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Ahmed G, Khalil SA, Elshafiey M, Abdelfattah N, Eid M, Zakaria AS, Elwakeel M, Elgendy A. Management strategy for children with ovarian immature teratoma: results from a tertiary pediatric oncology center. World J Surg Oncol 2024; 22:176. [PMID: 38965563 PMCID: PMC11223275 DOI: 10.1186/s12957-024-03452-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Accepted: 06/16/2024] [Indexed: 07/06/2024] Open
Abstract
OBJECTIVES We present an Egyptian study on pediatric ovarian immature teratomas (ITs), aiming to clarify our treatment strategy selection. METHODS A retrospective review of all children with pure ovarian ITs who were treated at our institution between 2008 and 2023. The analysis included clinical characteristics, tumor staging according to Children's Oncology Group (COG), grading based on the Norris system, management, and outcomes. RESULTS Thirty-two patients were included, with a median age of 9 years. All patients underwent primary surgery. Unilateral salpingo-oophorectomy was performed in 31 patients. Surgical staging was completed in all patients. Based on COG staging, there were 28 patients (87.5%) stage I, 1 (3%) stage II, and 3 (9.5%) stage III. According to Norris classification, 16 patients (50%) were classified as grade I, 9 (28%) grade II, and 7 (22%) grade III. All patients in stage I were treated using surgery-alone approach, whereas the remaining four (12.5%) received adjuvant chemotherapy. Five patients in stage I had gliomatosis peritonei (GP), and none of them underwent extensive surgery. At a median follow-up of 86 months, two patients had events. The first patient (stage III/grade I) developed IT relapse on the operative bed, and the second (stage I/grade I) had a metachronous IT on the contralateral ovary. Both patients were successfully managed with surgery followed by second-line chemotherapy. Five-year overall survival and event-free survival for all patients were 100% and 93.4%, respectively. CONCLUSIONS Surgery-alone strategy with close follow-up achieves excellent outcomes for localized ovarian ITs in children, irrespective of the Norris grading or the presence of GP. However, adjuvant chemotherapy is questionable for patients with incompletely resected or locally advanced tumors, and its role requires further evaluation through prospective multicentric studies with a larger sample size.
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Affiliation(s)
- Gehad Ahmed
- General Surgery Department, Faculty of Medicine, Helwan University, Cairo, Egypt
- Surgical Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Sahar Ahmed Khalil
- Pediatric Oncology Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Pediatric Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Maged Elshafiey
- Surgical Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
- Surgical Oncology Department, National Cancer Institute - Cairo University, Cairo, Egypt
| | - Nihal Abdelfattah
- Department of Research, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Mohamed Eid
- Pediatric Oncology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Al-Shaimaa Zakaria
- Pathology Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Pathology Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Madeeha Elwakeel
- Radio-Diagnosis Department, National Cancer Institute - Cairo University, Cairo, Egypt
- Radio-Diagnosis Department, Children's Cancer Hospital 57357, Cairo, Egypt
| | - Ahmed Elgendy
- Surgical Oncology Unit, Department of Surgery, Faculty of Medicine, Tanta University, 35 Ali Beek Elkbeer street, Tanta, 31515, Egypt.
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Alna'irat M, McCluggage WG, Al-Hussaini M. Ovarian Immature Teratoma With Nodal Gliomatosis: A Case Report and Literature Review. Int J Gynecol Pathol 2023; 42:627-631. [PMID: 36867505 DOI: 10.1097/pgp.0000000000000938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
Gliomatosis involving lymph nodes (nodal gliomatosis) is rarely encountered in association with an ovarian teratoma, with 12 cases previously reported. We report this rare occurrence in a 23-yr-old female with an ovarian immature teratoma. The ovary contained a grade 3 immature teratoma, with immature neuroepithelium. A subcapsular liver mass contained metastatic immature teratoma with neuroepithelium. The omentum and peritoneum contained mature glial tissue, consistent with gliomatosis peritonei with no evidence of immature elements. One pelvic lymph node contained multiple nodules of mature glial tissue, diffusely positive for glial fibrillary acidic protein, in keeping with nodal gliomatosis. In reporting this case, we review prior reports of nodal gliomatosis.
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3
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Heremans R, Valentin L, Sladkevicius P, Timmerman S, Moro F, Van Holsbeke C, Epstein E, Testa AC, Timmerman D, Froyman W. Imaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:549-558. [PMID: 35316568 DOI: 10.1002/uog.24904] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/16/2022] [Accepted: 03/14/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To describe the clinical and ultrasound features of ovarian mature cystic teratomas (MCTs). METHODS This was a retrospective study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histologically confirmed diagnosis of MCT who had undergone transvaginal ultrasound examination between 1999 and 2016 (IOTA phases 1, 2, 3 and 5) in one of five centers. Ultrasound was performed by an experienced examiner who used the standardized IOTA examination technique and terminology. In addition to extracting data from the IOTA database, available two-dimensional grayscale and color or power Doppler images were reviewed retrospectively to identify typical ultrasound features of MCT described previously and detect possible new features using pattern recognition. All images were reviewed by two independent examiners and further discussed with two ultrasound experts to reach consensus. RESULTS Included in the study were 454 patients with histologically confirmed MCT. Median age was 33 (range, 8-90) years and 66 (14.5%) patients were postmenopausal. Most MCTs were described by the original ultrasound examiner as unilocular (262/454 (57.7%)) or multilocular (70/454 (15.4%)) cysts with mixed echogenicity of cystic fluid (368/454 (81.1%)), acoustic shadowing (328/454 (72.2%)) and no or little vascularization on color Doppler (color score 1, 240/454 (52.9%); color score 2, 123/454 (27.1%)). The median largest lesion diameter was 66 (range, 15-310) mm. A correct preoperative diagnosis of MCT was suggested by the original ultrasound examiner in 372/454 (81.9%) cases. On retrospective review of ultrasound images of 334 MCTs that had quality sufficient for assessment, 'dots and/or lines' and/or 'echogenic white ball' (typical features according to the literature) were present in 271/334 (81.1%) masses. We identified four new ultrasound features characteristic of MCT: 'cotton wool tufts', 'mushroom cap sign', 'completely hyperechogenic lesion' and 'starry sky sign'. At least one classical or novel ultrasound feature was present in 315/334 (94.3%) MCTs. Twenty-nine (8.7%) MCTs manifested vascularized solid tissue, of which seven exhibited no typical features. CONCLUSION We provide a comprehensive overview of conventional and newly described ultrasound features of MCTs. Only a small proportion of MCTs did not manifest any of the typical features. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Heremans
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - P Sladkevicius
- Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - S Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - F Moro
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - C Van Holsbeke
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - E Epstein
- Department of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
| | - A C Testa
- Dipartimento Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCSS, Rome, Italy
| | - D Timmerman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
| | - W Froyman
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
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Li J, Li S, Xiao D, Song J, Mao J, Yin J. Extratesticular gliomatosis peritonei after mesenteric teratoma: a case report and literature review. J Int Med Res 2021; 49:3000605211047076. [PMID: 34586943 PMCID: PMC8485300 DOI: 10.1177/03000605211047076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Mesenteric teratoma is a rare extragonadal teratoma. Gliomatosis peritonei (GP) is mature glial tissue implanted into the peritoneum's surface and is mainly accompanied by ovarian teratoma. Only a few cases of gliomatosis have occurred in the extraperitoneum. We present a rare case of a 3-year-old boy who presented with extratesticular GP after excision of an immature mesenteric teratoma at 2 months old. After the extratesticular mass was excised, we found ductile tissue on the surface of the terminal spermatic cord and epididymis. Some ductile tissue of the epididymis was removed and sent to a laboratory for a pathological examination. The mass and the ductile tissue of the epididymis had a hard consistency. The pathological diagnosis was extratesticular gliomatosis. Complete surgical resection of the teratoma and GP is helpful for identifying the presence of malignant lesions and for preventing malignant transformation. However, characteristics of GP lesions are extensive and they are difficult to completely remove. Moreover, GP is usually benign. Therefore, the residual GP tissue was not completely removed in our case. The child is still in good health, but requires lifelong follow-up. In conclusion, we report our experience of a rare case of extraperitoneal GP from an extragonadal teratoma.
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Affiliation(s)
- Jiaqiang Li
- Department of Pediatric Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Shoulin Li
- Department of Pediatric Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Dong Xiao
- Department of Pediatric General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Jiaming Song
- Department of Pathology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Jianxiong Mao
- Department of Pediatric General Surgery, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
| | - Jianchun Yin
- Department of Pediatric Urology, Shenzhen Children's Hospital, Shenzhen, Guangdong Province, China
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Veena K, Jayasree M, Karthik B, Preethi N. Mature Teratoma with Gliomatosis Peritonei with Abdominal Tuberculosis: A Diagnostic Dilemma. J Gynecol Surg 2021. [DOI: 10.1089/gyn.2020.0130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K.S. Veena
- Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Manivasakan Jayasree
- Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Bhandary Karthik
- Department of Pediatric Surgery, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
| | - Natarajan Preethi
- Department of Obstetrics and Gynecology, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India
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Shao L, Heider A, Rabah R. Single nucleotide polymorphism array and cytogenetic analyses of ovarian teratomas in children. Genes Chromosomes Cancer 2021; 60:418-425. [PMID: 33377559 DOI: 10.1002/gcc.22934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 12/24/2020] [Accepted: 12/28/2020] [Indexed: 12/20/2022] Open
Abstract
Teratomas are the most common tumors in the ovary during childhood. Previous studies suggested that they may be derived from germ cells at any developmental stage from premeiotic oogonia through meiotic oocytes to post-meiotic ova. The majority of mature teratomas reveal normal karyotypes and immature teratomas show higher frequency of chromosomal abnormalities. We analyzed fresh tissue samples from 25 primary ovarian teratomas and three extraovarian deposits using whole genome single nucleotide polymorphism (SNP) array and karyotype. SNP array detected five patterns of copy neutral loss of heterozygosity (CN-LOH): failure of meiosis I (type I) in 12 tumors, failure of meiosis II (type II) in six tumors, endoreduplication of a haploid ovum (type III) in two tumors, premeiotic error (type IV) in four tumors, and both meiotic I and meiotic II errors in one tumor (type V). Three tumors with type I error had a single chromosome showing meiotic II error, and two tumors with type II error had a single chromosome showing premature sister-chromatid separation in meiosis I. Lack of recombination in multiple chromosomes in meiosis I were common, chromosomes 17, 7, 8, 21, and 22 were most commonly involved. Abnormal karyotypes were observed in four teratomas including +3, del(3q), +7, +8, +12, and i(18q). The extraovarian deposits revealed the same CN-LOH pattern as the primary teratoma. In summary, SNP array reveals the origin of ovarian teratoma and we propose a new mechanism that consecutive meiotic I and II errors occur frequently in ovarian teratomas.
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Affiliation(s)
- Lina Shao
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Amer Heider
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Raja Rabah
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Heskett MB, Sanborn JZ, Boniface C, Goode B, Chapman J, Garg K, Rabban JT, Zaloudek C, Benz SC, Spellman PT, Solomon DA, Cho RJ. Multiregion exome sequencing of ovarian immature teratomas reveals 2N near-diploid genomes, paucity of somatic mutations, and extensive allelic imbalances shared across mature, immature, and disseminated components. Mod Pathol 2020; 33:1193-1206. [PMID: 31911616 PMCID: PMC7286805 DOI: 10.1038/s41379-019-0446-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/30/2019] [Accepted: 12/15/2019] [Indexed: 01/31/2023]
Abstract
Immature teratoma is a subtype of malignant germ cell tumor of the ovary that occurs most commonly in the first three decades of life, frequently with bilateral ovarian disease. Despite being the second most common malignant germ cell tumor of the ovary, little is known about its genetic underpinnings. Here we performed multiregion whole-exome sequencing to interrogate the genetic zygosity, clonal relationship, DNA copy number, and mutational status of 52 pathologically distinct tumor components from ten females with ovarian immature teratomas, with bilateral tumors present in five cases and peritoneal dissemination in seven cases. We found that ovarian immature teratomas are genetically characterized by 2N near-diploid genomes with extensive loss of heterozygosity and an absence of genes harboring recurrent somatic mutations or known oncogenic variants. All components within a single ovarian tumor (immature teratoma, mature teratoma with different histologic patterns of differentiation, and yolk sac tumor) were found to harbor an identical pattern of loss of heterozygosity across the genome, indicating a shared clonal origin. In contrast, the four analyzed bilateral teratomas showed distinct patterns of zygosity changes in the right versus left sided tumors, indicating independent clonal origins. All disseminated teratoma components within the peritoneum (including gliomatosis peritonei) shared a clonal pattern of loss of heterozygosity with either the right or left primary ovarian tumor. The observed genomic loss of heterozygosity patterns indicate that diverse meiotic errors contribute to the formation of ovarian immature teratomas, with 11 out of the 15 genetically distinct clones determined to result from nondisjunction errors during meiosis I or II. Overall, these findings suggest that copy-neutral loss of heterozygosity resulting from meiotic abnormalities may be sufficient to generate ovarian immature teratomas from germ cells.
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Affiliation(s)
- Michael B. Heskett
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | | | - Christopher Boniface
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - Benjamin Goode
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Jocelyn Chapman
- Division of Gynecologic Oncology, Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Karuna Garg
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Joseph T. Rabban
- Department of Pathology, University of California, San Francisco, CA, USA
| | - Charles Zaloudek
- Department of Pathology, University of California, San Francisco, CA, USA
| | | | - Paul T. Spellman
- Department of Molecular & Medical Genetics, Oregon Health & Science University, Portland, OR, USA
| | - David A. Solomon
- Department of Pathology, University of California, San Francisco, CA, USA,To whom correspondence should be addressed: David A. Solomon, MD, PhD, Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA 94143, United States, Ph: (415) 514-9761, , Raymond J. Cho, MD, PhD, Department of Dermatology, University of California, San Francisco, 1701 Divisadero Street, 3rd floor, San Francisco, CA 94115, United States, Ph: (415) 650-5208,
| | - Raymond J. Cho
- Department of Dermatology, University of California, San Francisco, CA, USA,To whom correspondence should be addressed: David A. Solomon, MD, PhD, Department of Pathology, University of California, San Francisco, 513 Parnassus Ave, Health Sciences West 451, San Francisco, CA 94143, United States, Ph: (415) 514-9761, , Raymond J. Cho, MD, PhD, Department of Dermatology, University of California, San Francisco, 1701 Divisadero Street, 3rd floor, San Francisco, CA 94115, United States, Ph: (415) 650-5208,
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Pavone R, Dijoud F, Galmiche L, Ro V, Hameury F, Sarnacki S, Orbach D, Briandet C, Pasquet M, Bertrand A, Fresneau B, Faure-Conter C. Pure pediatric ovarian immature teratomas: The French experience. Pediatr Blood Cancer 2020; 67:e28186. [PMID: 31981415 DOI: 10.1002/pbc.28186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/23/2019] [Accepted: 12/30/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To describe characteristics and outcome of pediatric ovarian immature teratomas (IT) to better define the place of chemotherapy. METHODS Children with ovarian IT enrolled in TGM95 and TGM2013 studies were analyzed. Norris grading and International Federation of Gynecology and Obstetrics staging system were used. RESULTS Thirty-six cases were identified with a median age of 11 years (range = 1-18): 35 of 36 stage I (17 stage IA, 13 stage IC, and 5 stage IX), including seven patients with gliomatosis peritonei (GP), and 1 stage IIIB (IT peritoneal implants). Centrally reviewed Norris grading was performed in 31 cases: 14 grade I and 17 grade II/III tumors. All patients underwent upfront surgery: 19 unilateral oophorectomy, 14 unilateral adnexectomy, 2 unilateral cystectomy, and 1 bilateral cystectomy. No extensive GP surgery was performed. Six patients received adjuvant vinblastin, bleomycin, and cisplatinum because of tumor rupture (n = 5, including two patients with GP) or stage III (n = 1). After a median follow-up of 39.5 months (range = 6-238), two events occurred 10 and 11 months after diagnosis: one bilateralization (initial stage IX, grade I) and one IT peritoneal relapse (initial stage IA, grade II), respectively. Both were successfully rescued by platinum-based chemotherapy and delayed surgery. No stage IC patients treated without adjuvant chemotherapy relapsed (four grade I and three grade III). None of the seven patients with GP progressed. Five-year event-free survival and overall survival were 94% (95% CI = 81-98%) and 100%. CONCLUSIONS The current series confirms the excellent prognosis of pediatric ovarian IT, arguing for conservative surgical approach in GP and against systematic adjuvant chemotherapy, even in ruptured tumors.
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Affiliation(s)
- Rossana Pavone
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescent oncology, Villejuif, France
| | - Frederique Dijoud
- Institut Multisite de Pathologie, Hospices civils de Lyon, Bron, France
| | - Louise Galmiche
- Laboratoire d'Anatomie Pathologique, Hôpital Necker-Enfants Malades, Paris, France
| | | | - Frederic Hameury
- Department of Pediatric Surgery, Hospices civils de Lyon, Bron, France
| | - Sabine Sarnacki
- Department of Pediatric Surgery, Hôpital Necker-Enfants Malades, Paris, France
| | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and young Adults with Cancer) Institut Curie, Paris, France
| | - Claire Briandet
- Service d'Immuno-Hématologie Pédiatrique, CHU de Dijon, Dijon, France
| | - Maryline Pasquet
- Department of Pediatric Oncology, CHU de Toulouse, Toulouse, France
| | | | - Brice Fresneau
- Gustave Roussy, Université Paris-Saclay, Department of Children and Adolescent oncology, Villejuif, France.,Paris-Sud University (Paris-Saclay University), CESP, INSERM, Villejuif, France
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9
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Lin CS, Huang C, Li PC, Hsu YH, Ding DC. Huge ovarian mature cystic teratoma with gliomatosis peritonei and massive ascites in a postmenopausal woman. Tzu Chi Med J 2019; 31:289-291. [PMID: 31867262 PMCID: PMC6905228 DOI: 10.4103/tcmj.tcmj_176_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 12/14/2018] [Accepted: 12/15/2018] [Indexed: 11/18/2022] Open
Abstract
Teratoma of the ovary is the most frequently encountered germ cell tumor. It usually occurs in young women. Gliomatosis peritonei (GP) is mature neural glial tissue implanted onto the peritoneal surface. We present a case of a mature teratoma accompanied by GP and massive ascites in postmenopausal women. A 54-year-old, G0P0, woman presented in the gynecology outpatient department with abdominal distension for 6 months. Computed tomography scan of the abdomen and pelvis displayed an ovarian mass about 20 cm × 18 cm with peritoneal seeding, ascites, and enlarged paraaortic lymph nodes. A total hysterectomy and bilateral adnexectomy were performed. The pathology showed the left ovary contained a dermoid cyst. The biopsy of the peritoneal nodule displayed glial tissue confirming the diagnosis of GP. The patient remained in good condition 6 months postoperatively. We suggest GP be considered in patients presenting with teratomas and massive ascites. The radiological diagnosis is challenging due to the rarity of GP. Continued follow-up of patients with teratomas and GP is mandatory due to the potential of malignant transformation.
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Affiliation(s)
| | - Ci Huang
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Pei-Chen Li
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Yung-Hsiang Hsu
- Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Dah-Ching Ding
- Department of Obstetrics and Gynecology, Hualien Tzu Chi Hospital , Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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10
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Abstract
The question of giving or not adjuvant chemotherapy in pure ovarian immature teratomas (ITs) remains unsolved to date and illustrates differences in management between pediatric and adults oncologists. Because of the rarity of these tumors, this question has never been addressed through randomized trials. Standard of care for adult women with ovarian ITs is postoperative platinum based chemotherapy for all patients except FIGO stage IA, grade 1 tumors, whereas pediatric series concluded that surgery alone is curative for completely resected ovarian ITs, regardless of grade. Moreover the role of chemotherapy in incompletely resected tumors and its impact on the rate of malignant relapses needs to be better assessed. This emphasizes the urgent need for cooperation between adult and pediatric teams.
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11
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Snir OL, DeJoseph M, Wong S, Buza N, Hui P. Frequent homozygosity in both mature and immature ovarian teratomas: a shared genetic basis of tumorigenesis. Mod Pathol 2017; 30:1467-1475. [PMID: 28664933 DOI: 10.1038/modpathol.2017.66] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 05/07/2017] [Accepted: 05/08/2017] [Indexed: 01/02/2023]
Abstract
Although homozygosity is well documented in mature teratomas, the genetic zygosity of ovarian immature teratomas and mixed germ cell tumors is less well studied. Ten cases of mature cystic teratomas, eleven cases of grade 2 or 3 immature teratomas, and seven cases of mixed germ cell tumors with an immature teratoma component were investigated by short tandem repeat genotyping to interrogate their genetic zygosity. DNA genotyping was informative in eight mature teratomas, seven immature teratomas and six cases of mixed germ cell tumors. Out of the eight mature teratomas, five cases showed partial or complete homozygosity (63%) with two cases demonstrating complete homozygosity (25%). Of the immature teratomas, six cases showed partial or complete homozygosity (86%) with two cases demonstrating complete homozygosity (29%). For the mixed germ cell tumors, two cases showed partial homozygosity (33%) and none displayed complete homozygosity. Long-term clinical follow-up was available for five immature teratomas (mean follow-up 110 months) and five mixed germ cell tumors (mean follow-up 66 months). None of the five patients with pure immature teratoma had a recurrence; in contrast, four out of five mixed ovarian germ cell tumors recurred between 4 months to 8 years (P=0.048). In conclusion, both immature and mature teratomas harbor frequent genetic homozygosity suggesting a common cellular origin involving germ cells at the same developmental stage. The difference in the rate of homozygosity and tumor recurrence between pure immature teratomas and mixed germ cell tumors suggests that the two entities may involve different pathogenetic pathways and likely pursue different biological behaviors.
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Affiliation(s)
- Olivia L Snir
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Maura DeJoseph
- Office of the Chief Medical Examiner, Farmington, CT, USA
| | - Serena Wong
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Natalia Buza
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, CT, USA
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12
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Wang J, Xu J, Zhang M, Li B. Gliomatosis peritonei with bilateral ovarian teratomas: A report of two cases. Oncol Lett 2016; 12:2078-2080. [PMID: 27602142 DOI: 10.3892/ol.2016.4866] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Accepted: 06/17/2016] [Indexed: 11/06/2022] Open
Abstract
Gliomatosis peritonei (GP) is characterized by the presence of benign, mature neuroglial implants throughout the peritoneum and is typically accompanied by mature or immature ovarian teratomas. GP is a condition that has only been described relatively recently, with ~100 cases reported in the English literature. The majority of reported cases have focused on the pathology and clinical treatment of the disease; radiological findings are distinct, but the discussion of this is scarce in the literature. The current study presents two cases of GP with bilateral ovarian teratomas and provides a review of the relevant literature, with particular emphasis on the radiological differential diagnosis. The present study reinforces previously reported observations from imaging analysis and suggests that radiological investigation alone cannot sufficiently aid the differentiation of benign glial deposits from diffuse peritoneal malignant seeding. However, radiologists should be familiar with this rare condition in order to provide an accurate diagnosis, particularly in ovarian tumor staging, which may markedly impact the administered treatment. It is recommended that doctors undertake long-term follow-ups in patients presenting with GP due to the potential for malignant transformation.
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Affiliation(s)
- Jiawei Wang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Jingjing Xu
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Minming Zhang
- Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
| | - Baizhou Li
- Department of Pathology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310009, P.R. China
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Liang L, Zhang Y, Malpica A, Ramalingam P, Euscher ED, Fuller GN, Liu J. Gliomatosis peritonei: a clinicopathologic and immunohistochemical study of 21 cases. Mod Pathol 2015; 28:1613-20. [PMID: 26564007 PMCID: PMC4682736 DOI: 10.1038/modpathol.2015.116] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 08/27/2015] [Accepted: 08/29/2015] [Indexed: 02/02/2023]
Abstract
Gliomatosis peritonei, a rare condition often associated with immature ovarian teratoma, is characterized by the presence of mature glial tissue in the peritoneum. We retrospectively evaluated 21 patients with gliomatosis peritonei and studied their clinicopathologic features and immunophenotype. The patients' ages ranged from 5 to 42 years (median, 19 years). Their primary ovarian tumors consisted of immature teratoma (n=14), mixed germ cell tumors (n=6), and mature teratoma with a carcinoid tumor (n=1). Gliomatosis peritonei was diagnosed at the same time as primary ovarian neoplasm in 16 patients and secondary surgery in 5 patients. Also, 11 of 21 patients had metastatic immature teratoma (n=4), metastatic mature teratoma (n=2), or both (n=5). One patient developed glioma arising from gliomatosis peritonei. Seventeen patients had follow-up information and were alive with no evidence of disease (n=13), alive with disease (n=3), or alive with an unknown disease status (n=1). The follow-up durations ranged from 1 to 229 months (mean, 49 months; median, 23 months). Immunohistochemistry results demonstrated that SOX2 was expressed in all cases of gliomatosis peritonei and glioma with tissue available (nine of nine cases), whereas OCT4 and NANOG were negative in all cases with available tissue (eight of eight cases). In conclusion, both gliomatosis peritonei and glioma arising from it show a SOX2+/OCT4-/NANOG- immunophenotype. These findings demonstrated that gliomatosis peritonei is associated with favorable prognosis, although it is important to rule out potentially associated immature teratoma and malignant transformation. SOX2 may have an important role in the development of gliomatosis peritonei.
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Affiliation(s)
- Li Liang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Yifen Zhang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Department of Pathology, Nanjing Drum Tower Hospital, Nanjing University Medical School, Nanjing, People’s Republic of China
| | - Anais Malpica
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Elizabeth D. Euscher
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Gregory N. Fuller
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jinsong Liu
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA,Department of Pathology, The first Affiliated Hospital of Nanjing Medical University, Nanjing, People’s Republic of China
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Wu PS, Lai CR. Ovarian immature teratoma with gliomatosis peritonei and pleural glial implant: a case report. Int J Surg Pathol 2015; 23:336-8. [PMID: 25663333 DOI: 10.1177/1066896915570361] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Gliomatosis peritonei is a very rare phenomenon occurring almost exclusively in association with ovarian immature teratoma. It is characterized by numerous benign, mature glial nodules in the omentum and mesentery. The presence of glial tissue outside abdominal cavity is extremely rare in the setting of ovarian immature teratoma. We present a case of ovarian immature teratoma with both gliomatosis peritonei and pleural glial implant in a 4-year-old girl. Glial emboli were present in the pleural implant, suggesting lymphovascular dissemination might be the cause of extra-abdominal glial implantation.
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Affiliation(s)
- Pao-Shu Wu
- Taipei Veterans General Hospital, Taipei, Taiwan
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Bentivegna E, Gonthier C, Uzan C, Genestie C, Duvillard P, Morice P, Gouy S. Gliomatosis Peritonei: A Particular Entity With Specific Outcomes Within the Growing Teratoma Syndrome. Int J Gynecol Cancer 2015; 25:244-9. [DOI: 10.1097/igc.0000000000000345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
ObjectivesOvarian immature teratoma may be associated with peritoneal spread that could, after adjuvant chemotherapy, develop into disease exclusively composed of mature implants (growing teratoma syndrome) and/or gliomatosis peritonei (GP), defined as the presence of pure mature glial tissue. However, very few specific series are devoted to the outcomes of pure GP. This was the aim of the present study.PatientsFrom 1997 to 2013, data concerning patients treated for stage II/III immature teratoma were reviewed. All slides were reviewed by an expert pathologist. Patients with ovarian cancer associated with peritoneal spread in the form of pure GP (initially if patients were treated without adjuvant treatment or after adjuvant chemotherapy if done) were analyzed.ResultsTen patients fulfilled the inclusion criteria. The median age of patients at diagnosis was 36 years (range, 14–41 years). Six patients had undergone a conservative treatment. Five patients had macroscopic residual disease at the end of surgery.The median duration of follow-up from the diagnosis of GP was 39 months (range, 6–114 months). Six patients had undergone secondary surgery. Among them, 5 had incompletely resected macroscopic GP. No patients had died of their disease. All patients were asymptomatic at the time of the last consultation (1 of them with abnormal radiologic imaging).ConclusionsGliomatosis peritonei is a particular entity of the condition described as growing teratoma syndrome because residual peritoneal disease can be asymptomatic totally stable over a long period which raises the question of a more conservative surgical approach in patients with massive peritoneal spread.
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Abstract
CONTEXT The field of ovarian germ cell tumors (OGCTs) has remained relatively unchanged in the last 2 decades. However, the introduction of new stem cell pluripotency markers has provided a new understanding into the identification and taxonomy of OGCT types. New data have provided new insights into unusual teratoma-associated autoimmune disorders and the origin of gliomatosis peritonei. OBJECTIVE To review the impact of new pluripotency markers in the diagnosis of malignant OGCT (MOGCT) and analyze new nomenclature proposals and clinicopathologic entities. DATA SOURCES Ovarian germ cell tumors from routine material and expert consultation files at San Cecilio University Hospital, Granada, Spain, and the relevant literature were reviewed. CONCLUSIONS Although a correct diagnosis of MOGCT can often be made with histologic and classic immunohistochemical studies, the new immunohistochemical pluripotency markers give higher diagnostic accuracy. Germ cell tumors represent a caricature of the phases of normal embryonic differentiation from primordial germ and stem cells to extraembryonal and somatic tissue differentiation. Since every stage of differentiation and its related tumor type exhibit characteristic markers, the analysis of their expression facilitates tumor typing, thus complementing the use of classic antibodies. They also allow a more precise evaluation of the degree of immaturity in teratoma. The new term, primitive endodermal tumors, simplifies the understanding of the complex histology of the yolk sac tumor group, as this terminology encompasses its multiple endodermal differentiations. Recently described autoimmune encephalitis due to antibodies against the N-methyl-d-aspartate receptor has become the most frequent autoimmune disorder associated with ovarian teratoma.
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Affiliation(s)
- Francisco F Nogales
- From the Department of Pathology, San Cecilio University Hospital, Granada, Spain (Drs Nogales and Dulcey); and Department of Research and Development, Master Diagnostica, Granada, Spain (Dr Preda)
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Abe A, Utsugi K, Nomura H, Yamamoto A, Matoda M, Okamoto S, Omatsu K, Kato K, Umayahara K, Takesima N. Ovarian teratoma with gliomatosis peritonei: ten case reports. Int Cancer Conf J 2014. [DOI: 10.1007/s13691-013-0125-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Gheorghisan-Galateanu A, Terzea DC, Carsote M, Poiana C. Immature ovarian teratoma with unusual gliomatosis. J Ovarian Res 2013; 6:28. [PMID: 23590935 PMCID: PMC3637604 DOI: 10.1186/1757-2215-6-28] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 04/06/2013] [Indexed: 04/25/2023] Open
Abstract
This study aimed to investigate an unusual case of immature ovarian teratoma with onset of mature glial cells implanted on the contralateral ovary, a challenge in the diagnosis of the second ovarian tumor. We report the case of a 31- yr-old woman, who developed at the age of 16 an immature teratoma in the right ovary that was surgically removed. Six years later mature glial implants were present on the left ovary and six months later at the level of peritoneum that relapsed after other six months. The patient suffered three surgical resections after the initial one. Paraffin sections and immunohistochemical examinations using antibodies against glial and neuronal antigens were performed. In the teratoma, the neuroectodermal tissue expressed Glial fibrillary acidic protein (GFAP), S100 protein, Epithelial membrane antigen (EMA) and Cytokeratin 34 beta E12 (Ck34beta E12), wheares the implants expressed only GFAP and S100 protein. The immature teratoma is the rarest type of ovarian teratomas. Gliomatosis peritonei is an exceptional finding, expecially with onset on the contralaterally ovary. The implant of the mature glial cells has a high risk of relapse, as seen in our case, thus close follow-up of the patient is necessary.
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Affiliation(s)
- Ancuta Gheorghisan-Galateanu
- C.I.Parhon National Institute of Endocrinology, 34 Aviatorilor Blvd., Bucharest 011853, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., Bucharest 050474, Romania
| | - Dana Cristina Terzea
- C.I.Parhon National Institute of Endocrinology, 34 Aviatorilor Blvd., Bucharest 011853, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., Bucharest 050474, Romania
- V.Babes National Institute of Development and Research, 99- 101 Splaiul Independenţei, Bucharest 050096, Romania
| | - Mara Carsote
- C.I.Parhon National Institute of Endocrinology, 34 Aviatorilor Blvd., Bucharest 011853, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., Bucharest 050474, Romania
| | - Catalina Poiana
- C.I.Parhon National Institute of Endocrinology, 34 Aviatorilor Blvd., Bucharest 011853, Romania
- Carol Davila University of Medicine and Pharmacy, 8 Eroii Sanitari Blvd., Bucharest 050474, Romania
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Yoon NR, Lee JW, Kim BG, Bae DS, Sohn I, Sung CO, Song SY. Gliomatosis peritonei is associated with frequent recurrence, but does not affect overall survival in patients with ovarian immature teratoma. Virchows Arch 2012; 461:299-304. [DOI: 10.1007/s00428-012-1285-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2012] [Revised: 07/02/2012] [Accepted: 07/06/2012] [Indexed: 10/27/2022]
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20
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Growing teratoma syndrome and peritoneal gliomatosis. Case Rep Med 2011; 2011:123527. [PMID: 21541214 PMCID: PMC3085325 DOI: 10.1155/2011/123527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Revised: 02/15/2011] [Accepted: 02/17/2011] [Indexed: 11/18/2022] Open
Abstract
The growing teratoma syndrome (GTS) is defined as a detection of an enlarged mass during or after chemotherapy treatment for germ cell tumor. We report a case of an 18-year-old girl treated for growing teratoma syndrome after chemotherapy for malignant germ cell tumor of the ovary associated with peritoneal gliomatosis. Chemotherapy induced normalisation of alpha-fetoprotein rate whereas there was an enlargement of the mass. Subsequent complete resection was performed, and the patient remained in good control for 60 months. This clinical picture suggested the diagnosis of “GTS”. This syndrome can lead to confusion with progression or relapse of a germ cell tumour because of increase in tumour volume during chemotherapy, so it is important to recognize it.
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Abstract
We present a unique case of bilateral gonadoblastoma in a 23-year-old patient with Swyer syndrome. The gonadoblastoma on both sides underwent synchronous neoplastic transformation, into a stage I germinoma in the right streak gonad and a highly differentiated Sertoli cell tumor in the left one. The latter was associated with a myriad of microscopic, Sertoli cell implants on the peritoneal surface, which were considered benign as they had a high grade of differentiation, minimal proliferative activity, and an absence of invasion. Most probably, the pathogenesis of this abdominal dissemination was iatrogenic, with implantation occurring mechanically as a result of the multiple laparoscopic biopsies performed on both of the streak gonads 2 months before the abdominal surgery. The pathogenesis of other benign abdominal implants is discussed.
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22
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Targnion A, Broze B, Habonimana E, Jouan H, Frémond B. [Gliomatosis peritonei, an unusual abdominal carcinomatosis: report of two cases]. Arch Pediatr 2010; 17:1169-73. [PMID: 20452193 DOI: 10.1016/j.arcped.2010.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Revised: 09/23/2009] [Accepted: 03/25/2010] [Indexed: 11/26/2022]
Abstract
We report on 2 cases of ovarian teratoma associated with gliomatosis peritonei in 2 young girls aged 9 and 14 years. Gliomatosis peritonei is an unusual miliary-like peritoneal carcinomatosis of glial tissue. In our experience, follow-up was important to detect abdominal recurrence of glial implants, which had to be removed by iterative surgery. We report a 14-year follow-up and an unusual pleural metastatic disease.
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Affiliation(s)
- A Targnion
- Service de chirurgie pédiatrique, CHU Anne-de-Bretagne, hôpital Sud, 16, boulevard de Bulgarie, 35203 Rennes, France.
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23
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Karlo C, Leschka S, Dettmer M, Breitenstein S, Stolzmann P. Hepatic teratoma and peritoneal gliomatosis: a case report. CASES JOURNAL 2009; 2:9302. [PMID: 20062626 PMCID: PMC2803966 DOI: 10.1186/1757-1626-2-9302] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2009] [Accepted: 12/10/2009] [Indexed: 11/22/2022]
Abstract
The hepatic teratoma is a very rare entity of which only 25 cases have been published so far. In our case the hepatic teratoma is associated with peritoneal gliomatosis, which is an indicator for an ongoing peritoneal spread of a teratoma. Wall calcifications and the homogeneity as well as the well defined border misled the radiologist to the diagnosis of an echinococcal cyst, which is the most common differential diagnosis, however the hepatic teratoma has to be taking into consideration when dealing with unclear hepatic cysts, although it is very rare.
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Affiliation(s)
- Christoph Karlo
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100; 8091 Zurich/Switzerland
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24
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Lipskar AM, Rothstein DH, Soffer SZ, Edelman M, Glick RD. Intrathoracic glial implants in a child with gliomatosis peritonei. J Pediatr Surg 2009; 44:1817-20. [PMID: 19735831 DOI: 10.1016/j.jpedsurg.2009.04.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2009] [Revised: 04/28/2009] [Accepted: 04/28/2009] [Indexed: 12/20/2022]
Abstract
Glial peritoneal implants, commonly referred to as gliomatosis peritonei, are an occasional feature of ovarian teratomas. They are benign nodules of mature glial tissue and usually do not adversely affect outcome. We present the case of a 12-year-old girl who underwent excision of an immature ovarian teratoma, along with biopsies of multiple glial peritoneal implants. She also had a 2-cm right-sided pleural mass, which turned out to be normal glial tissue that was histologically indistinguishable from the peritoneal glial tissue. Pleural gliomatosis has not been described in the literature. The pathophysiology of gliomatosis peritonei was originally thought to be the direct extrusion or lymphatic spread of glial cells from the associated teratoma, although it has been postulated that the glial implants may instead be the result of pluripotent Mullerian stem cells that undergo metaplasia. This report provides evidence to bolster the metaplastic theory.
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Affiliation(s)
- Aaron M Lipskar
- Division of Pediatric Surgery, Schneider Children's Hospital, North Shore-Long Island Jewish Health System, New Hyde Park, NY 11040, USA.
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25
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Cheng FWT, To KF, Lee V, Shing MMK, Leung WK, Li CK. One man, one disease? BMJ Case Rep 2009; 2009:bcr07.2008.0516. [PMID: 21686767 DOI: 10.1136/bcr.07.2008.0516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
We report the case of a 12-year-old girl with a strong family history of malignancy who presented with immature teratoma and gliomatosis peritonei. Despite first and second line chemotherapy, the disease ran an unusually refractory course. Although the presentation was not the typical tumour presentation of Li-Fraumeni syndrome (LFS), we proceeded to undertake tumour genetic testing of the patient and her parents. LFS was diagnosed in this patient and her father with a sequence variation of CGG>TGG, R248W, which is one of the most common transcriptionally inactive mutations detected in LFS. Genetic counselling was offered to the father. A tumour screening programme and genetic screening for the p53 gene mutation for the surviving family members can be offered once consent is obtained from the father. This case illustrates the importance of cancer genetic study, even if the tumour presentation is not typical for any familial cancer syndrome.
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Affiliation(s)
- Frankie Wai Tsoi Cheng
- Prince of Wales Hospital, The Chinese University of Hong Kong, Department of Paediatrics, Shatin, New Territories, Hong Kong
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26
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Clement PB. The pathology of endometriosis: a survey of the many faces of a common disease emphasizing diagnostic pitfalls and unusual and newly appreciated aspects. Adv Anat Pathol 2007; 14:241-60. [PMID: 17592255 DOI: 10.1097/pap.0b013e3180ca7d7b] [Citation(s) in RCA: 209] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Although the histologic diagnosis of endometriosis is usually straightforward, many diagnostic problems can arise as a result of alterations or absence of its glandular or stromal components. The diagnostic difficulty in such cases can be compounded by tissue that is limited to a small biopsy specimen. The appearance of the glandular component can be altered by hormonal and metaplastic changes, as well as cytologic atypia and hyperplasia. Although the last 2 findings are often referred to collectively as "atypical endometriosis," they should be separately recognized as their premalignant potential likely differs. In some cases, the endometriotic glands are sparse or even absent (stromal endometriosis). The stromal component can be obscured or effaced by infiltrates of foamy and pigmented histiocytes, fibrosis, elastosis, smooth muscle metaplasia, myxoid change, and decidual change. Occasional findings in endometriosis that may raise concern for a neoplasm include necrotic pseudoxanthomatous nodules, polypoid growth (polypoid endometriosis), bulky disease, and venous, lymphatic, or perineural invasion. Inflammatory and reactive changes within, adjacent to, or at a distance from foci of endometriosis can complicate the histologic findings and include infection within endometriotic cysts, pseudoxanthomatous salpingitis, florid mesothelial hyperplasia, peritoneal inclusion cysts, and Liesegang rings. The histologic diagnosis of endometriosis can also be challenging when it involves an unusual or unexpected site. Five such site-specific problematic areas considered are endometriosis on or near the ovarian surface, superficial cervical endometriosis, vaginal endometriosis, tubal endometriosis, and intestinal endometriosis, including the important distinction of an endometrioid carcinoma arising from colonic endometriosis from a primary colonic adenocarcinoma. Finally, endometriotic foci can occasionally be intimately admixed with another process, such as peritoneal leiomyomatosis or gliomatosis, resulting in a potentially confusing histologic appearance.
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Affiliation(s)
- Philip B Clement
- Department of Pathology, Vancouver General Hospital, Vancouver, BC, Canada.
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27
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Abstract
Teratomas are the most frequent germ cell tumors of the ovary. Two main groups can be distinguished: mature and immature teratomas. Mature teratomas are benign tumors, which are most often composed of derivatives of two or three germ cell layers. Only in rare cases is the transition into a malignant tumor observed (most often squamous cell carcinoma). In contrast, immature teratomas are malignant ovarian tumors. They contain immature tissue elements in addition to the mature components, most often consisting of immature neural tissue. Histologically, this tumor component can be identified as neurotubules or rosettes. The proportion of immature tissue elements defines the grade of immaturity. Four grades have been defined in to the WHO classification. Grade 0 represents a mature teratoma. With the exception of childhood cases, grade 2 and 3 immature teratomas are treated with chemotherapy. In childhood cases, foci of yolk sac tumor (YST) must be looked for, since this determines the prognosis. If a focus of YST is present, the patient is treated with chemotherapy. Both in cases of mature and immature teratoma, peritoneal implants can be found (gliomatosis peritonei), which are also graded. In cases of immature peritoneal implants, patients are also treated with chemotherapy. Gliomatosis peritonei is most likely derived from metaplasia of subperitoneal stem cells; it does not represent a metastatic disease of the ovarian teratoma.
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Affiliation(s)
- D Schmidt
- Institut für Pathologie, A2,2, 68159 Mannheim, Germany.
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28
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Roth LM, Talerman A. Recent Advances in the Pathology and Classification of Ovarian Germ Cell Tumors. Int J Gynecol Pathol 2006; 25:305-20. [PMID: 16990705 DOI: 10.1097/01.pgp.0000225844.59621.9d] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In recent years, our knowledge of ovarian germ cell tumors has increased, and their classification has evolved. The introduction of cisplatin-based chemotherapy and the discovery of tumor markers, including alpha-fetoprotein and human chorionic gonadotropin, have dramatically changed the clinical outlook for most of these patients. In this review, recent advances in the classification and pathology of ovarian germ cell tumors are discussed. Where appropriate, comparisons are made with testicular germ cell tumors. The last section of the article discusses the pathogenesis of germ cell tumors. This review will emphasize the articles written in the last 10 years and those that have significantly advanced our knowledge of germ cell tumors in past decades.
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Affiliation(s)
- Lawrence M Roth
- Department of Pathology, Indiana University School of Medicine, Indianapolis, 46202-5120, USA.
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29
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Khan J, McClennan BL, Qureshi S, Martell M, Iyer A, Bokhari SJ. Meigs syndrome and gliomatosis peritonei: a case report and review of literature. Gynecol Oncol 2005; 98:313-7. [PMID: 15963555 DOI: 10.1016/j.ygyno.2005.03.048] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2005] [Revised: 03/17/2005] [Accepted: 03/31/2005] [Indexed: 11/15/2022]
Abstract
To the best of our knowledge, pseudo-Meigs syndrome (PMS) has never been described in the setting of gliomatosis peritonei (GP), both arising from an ovarian teratoma. We present a case of ovarian teratoma with both these rare findings. The case is unique as it presents two rare manifestations of ovarian teratoma in the same patient; there are many cases in the literature where both these manifestations have been described in different patients. The case is also rare because lymph node involvement along with gliomatosis was found. We review the literature for these two rare complications of ovarian teratoma.
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Affiliation(s)
- Jehanzeb Khan
- Department of Diagnostic Radiology, Yale New Haven Hospital, South Pavillion-2nd floor, 20 York Street, New Haven, CT 06510, USA.
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30
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Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol 2005; 18 Suppl 2:S61-79. [PMID: 15761467 DOI: 10.1038/modpathol.3800310] [Citation(s) in RCA: 324] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Gonadal germ cell tumors continue to be the cause of diverse, diagnostically challenging issues for the pathologist, and their correct resolution often has major important therapeutic and prognostic implications. They are academically interesting because of the biological diversity exhibited in the two gonads and variation in frequency of certain neoplasms. The most dramatic examples of the latter are the frequency of dermoid cyst in the ovary compared to the testis and the reverse pertaining to embryonal carcinoma. Within the teratoma group, there is strong evidence that ovarian and prepubertal testicular teratomas are derived from benign germ cells, a pathogenesis that likely applies also to the rare dermoid cysts and uncommon epidermoid cysts of the testis. In contrast, postpubertal testicular teratomas derive from malignant germ cells, specifically representing differentiation within a preexistent nonteratomatous cancer. As expected, given the foregoing, teratomas in boys are clinically benign, whereas in postpubertal males they are malignant, independent of their degree of immaturity. On the other hand, immaturity is an important finding in ovarian teratomas, irrespective of age, although its significance in children has recently been challenged. It is usually recognized on the basis of embryonic-appearing neuroepithelium, which shows mitotic activity and apoptosis in contrast to differentiated neuroepithelial tissues, which may occur in mature ovarian teratomas. Rarely it is based on the presence of cellular, mitotically active glial tissue. Fetal-type tissues alone are not sufficient for a diagnosis of immature teratoma. Further differences between the teratomatous tumors in the two gonads are the relative frequency of monodermal teratomas in the ovary in contrast to the testis, where only one subset, carcinoids, is seen with any frequency. When uncommon somatic-type malignancies (usually squamous cell carcinoma) occur in mature cystic teratomas of the ovary, this is a de novo form of malignant transformation; similar tumors in the testis, a very rare event, represent overgrowth of teratomatous elements that originated from malignant, nonteratomatous germ cell tumors and, therefore, had previously undergone malignant transformation. Germinomas may have several unusual features in each gonad; these include microcystic arrangements that suggest yolk sac tumor, tubular patterns that mimic Sertoli cell tumor, apparent increased cytological atypia that causes concern for embryonal carcinoma, and prominent syncytiotrophoblast giant cells that suggest choriocarcinoma. Awareness of these variants, good technical preparations, the retained typical cytological features of germinoma cells, and the judicious use of tailored panels of immunohistochemical stains resolve these dilemmas in virtually all instances. Two aspects of germinomas are unique to the testis. Firstly, intertubular growth of small seminomas may cause them to be overlooked. Secondly, the distinctive spermatocytic seminoma occurs only in the testis. A newly recognized aspect of this tumor is the propensity for some to be relatively monomorphic, making them apt to be mistaken for usual seminoma or embryonal carcinoma, although the characteristic polymorphic appearance in some foci, absence of intratubular germ cell neoplasia, unclassified type, and immunohistochemical stains should prevent this error. Cytoplasmic membrane immunoreactivity for placental alkaline phosphatase and CD117, with usual negativity for AE1/AE3 cytokeratins, is helpful in the diagnosis of germinoma. The recently described marker, OCT3/4, a nuclear transcription factor, is especially helpful in the differential of germinoma and embryonal carcinoma with other neoplasms. Yolk sac tumor continues to be confused occasionally with clear cell carcinoma of the ovary. Glandular ('endometrioid-like') yolk sac tumors mimic endometrioid carcinomas; predominant or pure hepatoid yolk sac tumors cause concern for metastatic hepatocellular carcinoma or, in the ovary, primary hepatoid carcinoma, and solid patterns, especially in limited samplings, may be misinterpreted as germinoma. The usually younger age of patients with yolk sac tumors helps with the differential considerations with the nongerm cell tumors, as do other clinical and microscopic features and selected immunohistochemical stains. Choriocarcinoma is rare in both gonads, and those in the ovary must be distinguished from metastatic tumors of placental origin. Syncytiotrophoblast cells alone, admixed with other forms of germ cell tumor, still are confused with choriocarcinoma, but this phenomenon, which is much more frequent than choriocarcinoma, lacks the plexiform arrangement of different trophoblast cell types that typifies the latter. Mixed germ cell tumors (which may show almost any combination of components) are common in the testis but rare in the ovary. A separately categorized, rare form of mixed germ cell tumor seen in both gonads is the polyembryoma. It is perhaps the most photogenic of all gonadal germ cell tumors and is also intriguing because of its distinctive, organized arrangement of yolk sac tumor and embryonal carcinoma elements and recapitulation of very early embryonic development, even to the extent of having in its fundamental unit, the embryoid body, a miniature yolk sac, and amniotic cavity. These tumors, which are constituted by innumerable embryoid bodies, almost always contain teratomatous glands in minor amounts, and one way of viewing the polyembryoma is to consider it the most immature form of teratoma. Embryoid bodies are also common as a minor component of many mixed germ cell tumors, particularly in the testis, and the diffuse embryoma is another variant that has a particular arrangement of yolk sac tumor and embryonal carcinoma elements. Regression of gonadal germ cell tumors is a phenomenon restricted to the testis, for unknown reasons. These so-called 'burnt-out' germ cell tumors can be recognized by a distinctive constellation of findings, including sometimes minor foci of residual recognizable germ cell neoplasia, a well-defined zone of scarring (often having residual ghost tubules), associated lymphoplasmacytic infiltrate, intratubular calcification and, in about 50%, of in situ germ cell neoplasia.
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Affiliation(s)
- Thomas M Ulbright
- Department of Pathology & Laboratory Medicine, Clarian Health Partners and Indiana University School of Medicine, Indianapolis, IN 46202-5280, USA.
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Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol 2005. [DOI: 10.1016/s0893-3952(22)04459-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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