Stage Ia squamous cell carcinoma as the malignant transformation of giant and unusual mature teratoma of the ovary in an elderly patient

Immunotherapy in young adults with mature cystic ovarian Teratoma-Derived squamous cell carcinoma: a case series

BACKGROUND

Mature cystic teratomas (MCTs), also known as dermoid cysts, are common benign germ cell tumors. These predominantly benign tumors can become malignant, particularly in postmenopausal women; the overall transformation rate of MCTs is 1-2%, accounting for approximately 80% squamous cell carcinoma of cases. Malignant transformation remains exceptionally rare in young adults.

CASE PRESENTATION

Herein, we report two cases of squamous cell carcinoma arising from MCTs in a 25-year-old patient, staged FIGO 2018 IIIA1 and IC2 according to the International Federation of Gynecology and Obstetrics (FIGO) 2018 classification. The results of histopathological examination confirmed squamous cell carcinoma arising from the teratomas. Immunohistochemical staining revealed programmed death-ligand 1 expression. Both patients underwent fertility-sparing surgeries and subsequently received adjuvant chemotherapy in combination with programmed death receptor 1 (PD-1) inhibitor immunotherapy. A complete clinical response was ultimately achieved. Patients 1 and 2 were monitored for 29 and 20 months after operation, respectively. A complete response was maintained in Patients1 and 2 for 14 and 16 months, respectively, as of the last follow-up.

CONCLUSION

Squamous cell carcinoma arising from MCTs is exceedingly rare in young adults and exhibits nonspecific clinical manifestations and imaging characteristics, hindering preoperative diagnosis. These tumors display highly aggressive biological behavior and are typically associated with a poor prognosis and a high postoperative recurrence rate. Immunotherapy intervention at diverse different time points for patients at different stages can increase their survival period.

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

BACKGROUND

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

CASE PRESENTATION

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

CONCLUSION

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