients and a review of the literature were performed.

RESULTS

The incidence rate of malignant transformation was 0.8% of all ovarian MCT. It accounted for 1.7% of all primary ovarian cancer. Squamous cell carcinoma was the most common histologic type, comprising 75%. The median age of the 16 patients was 50 years (range, 29-75 years). Mean tumor size was 14.5 cm (range, 5-26 cm). Twelve patients had some solid portions in the cyst containing fat fluid, hair, and/or calcification. According to the review of the patients in our study and of the literature, early detection and complete surgical resection are important for long-term survival. It seems that adjuvant chemotherapy or concurrent chemoradiation therapy have roles in treating this malignancy.

CONCLUSIONS

Early detection is important for long-term survival. Old age, large tumor size, and solid portion in mature cystic teratoma seem to predict the malignant transformation of mature cystic teratoma.