Ovarian teratoma with peritoneal gliomatosis

Gliomatosis peritonei: a report of two cases and review of the literature

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.

Gliomatosis peritonei with malignant transformation: a case report and review of the literature

Gliomatosis peritonei is the implantation of glial tissue within the peritoneal cavity associated with ovarian teratomas. Previous reports have emphasized improved outcomes when these implants are found to be mature, even if the ovarian component is immature. A 16-year-old female with grade 3 immature teratoma was found on two subsequent laparotomies to have extensive peritoneal implantation of mature glial tissue. More than 5 years after the original surgery she was found to have a malignant abdominal glial neoplasm. This case illustrates a rare finding of malignant transformation of previously mature gliomatosis peritonei.

Gliomatosis peritonei with endometriosis externa

A case of gliomatosis peritonei developed 9 years after the removal of an immature ovarian teratoma is reported. An unique association of gliomatosis with endometriosis externa was found without the usual symptoms of endometriosis. The prognosis of gliomatosis is generally excellent and depends on the histological grade of the primary tumor and on the presence of organ metastasis or immature tumor elements in the implants. Pathogenetical aspects of both lesions are discussed briefly.

Gliomatosis peritonei

Gliomatosis peritonei, the occurrence of mature glial peritoneal implants, is a rare complication that is observed almost exclusively in the setting of ovarian teratoma. The clinicopathologic features of four such cases associated with ovarian teratoma of all grades are described herein. Gliomatosis peritonei is a benign condition. Although its presence is believed to suggest a more favorable prognosis in cases of high-grade ovarian teratoma, this was not found in one of our cases. Extensive histopathologic sampling of peritoneal implants is essential to exclude the presence of other teratomatous or germ cell elements, a negative factor in prognosis.

Nodular and tumorlike gliomatosis peritonei with endometriosis caused by a mature ovarian teratoma

Peritoneal glial implants are found in childhood, adolescence as well as in young women and are the result of a ruptured capsule of mature or immature teratoma of the ovary. The implants of glia nodules have a distinct gross feature and are localized mostly in the parietal and visceral peritoneum, in the omentum and in the space of Douglas. According to the review by Robboy and Scully (1970), seventeen other cases have been reported.

CASE REPORT

A ten year old girl was operated on for a benign cystic teratoma of the right ovary. After an interval of 12-13 years, two laparotomies were performed because of recurring pains, adhesions of the abdomen and the formation of tumor-shaped resistances. Biopsies from both operations taken from the peritoneum, omentum and space of Douglas yielded disseminated gliomatosis and endometriosis. The uniqueness of this case lies in the length of the interval of 12 years after the operation, the size of the gliomatosis-tumor in the pelvis as well as its regressive changes. X-ray examination of this tissue revealed diffuse calcification. A partially infiltrative growth of the glial mass into fat tissue was determined despite the low grading of the implant. The size of the tumor-like infiltration can be understood as a result of growth and confluence of several nodes. As an expression of a local defense reaction, there was found at one location on the circumference of a glial node an intense lymphofollicular infiltration. The combination of gliomatosis and endometriosis has not been observed up until now. The formation of endometriod glands could be the result of a metaplasia of the subcoelomic mesenchyme. Peritoneal gliomatosis can be considered to be implantation metastases of ovarian teratoma with varying degrees of maturity.