First case report of papillary thyroid carcinoma arising within a functional teratoma in Graves' disease patient

AIM

Mature cystic teratoma is the most common kind of ovarian germ tumor. However, malignant transformation is uncommon, differentiated thyroid carcinoma is even rare. Hyperthyroidism due to coexistence of Graves' disease (GD) and struma ovarii has been reported. Functional teratoma with papillary thyroid carcinoma (PTC) in GD case has never been reported in literature.

MATERIAL AND METHOD

A 48-year-old woman with GD for 4 years, who visited our hospital with complaints of severe abdominal pain for 1 day. Computed tomography of the abdominal revealed a large fat-containing lesion with dense calcification, measured 8.6 × 7.2 cm in size. Laparotomy right total oophorectomy was performed, and a huge gangrenous right ovary was noted during exploration. The final pathological diagnosis was teratoma with PTC change at right ovary. We performed thyroglobulin, TTF-1 and CK19 staining in the teratoma, the results were positive, suggesting the thyroid-hormone secretion in the PTC tissue.

RESULT

After resection of the ovarian lesion, euthyroidism was achieved. Adjuvant thyroidectomy is not performed for no evidence of thyroid lesion or distant metastases. No GD recurrence in the 2 years after operation. The patient also does not manifest any gynecological disease symptoms, whereas the other ovary, in the follow-up ultrasound examinations, shows normal size and echo structure.

CONCLUSION

PTC can arise within ovarian teratoma and may have thyroid hormone production. Surgeries of unilateral oophorectomy or cystectomy are a reasonable treatment, and follow-up of thyroid image and data is necessary.

Conservative treatment versus surgical excision of ovarian dermoid cysts: Impact on ovarian stimulation and IVF cycle success

OBJECTIVE

To analyze outcomes of IVF treatment among women diagnosed with an ovarian dermoid cyst (DC).

METHODS

Retrospective analysis of women with an ovarian DC who underwent IVF with fresh blastocyst transfer at a single center in New York from January 2010 to March 2018. Outcomes were compared between women with conservative treatment and those with surgical excision of the DC. Multivariate logistic regression was used to assess associations between variables and the presence of a DC during treatment.

RESULTS

Overall, 119 women with a DC were included. No differences were found in demographic characteristics, controlled ovarian hyperstimulation parameters, and IVF outcomes between women with an intact DC (n=65, 54.6%) and those who underwent cystectomy (n=54, 45.4%) (all P<0.05). Similarly, there was no difference in anti-Mϋllerian hormone and basal antral follicle count among women with a DC (respectively, β=-0.1, P=0.8, and β=-1.0, P=0.28) or resected DC (respectively, β=0.9, P=0.07, and β=1.5, P=0.08) as compared with control women with no DC (n=352).

CONCLUSION

Ovarian reserve, embryo implantation and IVF success rates were not lower in the presence of an ovarian DC. Surgical therapy, if indicated, can be safely postponed until family planning goals have been achieved.

A Squamous Cell Carcinoma and a Malignant Fibrous Histiocytoma Developing in a Patient with a Mature Cystic Teratoma

We present a very rare case of malignant transformation of a benign mature cystic teratoma. The pathology report revealed malignant transformation of both the epithelial and sarcomatous elements of a benign dermoid cyst. To the best of our knowledge, this appears to be the third case of a malignant fibrous histiocytoma and a squamous cell carcinoma developing from a mature cystic teratoma. Malignant transformation of a dermoid cyst is usually diagnosed postmenopausally, but our patient was premenopausal. The etiology and prognosis of malignant transformation of this benign condition remain unknown.

Mature cystic teratoma of the pancreas: Role of endoscopic ultrasound

Cystic teratomas are a rare type of germ cell neoplasms derived from one or more germ layers. They can be classified as mature and immature teratomas based on the maturity of neuroectodermal elements within the tumor. Mature teratomas are benign, well-differentiated lesions, which may be solid or cystic. Mature cystic teratomas (MCTs) are also called dermoid cysts - a term likely coming from early surgical literature when the resected cysts resembled skin. Immature teratomas are malignant, undifferentiated tumors and generally solid. The most common location for MCTs is sacrococcygeus followed by ovaries and testes. MCTs in the pancreas are extremely rare with only few published case reports. Diagnosis of teratomas is challenging since there are no definitive preoperative diagnostic tests or pathognomonic findings. Even though EUS is commonly used for diagnosis of pancreatic cysts, the imaging features and cyst fluid characteristics of MCTs on EUS FNA have not been described. We describe a challenging case of a 65-year-old patient who had a 9 cm × 7 cm MCT in the body of the pancreas and discuss the role of EUS in diagnosis and management of these rare lesions. Complete surgical removal seems to be the current standard of care.

[Presacral tumor as a differential diagnosis of recurrent pilonidal sinus]

BACKGROUND

Retrorectal or presacral space is occupied during embryological stem cell development and therefore may contain a heterogeneous group of tumors.

CLINICAL CASE

We report the case of a 22-year-old male with a pilonidal cyst operated due to recurrent pilonidal sinus cyst. Final diagnosis after pelvic computed tomography is large retrorectal cystic tumor and magnetic resonance diagnosis of a presacral cystic compatible wtih germ cell tumor. The tumor was removed surgically through the abdomen and diagnosis of cystic teratoma was established.

CONCLUSION

Retrorectal tumors are rare lesions whose presence must be ruled out in case of recurrent sinus.

Head and neck teratoma: from diagnosis to treatment

INTRODUCTION

Head and neck teratoma is a rare entity. Its prognosis mostly depends on the risk of neonatal respiratory distress, its extension and potential malignancy. Surgical management must be as complete as possible to avoid recurrences and malignant transformation. The authors present a retrospective analysis of 6 cervicofacial teratomas and a review of the literature. The aim of the study was to analyse prenatal, neonatal and postnatal management of teratoma.

MATERIALS AND METHODS

Charts of children presenting with a head and neck teratoma, managed by our maxillofacial and plastic surgery unit, were analysed and antenatal, clinical, biological, radiological and pathological characteristics were collected. Surgical treatment, recurrences and surgical outcomes were analysed.

RESULTS

Six patients were included: 2 with a cervical teratoma, 2 with a facial teratoma and 2 with intraoral teratomas. In 2 cases, the lesions were diagnosed antenatally and both patients required neonatal resuscitation. All the patients underwent early surgery, and 3 with complete excisions. All patients with an initial incomplete excision eventually presented a recurrence and therefore second look surgery. No malignant transformation was noted.

CONCLUSION

Early prenatal diagnosis is crucial to neonatal care. Early surgery and meticulous follow-up are critical in the long-term favourable outcome.

Primary mature cystıc teratoma mimickıng an adrenal mass in an adult male patient

Teratomas are bizarre neoplasms derived from embryonic tissues that are typically found only in the gonadal and sacrococcygeal regions of adults. Primary retroperitoneal teratomas are rare and present challenging management options. We report a case of a unilateral primary retroperitoneal mature cystic teratoma mimicking an adrenal mass in a 54-year-old male patient. Complete resection of the adrenal mass was performed by the flank approach by using the 11th rib resection. Because of the risk of malignancy, follow-up radiographic studies were performed to ensure the oncologic efficacy of resection. The patient has been free of recurrence for longer than 12 months.