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Kakinuma T, Kakinuma K, Shinohara T, Shimizu A, Okamoto R, Kaneko A, Takeshima N, Yanagida K, Ohwada M. Efficacy and safety of an Aron Alpha method in managing giant ovarian tumors. Gynecol Oncol Rep 2023; 46:101167. [PMID: 37033210 PMCID: PMC10073634 DOI: 10.1016/j.gore.2023.101167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Background Giant malignant tumors have an increased risk of intraoperative rupture, which might lead to a worse disease condition and tumor recurrence. We performed a clinical study on patients with a giant ovarian mass who underwent laparoscopy combined with an Aron Alpha method. Methods This retrospective clinical study spanned from January 2016 to September 2022 and included 23 patients with giant ovarian tumors treated with an Aron Alpha method. Results The mean age of the subjects was 47.6 ± 17.8 years, mean tumor diameter 20.4 ± 5.8 cm, mean surgical duration 87.2 ± 33.1 min, and mean hemorrhage volume 94.1 ± 92.2 mL. No patient experienced intraoperative tumor rupture or surgery-related symptoms. Histopathology of excised samples revealed serous cyst adenoma and mucinous cystadenoma, mucinous cystadenoma of borderline malignancy and mature cystic teratoma, and endometriotic cyst adenoma in 6, 4, and 3 patients, respectively. The mean hospitalization period was 6.0 ± 1.2 days, and the hospitalization period was not extended in any subject. Conclusion The Aron Alpha method allows tumor resection without capsular rupture and is a useful, minimally invasive surgical method for resecting giant ovarian tumors in which malignancy cannot be ruled out.
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Guo F, Liu Y, Lu J, Wu Z, Zhu X. Human chorionic gonadotropin elevation in gliomatosis peritonei complicated with immature teratoma: A case report and review of the literature. Medicine (Baltimore) 2022; 101:e31305. [PMID: 36316907 PMCID: PMC9622604 DOI: 10.1097/md.0000000000031305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Gliomatosis peritonei (GP) refers to the implantation of glial tissue on the visceral and parietal peritoneal surface, often associated with immature teratoma. It is a rare condition and the pathogenesis is not fully understood. In addition, the indistinguishable radiological appearance of immature and mature teratomas, and limited pathology samples make an accurate diagnosis difficult in most cases. More importantly, patients are also at risk of recurrence after surgery. This report aims to describe the process of diagnosis and treatment of GP with immature teratoma. PATIENT CONCERNS The patient, a 38-year-old woman presented with GP complicated with immature teratoma after laparoscopic ovarian cyst excision. DIAGNOSES On physical examination, a 15 cm-pelvic mass, with poor mobility, was palpated. And tumor marker demonstrated a moderate increase in α-fetoprotein and carbohydrate antigen 125. We suspected malignancy according to the comprehensive preoperative evaluation, the postoperative pathology revealed an immature teratoma of the left ovary and complicated with gliomatosis peritonei. Three months after the second surgery, possible recurrence of immature teratoma was considered and the patient underwent the third laparotomy. But the postoperative pathology indicated mature teratoma and mature glial components in the pelvic lesions. INTERVENTIONS AND OUTCOME The patient underwent 2 more surgical resections after the initial resection and 3 cycles of bleomycin, etoposide, and cisplatin regimen chemotherapy. She was regularly followed up in the outpatient after surgery, and no recurrence has been reported in the pelvic cavity till date. LESSON The case illuminated that the primary diagnosis of GP complicated with immature teratoma is critical but highly challenging for both gynecologists and pathologists and more attention should be paid to "GP complicated with immature cystic teratoma" patients to avoid inappropriate treatment.
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Affiliation(s)
- Fei Guo
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Yukai Liu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jiaqi Lu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Zhiyong Wu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xiaoyong Zhu
- Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- * Correspondence: Xiaoyong Zhu, Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, China (e-mail: )
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Patel T, Meena V. Gliomatosis Peritonei and Its Relation to Teratoma: Role of Imaging and Histological Aspects. Cureus 2022; 14:e28849. [PMID: 36225445 PMCID: PMC9536809 DOI: 10.7759/cureus.28849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 11/12/2022] Open
Abstract
Gliomatosis peritonei (GP) is a rare disease, usually associated with immature ovarian teratoma. GP may be rarely associated with mature ovarian teratoma. GP is composed of mature glial tissue elements, which histopathological examination can further confirm. Benign glial implants usually involve the omentum, peritoneum and lymph nodes. Many benign and malignant peritoneal diseases may mimic GP on clinical examination. GP may be confused with peritoneal carcinomatosis on computed tomography (CT) scan. A microscopic examination from peritoneal mass biopsy helps to rule out differential diagnosis. GP consists of mature glial tissue and is regarded as grade 0 according to the WHO grading of immature teratoma (IT). GP corresponds to a good prognosis with occasional cases showing malignant evolution.
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4
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Watanabe E, Tanaka K, Takeda N, Takayasu H, Yokota K, Watanabe M. Surgical technique to prevent spillage of cyst fluid during operation for cystic ovarian tumors. Pediatr Surg Int 2013; 29:645-9. [PMID: 23397589 PMCID: PMC3657350 DOI: 10.1007/s00383-013-3277-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 11/01/2022]
Abstract
We describe a new technique to prevent spillage of cyst fluid in patients undergoing surgery for cystic ovarian tumors. The cyst is first covered with a sterilized surgical sheet applied with quick-drying glue and is then punctured. This technique completely prevents spillage of cyst fluid into abdominal cavity.
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Affiliation(s)
- Eiichiro Watanabe
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Kiyoshi Tanaka
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Noriko Takeda
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Hajime Takayasu
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Kazuko Yokota
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
| | - Masahiko Watanabe
- Department of Surgery, School of Medicine, Kitasato University, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374 Japan
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5
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Ud Din N, Memon A, Aftab K, Ahmad Z, Ahmed R, Hassan S. Oligodendroglioma arising in the glial component of ovarian teratomas: a series of six cases and review of literature. J Clin Pathol 2012; 65:631-4. [PMID: 22496515 DOI: 10.1136/jclinpath-2012-200714] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIMS To report the exceedingly rare occurrence of oligodendroglioma in the glial component of ovarian teratomas. METHODS Six cases of oligodendrogliomas arising in the glial component of ovarian teratomas were studied and the literature was reviewed. Immunohistochemistry was performed by the Flex technique. RESULTS The ages of the patients ranged from 12 to 28 years (mean 21 years). Four tumours were located in the right and one in the left ovary. The size of the ovarian cysts ranged from 7 cm to 29 cm (mean 19.6 cm). Four cases arose in immature and two cases in mature teratomas. In all cases, oligodendroglioma was WHO grade II. On immunohistochemistry, glial fibrillary acidic protein stain was positive in all cases. The Mib 1 (Ki 67) proliferative index was low and the tumour cells were negative for synaptophysin. Follow-up was available in five patients and ranged from 1 to 42 months. Two patients died of disease after 1 and 36 months of diagnosis, respectively. In both these cases oligodendroglioma arose in an immature teratoma. The remaining three patients are alive with a follow-up of 4-42 months. CONCLUSIONS Oligodendroglioma arising in the glial component of ovarian teratomas is exceedingly rare. Ovarian teratomas should be extensively sampled and carefully evaluated to rule out the possibility of a glial tumour. This is the single and largest series of oligodendrogliomas arising in ovarian teratomas. The prognosis is good for oligodendrogliomas arising in mature teratomas compared with those arising in immature teratomas, although long-term follow-up is needed to determine the exact behaviour.
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Affiliation(s)
- Nasir Ud Din
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
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6
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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: 0.8] [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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7
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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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8
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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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9
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Moukarram H, Chia KV. Conservative treatment of an immature ovarian teratoma with gliomatosis peritonei. J OBSTET GYNAECOL 2009; 26:277-8. [PMID: 16698648 DOI: 10.1080/01443610600559867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- H Moukarram
- Department of Obstetrics and Gynaecology, Royal Bolton Hospital, Bolton, UK.
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10
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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: 4.1] [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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11
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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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12
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Marsaudon X, Fermeaux V, Mathonnet M. [Peritoneal pseudo-carcinosis in a young woman: peritoneal gliomatosis]. ACTA ACUST UNITED AC 2005; 29:740-2. [PMID: 16142011 DOI: 10.1016/s0399-8320(05)82165-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Gliomatosis peritonei is a peritoneal colonization of glial cells producing nodules similar to peritoneum carcinosis. Gliomatosis is often associated with ovarian teratoma. We describe a case of gliomatosis 8 years after the removal of a mature ovarian teratoma. The physiopathology, treatment and medical follow up of this benign disease is discussed.
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Affiliation(s)
- Xavier Marsaudon
- Service de Chirurgie Digestive, Endocrinienne et Générale, CHU Dupuytren, 2 avenue Martin Luther-King, 87042 Limoges, France
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13
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Tatekawa Y, Kemmotsu H, Mouri T, Joe K, Ohkawa H. A case of pediatric ovarian dysgerminoma associated with high serum levels and positive immunohistochemical staining of neuron-specific enolase. J Pediatr Surg 2004; 39:1437-9. [PMID: 15359410 DOI: 10.1016/j.jpedsurg.2004.05.023] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 5-year-old girl presented with a painful abdominal mass. Abdominal magnetic resonance imaging (MRI) showed 3 separate masses. Tumor markers including lactate dehydrogenase (LDH), cancer antigen-125 (CA-125), beta-subunit of human chorionic gonadotropin (beta-hCG) and neuron-specific enolase (NSE) were elevated. At operation, the main tumor arose from the left ovary and was associated with torsion, whereas the other lesions were lymph node metastases. A salpingo-oophorectomy was performed. Histopathologic examination indicated that the tumor was a dysgerminoma. Immunohistochemicallly, the cells were positive for NSE and placental alkaline phosphatase (PALP) but were negative for CA-125, beta-hCG, S-100, glial fibrillary acidic protein, and vimentin. The elevated serum levels of tumor markers improved dramatically after the operation and chemotherapy.
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Affiliation(s)
- Yukihiro Tatekawa
- Department of Pediatric Surgery, Ibaraki Children's Hospital, Futabadai, Mito, Japan
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14
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Abstract
Gliomatosis peritonei, a rare condition that occurs almost exclusively in the setting of ovarian immature teratoma, is characterized by the occurrence of nodules of mature glial tissues in the peritoneum. It is controversial whether glial tissues are derived from maturation of the associated teratomatous tissue that has implanted in the peritoneum, or glial differentiation of subperitoneal stem cells. In this study, we employed the unique genetic characteristics of ovarian teratomas (often with a duplicated set of maternal chromosomes and thus homozygous at many polymorphic microsatellite loci) versus normal tissues (heterozygous pattern due to presence of maternal and paternal genetic materials) to investigate the origin of gliomatosis peritonei. DNA samples were extracted from microdissected paraffin-embedded tissues, including the glial implants, the associated ovarian teratomas, and normal tissues, to determine their patterns of microsatellite loci in a multiplex polymerase chain reaction system. Two cases were not informative because the ovarian teratoma showed a heterozygous microsatellite pattern. In the 5 informative cases, the normal tissues showed a heterozygous pattern in the microsatellite loci, the associated teratomas showed a homozygous pattern, and the glial tissues showed a heterozygous pattern. Thus, gliomatosis peritonei is genetically unrelated to the associated teratoma but is probably derived from nonteratomatous cells, such as through metaplasia of submesothelial cells.
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Affiliation(s)
- Man-Yee Kwan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
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15
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Abstract
The placenta from a 300-day-gestational age, female, Arabian equine fetus was examined. Multifocal to coalescing, 0.5- to 4-cm-diameter, white, smooth nodules covered 50% of the placenta. Microscopic evaluation of the nodules revealed undifferentiated germ cells and a haphazard arrangement of immature, mesenchymal stroma, cartilage, squamous cornifying epithelium, scattered ducts and secretory acini lined by cuboidal to columnar epithelium, and mineralized foci. No umbilicus, arrangement about an axial skeleton, or organized polarity of structures was present. The lesion was diagnosed as a placental teratoma, a lesion not reported in species other than man.
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Affiliation(s)
- N Gurfield
- San Diego County Animal Disease Diagnostic Laboratory, Department of Agriculture, Weights and Measures, 5555 Overland Avenue, Building 4, San Diego, CA 92123, USA.
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Müller AM, Söndgen D, Strunz R, Müller KM. Gliomatosis peritonei: a report of two cases and review of the literature. Eur J Obstet Gynecol Reprod Biol 2002; 100:213-22. [PMID: 11750968 DOI: 10.1016/s0301-2115(01)00486-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gliomatosis peritonei is the implantation of miliary glial tissue within the peritoneal cavity of patients with ovarian teratomas. Up to now 86 cases of this rare entity have been reported. In addition to the small number of reported gliomatosis peritonei cases, a condition easily mistaken for peritoneal carcinomatosis, we report two further cases, one combined with endometriosis (fifth case published until now) and one without endometriosis. Both cases were followed up for more than 5.5 years. Thus, further data concerning biological behaviour and prognosis of this rare entity are made available. In addition, a review of all cases published until today is provided, thus summarising the data presently known.
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Affiliation(s)
- Annette M Müller
- Institute of Pathology, University Clinic Bergmannsheil, Ruhr-University Bochum, Burkle-de-la-Camp-Platz 1, D-44789, Bochum, Germany.
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Skopelitou A, Mitselou A, Michail M, Mitselos V, Stefanou D. Pilocytic astrocytoma arising in a dermoid cyst of the ovary: a case presentation. Virchows Arch 2002; 440:105-6. [PMID: 11942569 DOI: 10.1007/s00428-001-0546-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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18
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Ferguson AW, Katabuchi H, Ronnett BM, Cho KR. Glial implants in gliomatosis peritonei arise from normal tissue, not from the associated teratoma. THE AMERICAN JOURNAL OF PATHOLOGY 2001; 159:51-5. [PMID: 11438453 PMCID: PMC1850430 DOI: 10.1016/s0002-9440(10)61672-0] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Metaplasia of subcoelomic mesenchyme has been implicated, but not proven, in the pathogenesis of common gynecological diseases such as endometriosis and rarer entities such as leiomyomatosis peritonealis disseminata and gliomatosis peritonei (GP). GP is associated with ovarian teratomas and is characterized by numerous peritoneal and omental implants composed of glial tissue. Two theories to explain the origin of GP have been proposed. In one, glial implants arise from the teratoma, whereas in the other, pluripotent Müllerian stem cells in the peritoneum or subjacent mesenchyme undergo glial metaplasia. To address the origin of GP, we exploited a unique characteristic of many ovarian teratomas: they often contain a duplicated set of maternal chromosomes and are thus homozygous at polymorphic microsatellite (MS) loci. In contrast, DNA from matched normal or metaplastic tissue (containing genetic material of both maternal and paternal origin) is expected to show heterozygosity at many of these same MS loci. DNA samples extracted from paraffin-embedded normal tissue, ovarian teratoma and three individual laser-dissected glial implants were studied in two cases of GP. In one case, all three implants and normal tissue showed heterozygosity at each of three MS loci on different chromosomes, whereas the teratoma showed homozygosity at the same MS loci. Similar results were observed in the second case. Our findings indicate that glial implants in GP often arise from cells within the peritoneum, presumably pluripotent Müllerian stem cells, and not from the associated ovarian teratoma. This finding has important implications for more common gynecological entities with debatable pathogenesis, such as endometriosis, by definitively demonstrating the metaplastic potential of stem cells within the peritoneal cavity.
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Affiliation(s)
- A W Ferguson
- Department of Pathology, University of Michigan Hospital, Ann Arbor 48109, USA
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19
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Hill DA, Dehner LP, White FV, Langer JC. Gliomatosis peritonei as a complication of a ventriculoperitoneal shunt: case report and review of the literature. J Pediatr Surg 2000; 35:497-9. [PMID: 10726696 DOI: 10.1016/s0022-3468(00)90221-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Gliomatosis peritonei, the implantation of neuroglial tissue upon the peritoneal surfaces, is a rare event most often associated with solid or immature teratomas of the ovary in young girls. The authors report a case of a 10-month-old girl with a ventriculoperitoneal shunt (VPS) who presented with bilateral inguinal hernias. Herniorrhaphy was uneventful. Microscopic examination of the hernia sacs showed exuberant mesothelial hyperplasia containing multiple nests of differentiated glial tissue. Subsequent computed tomography and laparoscopy disclosed normal ovaries with no evidence of intraabdominal or pelvic abnormalities. Gliomatosis peritonei in this case was attributed to transport of glial tissue from the cerebrospinal fluid into the peritoneal cavity via the shunt. With the exclusion of an ovarian germ cell neoplasm and in the presence of a VPS, the clinical course with regard to the glial implants in these children is uneventful. If it is appreciated that gliomatosis peritonei may be a complication of a VPS, an extensive clinical evaluation generally is unnecessary.
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Affiliation(s)
- D A Hill
- Department of Surgery, St Louis Children's Hospital, Washington University Medical Center, MO 63110, USA
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20
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Nanda S, Kalra B, Arora B, Singh S. Massive mature solid teratoma of the ovary with gliomatosis peritonei. Aust N Z J Obstet Gynaecol 1998; 38:329-31. [PMID: 9761166 DOI: 10.1111/j.1479-828x.1998.tb03079.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Glial implants on peritoneum and omentum may occur with mature solid teratoma of the ovary (gliomatosis peritonei). The case of a 17-year-old girl is presented, who had a massive solid ovarian teratoma with glial implants on visceral peritoneum and omentum. The massive size of the tumour posed difficulty in diagnosis. CT demonstrated a large teratoma. At laparotomy, the seedlings were initially thought to be evidence of malignancy and hysterectomy was offered which was refused by the parents. Oophorectomy was performed and the benign nature of the tumour and implants was seen on histopathology. It is important to recognize the benign nature of glial seedlings in such cases to avoid unnecessary extensive surgery.
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Affiliation(s)
- S Nanda
- Department of Obstetrics and Gynaecology, Postgraduate Institute of Medical Sciences, Rohtak, India
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