Peritoneal implantation of squamous cell carcinoma following rupture of a dermoid cyst during laparoscopic removal

Subsequent ovarian yolk sac tumor after operation of ovarian mature teratoma: a case report and review of the literature

Ovarian mature teratoma represents a benign ovarian tumor, while ovarian yolk sac tumor (YST, endodermal sinus tumor) is a rare malignant tumor predominantly affecting young women, often associated with a grim prognosis post-metastasis. Both ovarian mature teratoma and ovarian YST are germ cell tumors. There are few studies on the correlation between ovarian YST and mature teratoma. Recurrence or malignant transformation may occur following the surgical intervention for ovarian mature teratoma. However, the occurrence of YST subsequent to such procedures is notably rare. In this investigation, we reported a case involving a 24-year-old unmarried woman with both mature ovarian teratoma and YST within a brief 1-year interval. Regular reexamination protocols facilitated the early-stage detection of YST. The patient underwent surgical treatment, chemotherapy, and measures to preserve ovarian function, resulting in a favorable prognosis. Our primary purpose is to distill clinical insights from the diagnostic and therapeutic journey of this patient. Our purpose is to enhance medical professionals' awareness that YST may be secondary to mature teratoma. Additionally, we underscore the critical importance of routine postoperative surveillance for ovarian mature teratoma, emphasizing its pivotal role in early malignant tumor detection-a factor paramount to the prognosis of patients.

A Systematic Review and Meta-Analysis of Bag Extraction Versus Direct Extraction for Retrieval of Gallbladder After Laparoscopic Cholecystectomy

This analysis aims to evaluate the comparative outcomes of gallbladder extraction with a bag versus direct extraction in laparoscopic cholecystectomy (LC). A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov, and Science Direct. Comparative studies comparing bag versus direct extraction of the gallbladder in LC were included. Outcomes were surgical site infection (SSI), the extension of fascial defect to extract the gallbladder, intra-abdominal collection, bile spillage, and port-site hernia. Revman 5.4 (Cochrane, London, United Kingdom) was used for the data analysis. The results show eight studies were eligible to be included in this review with a total number of 1805 patients divided between endo-bag (n=835) and direct extraction (n=970). Four of the included studies were randomized controlled trials (RCTs) while the rest were observational studies. The rate of SSI and bile spillage were significantly higher in the direct extraction group: odds ratio (OR)=2.50, p=0.006 and OR=2.83, p=0.01, respectively. Comparable results were observed regarding intra-abdominal collection between the two groups(OR=0.01, p=0.51). However, the extension of a fascial defect was higher in the endo-bag group (OR=0.22, p=0.00001), and no difference was observed regarding the port-site hernia rate (OR-0.70, p=0.55). In conclusion, extraction of the gallbladder with an endo-bag provides a lower rate of SSI and bile spillage with similar results regarding post-operative intra-abdominal collection. Although with the endo-bag, the fascial defect will more likely need to be increased to extract the gallbladder. However, the port-site hernia rate remains similar between the two groups.

High-Grade Endometrioid Stromal Sarcoma of the Ovary: Malignant Transformation of Ovarian Mature Cystic Teratoma

We report an extremely rare case of ovarian high-grade endometrioid stromal sarcoma arising from a mature cystic teratoma with clinicopathologic features, and then we briefly review the pertinent literature. A 62-year-old nulliparous woman presented with lower abdominal pain that had begun 6 months earlier. Magnetic resonance imaging showed two adnexal masses with fat components, which suggested that they were mature cystic teratomas. The eccentric thick rim of the left mass showed irregular invasion of the uterus, which was suggestive of malignancy. Positron emission tomography/computed tomography demonstrated high fluorodeoxyglucose uptake in the corresponding area. The patient underwent debulking cytoreductive surgery. The diagnosis was of an International Federation of Obstetrics and Gynecology stage IIIC high-grade endometrioid stromal sarcoma arising from a mature cystic teratoma. After surgery, the patient received adjuvant chemotherapy with three courses of doxorubicin regimen. The cancer recurred 3 months after surgery, and the patient died of progressive disease. It might be helpful for clinicians to be aware of this rare disease and the poor prognosis when it is at an advanced stage.

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.

Keratin Granulomas in the Peritoneum on Frozen Section: A Case Report with Multiple Suspects and the Search for the Culprit

Keratin granulomas in the peritoneum are a rare finding with multiple etiologies and can be especially challenging for both the pathologist and the surgeon when these lesions are grossly visible. We report a case of a unique frozen section diagnostic scenario of evaluation of keratin granulomas in the peritoneum of a 47-year-old woman in the setting of multiple potential culprits: endometrial endometrioid adenocarcinoma following fertility sparing treatment, and a concurrent dermoid cyst. We discuss the various etiologies of keratin granulomas in the peritoneum, mechanism of their formation, diagnostic significance, as well as implications of fertility sparing treatments. To the best of our knowledge, this is the only case of keratin granulomas in the peritoneum with multiple distinct potential pathologic culprits as well the only case following fertility sparing treatment.

Feasibility and validity of double-arm specimen extraction method after partial lung resection in single-port thoracoscopic surgery

Background

Few previous reports have evaluated lung specimen extraction method or how to improve lung specimen extraction method, especially with single-port thoracoscopic surgery. We evaluated the feasibility and surgical advantages of double-arm lung specimen extraction method by comparing double-arm vs. single-arm specimen extraction times.

Methods

We retrospectively analyzed data for 268 patients undergoing partial lung resection via single-port thoracoscopy and specimen extraction using a specimen extractor in the Union Medical College Hospital of Fujian Medical University from November 2017 to June 2018. We divided patients into groups based on the specimen location as an upper-lobe group (group I), lower-lobe group (group II), and lung-segment group (group III). We then performed a subgroup analysis based on the degree of collapse of the lung lobe specimens during extraction as follows: good in group IA and IIA, and poor in group IB and IIB.

Results

The double-arm method required statistically significantly less time than the single-arm method: (69.6±31.9 vs. 89.9±47.8 s, respectively, P=0.037). We found no significant difference in lung specimen extraction time for double-arm vs. single-arm extraction in group I, II, or III (P=0.093, P=0.153, P=0.174, respectively). We also found no significant difference in lung specimen extraction time between the two methods in group IA and group IIA (P=0.165, P=0.649, respectively). However, in groups IB and IIB, extraction time with the double-arm method was significantly shorter compared with the single-arm method (64.4±12.3 vs. 89.1±12.1 s, P=0.034 and 113.8±27.1 vs. 160.0±31.8 s, P=0.042, respectively).

Conclusions

In single-port thoracoscopic partial lung resection, double-arm specimen extraction method is more convenient and can shorten sample extraction time, especially for upper- and lower-lung lobes with poor degree of collapse. Double-arm specimen extraction method is feasible and effective after single-port thoracoscopic partial lung resection.

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.

A Huge Ovarian Dermoid Cyst: Successful Laparoscopic Total Excision

Giant ovarian cysts, ≥15 cm in diameter, are quite rare in women of reproductive age. Here, we present a case of ovarian cyst with unusual presentation treated by laparoscopic surgery. On histology, mass was found to be mature cystic teratoma. The diagnostic and management challenges posed by this huge ovarian cyst were discussed in the light of the literature.

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.

Laparoscopic specimen retrieval bags

Specimen retrieval bags have long been used in laparoscopic gynecologic surgery for contained removal of adnexal cysts and masses. More recently, the concerns regarding spread of malignant cells during mechanical morcellation of myoma have led to an additional use of specimen retrieval bags for contained "in-bag" morcellation. This review will discuss the indications for use retrieval bags in gynecologic endoscopy, and describe the different specimen bags available to date.

Ovarian masses in children and adolescents in China: analysis of 203 cases

Objective

The true incidence of ovarian tumors in children is unknown. Few studies beyond case reports and case series have been published concerning pediatric ovarian tumors. Herein we review a large number of ovarian tumor cases.

Methods

The charts of 203 patients who presented with adnexal masses were reviewed.

Results

The patient’s ranged in age from 2 to 18 years (mean = 15.6 years), with 30 being premenarchal (14.8%). The incidence of ovarian tumor increases with age, especially in patients older than 14 years. The main complaint was abdominal pain or abdominal distension in 117 patients (57.7%). A high AFP level in a pre-pubic girl with an adnexal mass is indicative of a malignant ovarian tumor. The 214 adnexal masses (11 patients had bilateral cysts) consisted of benign tumorous oophoropathy (107 masses, 50.0%), borderline and malignant tumors (29 masses, 13.6%), and nontumorous oophoropathy (78 masses, 36.5%). Of the 136 neoplasia, germ cell tumors accounted for 71.5%. Surgical intervention was performed in 98.5% of cases. There were statistically decreased blood loss, surgery duration and days of hospitalization with the laparoscopic procedure when compared with open surgery.

Conclusions

Abdominal pain is the most common complaint in young patients with adnexal masses. AFP is the most useful diagnostic biomarker of ovarian tumors in young females. Laparoscopic resection of ovarian cysts is an alternative operation approach.

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.

Laparoscopic treatment of ovarian dermoid cysts is a safe procedure

Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of ovarian dermoid cysts in selected cases. The aim of this study was to analyze the safety of laparoscopy in ovarian dermoid cysts treatment and risk of chemical peritonitis. We report 63 cases of patients (mean age of 37) with ovarian dermoid cysts originating from the ovary, treated from 2002 to 2010. Most of the patients underwent cysts removal. In 7 patients salpingo-oophorectomy was performed. We used 15 mm trocars for removing specimens. In patients with dermoid cyst rupture peritoneal cavity was washed out thoroughly with Ringer lactate and drained for 24-48 hours. All the material extracted was sent for a histopathology examination. The diagnosis of mature ovarian dermoid cysts was confirmed in 58 (92.63%) of cases and immature ovarian dermoid cysts in 5 (7.37%) cases. Dermoid cysts were composed of tissue developed from three germinative layers in 31 (49%) patients, from two germinative layers in 25 (40%), and in 7 (11%) patients from one germinative layer. No intra or postoperative complications occurred. No signs or symptoms of chemical peritonitis were observed regardless of cystic spillage or not. We conclude that the risk of chemical peritonitis can be minimized when undertaking laparoscopic removal of ovarian dermoid cysts if the peritoneal cavity is washed out thoroughly from spillage of cyst contents. Drainage of peritoneal cavity should be performed in the patients with the ruptured dermoid cysts.

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.

Laparoscopic approach to ovarian mass in children and adolescents: already a standard in therapy

INTRODUCTION

Functional cysts, ovarian torsion, and benign neoplasms are the most common ovarian masses among young adolescents. The laparoscopic approach to giant ovarian cysts in the pediatric population maybe difficult due the limited working space and the high risk of spillage. In this paper, we evaluate the role of laparoscopic surgery in the treatment of adnexal disease occurring in young girls.

MATERIALS AND METHODS

With the approval of the institutional review board, a retrospective chart review(2007-2003) of patients with adnexal disease was conducted.

RESULTS

Overall, 12 patients were evaluated with preoperative imaging, sonography, and magnetic resonance imaging (MRI) scan and laboratory values. None resulted in malignant histology. All resections of ovarian cysts were performed laparoscopically. The outcome was uneventful in all patients.

CONCLUSIONS

Treatment is indicated if the diagnosis is in question, the cyst persists, in the case of ovarian torsion,or if the patient is symptomatic. Laparoscopy is becoming the favored approach by most pediatric surgeons for the treatment of ovarian cysts. All surgical procedures for ovarian cysts should spare functional ovary as much as is technically possible. Simple cysts can be fenestrated, but complex or functional cysts should be excised, with the preservation of the remaining ovary by careful dissection. The laparoscopic approach for adnexal masses can be performed in an acceptable manner, with comparable results to an open approach, plus the cosmetic advantages of minimally invasive surgery, which is an important aspect for the treated patients.

Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy: a case report

BACKGROUND

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.

CASE

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.

CONCLUSION

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.

Squamous cell carcinoma arising in mature cystic teratoma of the ovary: A case series and review of the literature

OBJECTIVES

Malignant transformation of mature cystic teratomas is rare, with squamous cell carcinoma being the most common type. The prognosis is generally poor when disease has spread beyond the ovary. We conducted this study to review our experience with this disease and describe our current treatment modality.

METHODS

During a 22-year period (1983-2005), we identified 17 women treated for squamous cell carcinoma arising in a mature cystic teratoma of the ovary. All pathologic diagnoses were confirmed at our institution. A retrospective chart review and comprehensive review of the literature were conducted.

RESULTS

The median age was 55 (mean, 54.8; range, 37-75). Eight cases were stage I, 5 were stage II, and 4 were stage III. Mean tumor size was 14.2 cm. All patients underwent surgery, with positive lymph nodes noted in 0 of 10 cases that included lymph node dissection. Ten patients received adjuvant treatment-6 with chemotherapy and 4 with chemoradiation. Six patients had recurrent disease in the pelvis after adjuvant treatment. Four patients died of disease. The overall 1-year survival rate was 60%. The 4 patients with stages IA-IIB disease treated with adjuvant platinum-based chemotherapy and radiation survived at 12-56 months' follow-up.

CONCLUSIONS

Squamous carcinomas arising in mature cystic teratomas are commonly large ovarian tumors that occur in perimenopausal women and often present as an incidental pathologic finding. While the prognosis seems highly dependent on surgical stage, there is a lack of consensus in the literature regarding adjuvant treatment. Platinum-based chemotherapy with pelvic radiation may be a reasonable adjuvant therapy for early-stage disease.

Poor prognosis of intraoperative rupture of mature cystic teratoma with malignant transformation

OBJECTIVE

To present the phenomenon of the postoperative rapid progression of mature cystic teratoma (MCT) with malignant transformation (MT) when intraoperative spillage occurs during operation.

CASE REPORTS

Two patients with MCT were treated, one with total hysterectomy plus bilateral salpingo-oophorectomy in an exploratory laparotomy, and the other with cystectomy with laparoscopy, respectively. Tumor spillage occurred during both operations. The postoperative pathology showed MCT with MT (squamous cell carcinoma type). Both patients were referred to our hospital and underwent treatment (3 months and 8 days, respectively, after the initial operation). At the secondary laparotomy for staging surgery, tumor dissemination was observed in both patients.

CONCLUSION

Whether or not tumor dissemination is correlated with tumor rupture during operation, we emphasize that any patient with a preoperative diagnosis of MCT should have it removed intact to avoid the possibly catastrophic event of tumor dissemination.

Intestinal metastases in a squamous cell carcinoma arising in mature cystic teratoma of the ovary: a case report

Metastatic spread to the intestines by squamous cell carcinoma (SCC) arising in mature cystic teratoma (MCT) or dermoid cyst is a very rare event. A case of a 40-year-old cachectic woman is presented with an MCT of the left ovary found at autopsy. Focal mural thickening of the cyst wall harbored a moderately differentiated SCC with single cell keratinization. Intramural metastases were noted in the jejunum, ileum, colon transversum, and left colonic flexure. In addition, liver metastases were detected. The tumor was staged as FIGO IV. The peritoneum was covered diffusely by fibrinous and suppurative exudate. In this unusual case, metastasizing SCC of the ovary arising in an MCT led to suppurative peritonitis and consequently to death of the patient. Follow-up procedures regarding intestinal spread could be useful in patients with SCC in MCT.

Ovarian teratoma diagnosis and management: case presentations

BACKGROUND

Ovarian teratomas (OTs) may be of mature or immature morphologies. Mature cystic teratomas (MCTs), often referred to as dermoid cysts, are the most common germ cell tumours of the ovary in women of reproductive age. OTs are usually asymptomatic until they reach considerable size. Frequently, ultrasonography is diagnostic. Women requiring surgery for OTs should be appropriately counselled about the risks and benefits of laparoscopic and open approaches.

CASE PRESENTATIONS

Case I: An 18-year-old woman presented with hirsutism and irregular menses, both of which reversed after bilateral MCT removal by laparoscopy. Case II: A 47-year-old multigravid woman presented with a large unilateral OT, with a focus of malignancy. Case III: A 19-year-old woman presented with a large unilateral OT associated with gliomatosis peritonei.

CONCLUSION

Experienced laparoscopic surgeons should consider laparoscopy as an alternative to laparotomy in management of OT in selected cases. Women younger than 15 years of age or older than 45 years of age who have large, solid teratomas on ultrasound or positive markers for germ cell tumours are at risk for malignant variants, and for these women laparotomy is the preferred approach.

Squamous cell carcinoma arising from dermoid cyst: Case reports and review of literature

Malignant transformation of a dermoid cyst is rare, with squamous cell carcinoma (SCC) being the most common type. During a 10-year period in our institution, we encountered only four cases of SCC out of 425 cases of dermoid cyst, an incidence of 0.94%. Two were of old age, in menopausal status (63 and 74 y), while the other two were in their early forties. Three cases presented with pelvic masses while the other one had nonspecific wasting symptoms and later diarrhea. Three were in early stage and have survived to date without evidence of disease at 8, 12, and 116 months after diagnosis. The other case, in stage III, had suboptimal surgery and responded partially to chemotherapy, subsequently progressed after cessation of the drug, and finally died within a year after diagnosis.

Laparoscopic management of adnexal masses: a gold standard?

PURPOSE OF REVIEW

To review recent literature on the laparoscopic management of adnexal masses, when this approach may be considered as a gold standard.

RECENT FINDINGS

Cyst rupture was recently demonstrated to be a significant prognostic factor in stage I invasive epithelial carcinoma, and it was recommended to restrict the laparoscopic approach to patients with preoperative evidence that the cyst was benign. The laparoscopic approach is still highly controversial in masses suspicious at ultrasound. The limits of the laparoscopic approach are discussed reviewing recent literature and our experience. The laparoscopic management of adnexal masses appears to be safe in most hospitals even in developing countries. This approach is being used with increasing frequency in unusual indications such as newborns, children, adolescents and pregnant women. The learning curve for endoscopic surgery appears to be longer than expected. Many patients with benign adnexal masses, such as ovarian endometrioma, are still treated by laparotomy or with an inadequate endoscopic technique. Several studies have suggested that the stripping technique is a tissue-sparing procedure.

SUMMARY

The laparoscopic puncture of malignant ovarian tumours confined to the ovaries is uncommon, and should be avoided whenever possible. The teaching of endoscopy is essential to promote adequate procedures performed according to the principles of microsurgery and to preserve postoperative ovarian physiology.