Management options for a patient with squamous cell carcinoma arising in a mature cystic teratoma of the ovary

Mature cystic teratomas, also referred to as dermoid cysts, are one of the commonly occurring ovarian germ cell tumors. Malignant transformation of a germ cell tumor occurs approximately 1-2% of the time. Treatment options vary by stage and are not well outlined in the literature. Here we report a case of a perimenopausal female who presented with increasing abdominal girth and an elevated CA-125. Final pathology revealed an invasive squamous cell carcinoma, moderately to poorly differentiated, multifocal, arising in a cyst on the left ovary, possibly a teratoma. At the time of diagnosis, the patient was FIGO stage IA. The decision was made against adjuvant treatment. Squamous cell carcinoma arising in a mature cystic teratoma of the ovary is rare. Treatment options are not well outlined in the literature, especially for disease less than stage II. Further research is needed to better inform the clinician on management recommendations.

Minimally invasive treatment of pediatric head and neck dermoids: percutaneous drainage and radiofrequency coblation

BACKGROUND

Dermoids are common benign head and neck cysts in children containing a variety of different skin elements. Current standard treatment is surgical removal that sometimes requires extensive dissection to ensure complete resection and often leaves unwanted facial scarring. A minimally invasive treatment alternative should offer a similar rate of success with a decrease in operative complexity, recovery time and postoperative scarring.

OBJECTIVE

To assess the outcomes of our minimally invasive percutaneous treatment of head and neck dermoids, we reviewed our 9-year interventional radiology (IR) department experience.

MATERIALS AND METHODS

The medical records, imaging and procedural details were reviewed from a cohort of pediatric patients with dermoids treated in our IR department from January 2009 through February 2018. Patients in the study underwent ultrasound (US)-guided cyst puncture, 3% Sotradecol (sodium tetradecyl sulfate [STS]) emulsification of the thick cyst contents allowing complete drainage, and radiofrequency coblation of the cyst wall.

RESULTS

In this retrospective study, we report on 22 dermoids in 21 patients. The average patient age was 3 years. Twenty-one of the 22 dermoids were successfully treated for an overall success rate of 95%. Four intraosseous dermoids were successfully treated using computed tomography (CT) guidance instead of, or in addition to, US. Average follow-up time was 22 months.

CONCLUSION

The combination of percutaneous cyst drainage using STS as an emulsifying agent followed by radiofrequency coblation is a safe, effective, minimally invasive treatment for pediatric patients with head and neck dermoids.

[Dermoid cyst in the floor of the mouth with tongue fistula: a case report]

Dermoid cysts in the floor of the mouth with tongue fistula are unusual lesions. This study reported a case of dermoid cyst in the floor of the mouth with tongue fistula, analyzed the causes of such formation, and discussed the appropriate diagnosis and treatment methods by reviewing relevant literature.

[Congenital median dermoid fistula of nasal dorsum: one case report]

Congenital median dermoid is an uncommon disease. Surgery is the main curative treatment. To review a clinical case and to summarise the characteristics and treatment experience of this disease, referring to the related literature, it is expected that we can provide more clinical thought and therapeutic method for congenital median dermoid fistula of nasal dorsum.

Congenital anomalies presenting as recurrent post-auricular abscesses: an institution based retrospective study

OBJECTIVES

This report is intended to bring out the association of recurrent postauricular abscess in children with various underlying congenital anomalies.

MATERIALS AND METHODS

A retrospective study was done in tertiary care setting from the year August 2005 to February 2012 using the medical record department database to retrieve the patient details. During this study period, a total of 215 children with an age range of 1-14 years were treated at the hospital with postauricular abscess. We analysed the data using appropriate statistical tests for parametric and nonparametric data and setting the p value at 0.05 for significance. For testing the association between the recurrence of abscess and the presence of underlying congenital anomalies, Fischer's t test was used.

RESULTS

A total of 215 patients were studied, of which 41 patients presented with recurrence. 26 of the 41 patients (63.4%) had recurrent postauricular abscess with associated congenital anomalies. Among the 26 patients, in 16 patients (62%), the recurrent abscesses were due to postauricular sinuses. Other less common causes were infected post auricular dermoid cyst, first branchial cysts, collaural fistula and congenital aural atresia. There was a statistically significant association of the recurrence of abscess with presence of underlying congenital anomalies.

CONCLUSION

Paediatric recurrent postauricular abscesses are rare in the post antibiotic era. Their presence should alert a treating physician of an underlying congenital anomaly.

Squamous cell carcinoma and osteosarcoma arising from a dermoid cyst--a case report and review of literature

A rare case of multiple malignant tumors (poorly differentiated squamous cell carcinoma and high grade osteosarcoma) arising in an ovarian dermoid cyst of a 55 year old female is reported. To the best of our knowledge, this is the first well documented example of such an unusual combination of tumors arising in a dermoid cyst. The osteosarcoma and squamous cell carcinoma appear to arise in the background of benign teratomatous environment of a dermoid cyst rather than from "pure" mixed mesodermal tumors of the ovary. The tumors did not appear to have well demarcated boundaries with a junction or close intermingling of both cell types, features less favorable for collision tumor or carcinosarcoma. Despite extensive surgery with negative surgical margins and combination chemotherapy, the patient had recurrence of the tumor within four months and she died secondary to septicemia to chemotherapy and bilateral pulmonary emboli shortly after.

Squamous cell carcinoma arising in a dermoid cyst of the ovary: a case series

OBJECTIVE

Malignant transformation in a dermoid cyst of the ovary is a rare complication, occurring in only 1-2% of cases, with squamous cell carcinoma being the most common type. Preoperative diagnosis is difficult because of the lack of specific symptoms and signs to suggest malignancy. Because of the small numbers of women involved, our knowledge of this rare tumour type is limited. This study aims to further characterise the population of women affected, the disease itself and the most appropriate management strategy.

DESIGN

We identified 14 women with this diagnosis between 1989 and 2006. This is a descriptive study, looking at the patient characteristics, mode of presentation and the role of tumour markers and radiological imaging in diagnosis. We also examined the stage and pathological features of the tumour at presentation and the subsequent course of the disease. We have also described our experiences using surgery, chemotherapy and radiotherapy in the management of these women.

RESULTS

We found that these tumours present at an age older than that of mature teratomas and that there are no reliable diagnostic tools or prognostic indicators. The behaviour of these tumours is unpredictable, and the role of chemotherapy and radiotherapy remains unclear. We suggest that repeated surgical resection of disease at the time of relapse could give a very durable response in selected women.

Extradural dermoid tumor of the petrous apex. Case report

Dermoid cysts are rare, benign, congenital tumors. Most case series thus far have featured intradural tumors. The authors report on a case of an extradural dermoid tumor of the middle cranial fossa with osseous invasion, successfully removed using a left subtemporal extradural approach. The clinical presentation, histological features, radiological findings, and management of this unique case are described.

Posterior fossa dermoid cysts causing cerebellar abscesses

Dermoid cysts are uncommon tumors, and posterior fossa dermoid cysts may rarely cause abscess formation or formation of daughter abscesses within the cerebellum. At present, there are only 16 cases with posterior fossa dermoid cysts causing cerebellar abscesses reported in the literature. Two cases, 22 and 14 months old, with posterior fossa dermoid cysts and dermal sinus causing multiple cerebellar abscesses are reported. In the first one, there was also marked hydrocephalus. Retrospective examination of the patients revealed pinpoint-sized dimples in their suboccipital regions. Both patients were treated with antibiotics and underwent posterior fossa surgery. In the patient with marked hydrocephalus, ventriculoperitoneal shunting was performed after treatment of the infection. Both patients were neurologically normal, and there were no complaints, except a light learning difficulty in the patient with ventriculoperitoneal shunting, 133 and 34 months after surgery, respectively. Early detection of congenital dermal abnormalities along the craniospinal axis by routine examination of newborns is highly important before development of serious complications. Because surgery is the only effective treatment modality for these lesions, radical excision should be performed in all cases to avoid tumor recurrence. However, subtotal excision may be performed in selected cases, because the cyst capsule may adhere firmly to vital structures.

Fine needle aspiration biopsy in the management of tumours in superolateral quadrant of orbit

Forty-two cases of orbital lesions in superolateral quadrant were evaluated in our study by fine needle aspiration biopsy. Cases were histologically proven wherever possible. In 92.85% cases the diseases were correctly diagnosed. Females were mainly affected. Lymphomatous tumours were diagnosed on the basis of atypical lymphoid proliferation, correlated with clinical features and findings of computed tomographic scan and managed by radiotherapy. Pseudotumours, dermoid and epithelial tumours of lacrimal gland were diagnosed accurately except in one case of malignant mixed tumour where the malignant component was aspirated. Pseudotumours were treated by steroid, dermoid by excision. In case of adenocarcinoma and adenocystic carcinoma, tumour masses were removed by lateral orbitotomy and radiotherapy was applied when bony erosion was present. One case of eosinophilic granuloma was treated by radiotherapy and curettage. The suspected case of intra-osseous cavernous haemangioma did not turn up for treatment.

Treatment of "hernia" in the writings of Celsus (first century AD)

Descriptions concerning "hernia" can be found from the early historical years, and its treatment was a subject mentioned by numerous physicians of Antiquity, such as Hippocrates and Praxagoras of Kos. Yet, Aulus Cornelius Celsus, a famous doctor and encyclopedist of the first century AD, was among the first to propose surgical treatment and carry it out successfully, according to his accounts. Many physicians attempted to treat several types of "hernia" before him, but more "scientific" information with details and complete descriptions could be found only in Celsus' work. In his book De Medicina, Celsus described eight types of "hernia": bronchocele, umbilical hernia, intestinal and omental hernias, hydrocele, varicocele, sarcocele (hernia carnosa), and inguinal hernia. Among them, some retain their ancient nomenclature up to now, although others have acquired gradually different terminology or are not recognized by physicians today as "hernias" (e.g. , bronchocele). For each type of "hernia", Celsus provided his readers with an extremely detailed, well reasoned description of the execution of surgical procedures accompanied usually with pre- and postoperative instructions. His innovations particularly concerned ligature of the vessels. He recommended that an injured vessel be tied in two places with lint threads and then cut between the ties. Other pre- and postoperative practices, such as sterilization and bandaging of the incised area, were elements that helped in the advances of medicine, and some of them still exist in modern medicine.

[Dermoid cysts: epidemiological, clinical and pathological studies]

We retrospectively analyzed 31 cases of dermoid cysts surgically treated between January 1992 and October 2000. Mean patient age was 18.9 years. The preseptal localization predominated, with 29 cases. Two cases of intraorbital localization required orbitotomy. The surgical result was excellent.

Autoamputation of a congenital oropharyngeal hairy polyp

Hairy polyps or dermoids are rare, benign congenital tumours of the oronasopharynx containing elements of both ectodermal and mesodermal origin. They occur most commonly in young infants and can cause respiratory distress or failure to thrive due to feeding difficulties. Computed tomography, magnetic resonance imaging, and barium video fluoroscopy can be useful in delineating the origin and extent of these lesions. Treatment usually consists of surgical removal. We describe a case of spontaneous resolution of symptoms in an 11-week-old baby due to autoamputation of the lesion.

[An unusual tumor of the oral cavity in a fetus and prenatal ultrasonography--case report]

OBJECTIVE

The tumours and pseudotumours of the foetal face are very rare diseases. Basic method for their prenatal diagnosis is ultrasound. The authors describe the case of diagnosed orofacial pseudotumour--sublingual cyst.

DESIGN

Case report introduces some rules for ultrasound investigation of foetal face.

SETTING

Department of Clinical Genetics and Foetal Medicine, University Hospital Olomouc.

SUBJECT AND METHOD

The cyst of oral cavity was diagnosed by ultrasound in second trimester of gestation. It was repeatedly punctured during pregnancy and the content was cytologically examined. Exstirpation was performed after delivery. Histological etiology--dysontogenetic cyst--was established.

CONCLUSION

Prenatal ultrasonographical diagnosis of the oral pseudotumour was completed by puncture procedures. This invasive way verifies anatomical conditions, enables histological investigation and warrants the swallowing act which is the prevention of polyhydramnion.

Nasal dermoid sinus in an American cocker spaniel

An American cocker spaniel was presented for a subcutaneous mass and draining tract located between its eyes. Contrast radiography and surgical excision showed communication of the tract with the left frontal sinus and rostral cerebral dura, respectively. A dermoid sinus was diagnosed by a combination of gross and histologic findings.

Mature teratoma with secondary infection: case report

Mature teratoma (dermoid cyst) is a common disorder in women of reproductive age. Sometimes the tumor is complicated by torsion, rupture, and malignant change. However, it rarely presents with fever. We present a 38-year-old woman with an intermittent fever for 30 days, who received occasional medical treatment without improvement. She was to our clinic for evaluation and treatment; however, fever persisted for three days without clinical improvement. No definite infection source could be identified except the presence of a huge pelvic tumor. The patient underwent exploratory laparotomy and an ovarian dermoid cyst with infection was noted. Pathology review revealed mature teratoma with superimposed infection by Escherichia coli. Fever impressively subsided on the fifth postoperative day. Although the majority of patients suffering from fever initially search for medical treatment at primary clinics, rare conditions such as persistent fever should be consulted by specialists to make differential diagnosis. Mature teratoma is rarely superimposed by infection and rarely causes fever. Furthermore, the possibility of fever caused by tubo-ovarian abscess (TOA) is often missed in patients with history of tubal ligation since there is a lower incidence of TOA in these unique patients. However, based on this case report, we should be alert whenever long-term fever is noted. Prompt surgical treatment for extirpation and an appropriate antibiotic treatment would be the choice of treatment in such cases.

Adenoid cystic carcinoma of the lacrimal gland simulating a dermoid cyst in a 9-year-old boy

Adenoid cystic carcinoma of the lacrimal gland is a malignant neoplasm that is generally found in adults and is usually managed by orbital exenteration and supplemental external beam irradiation or chemotherapy. A recent report has suggested that the tumor may have a less malignant course in children. We describe a case of adenoid cystic carcinoma of the lacrimal gland that simulated a dermoid cyst clinically and radiographically in a 9-year-old boy. The patient was treated with local surgical resection of the mass, followed by orbital plaque brachytherapy. Based on a review of the literature and our recent experience, the advisability of a more conservative approach to this tumor in selected cases is discussed. Although no prognostic conclusions can be drawn on the basis of a single case report with short follow-up, the relatively earlier detection of this tumor made possible by modern orbital imaging studies may allow total removal at an earlier stage and prevent orbital exenteration in a patient with normal vision. Recent developments suggest that there may be a basis for reassessing the advisability of a radical approach to the management of adenoid cystic carcinoma of the lacrimal gland in selected cases.

[Dermoid cysts of the oral cavity]

The authors describe ethiology, clinical picture, diagnosis and treatment of the dermoid cyst of oral cavity floor. They show the advantages after using ultrasonography and computer tomography in treatment of these cysts.

Paratesticular epidermoid cyst and ipsilateral spermatic cord dermoid cyst: case report and discussion of pathogenesis, diagnosis and treatment

We report a case of a paratesticular epidermoid cyst with a concurrent dermoid cyst of the ipsilateral spermatic cord at the internal inguinal ring. The patient presented for evaluation of a presumed testicular neoplasm. Epidermoid and dermoid cysts were confirmed histologically after local excision. To our knowledge concomitant occurrence of these lesions has not been reported previously. We discuss the pathogenesis, diagnosis and treatment.

Small cell carcinoma with neurosecretory granules arising in an ovarian dermoid cyst

A rare small cell carcinoma with neurosecretory granules arising in an ovarian dermoid cyst with 7 years survival after conservative surgery and adjuvant chemotherapy with cisplatin, adriamycin, and cyclophosphamide is described. Light microscopy showed the typical uniformly small cells with hyperchromic nuclei and scanty basophilic cytoplasm within the mature cystic teratoma. Although none of the immunohistochemical stains were reactive, electron microscopy demonstrated the membrane-bound neurosecretory granules in some tumor cells. The related literature is reviewed and the issues concerning treatment options in this unusual malignancy are discussed.

Haematogenous tumour growth in the inferior vena cava in a patient with a nonseminomatous testicular tumour

The case history is reported of a patient with an invasion of the inferior vena cava by metastases of a non-seminomatous testicular tumour. He was treated with combination chemotherapy, followed by laparotomy and resection of residual tumour tissue. Fourteen months after this operation he is in good health. For every retroperitoneal lymph node dissection it is necessary to be on the look-out for invasion of the vena cava, because of the risk of a sudden pulmonary embolism.

Malignant transformation in benign cystic teratomas: dermoids of the ovary

Twenty-four cases with a malignant change involving one of the elements of a benign ovarian dermoid cyst are reported. Squamous cell carcinoma was most frequent. Eighteen patients (75%) were over 50 years of age. The prognosis is rather good if the tumor has not extended beyond the capsule, 85% surviving without detectable disease after 4 months to 9 years. The prognosis is very poor if the tumor has extended beyond the capsule, over 80% dying within 2 years. Hysterectomy with bilateral salpingo-oophorectomy is the treatment of choice, certainly in older patients. Additional treatment with cytostatics or radiation seems to have little influence on the prognosis.

Squamous carcinoma arising in dermoid cysts and associated with hypercalcemia: a clinicopathologic study of six cases

Six cases of squamous carcinoma arising in dermoid cysts are reported. In four out of five cases in which serum calcium was measured hypercalcemia was present and increased pari passu with increases of tumor size. The presence of hypercalcemia in association with an ovarian tumor may therefore point to the possibility of this background. In all cases survival was short, ranging from 3 to 17 months. Five patients were treated with cisplatin, etoposide, and bleomycin but without great benefit. These cases, together with a review of the literature, suggest that a new treatment will be needed to improve survival in all but a few stage I cases.

Primary malignant melanoma arising in a cystic teratoma of the ovary

The 11th well-documented case of malignant melanoma, arising in a cystic teratoma of the ovary, is described. The melanoma which recurred 4 months after surgery responded completely to immunochemotherapy.

Sacrococcygeal teratomas in infants and children

From 1941 through 1983, a total of 66 patients with sacrococcygeal teratoma were seen, representing 41 percent of the total of 162 patients with teratomas from all anatomic sites seen over this period. Forty-six (70 percent) of the patients with sacrococcygeal teratomas were female and 34 (52 percent) were neonates. Younger patients had a significantly better prognosis. Approximately half (48 percent) of the patients had benign tumors. Of the other 34 patients, 19 (29 percent) had frank malignancy, being either a purely malignant tumor or a tumor with malignant mixed with benign elements, and 15 (23 percent) patients had tumors containing embryonic but no malignant components. Patients with tumors containing mature adult or embryonic tissues have a good prognosis. However, malignant sacrococcygeal teratoma portends a bleak prognosis irrespective of therapy (in this series only one patient survived among 19 patients with an average survival of 16 months after diagnosis).

Response of differentiated but not anaplastic teratoma to interferon

A Phase 2 trial was conducted using intramuscular lymphoblastoid interferon (IFN, Wellcome Research Laboratories), 4 MU per day, in 10 patients with chemotherapy-resistant teratomas. There was stabilisation of disease in 2 patients both of whom were in retrospect considered to have had differentiated teratoma at the time of IFN administration. There was progression of presumed active anaplastic germ cell tumour in 8 patients. One of these patients, a 15-year-old boy with biopsy proven differentiated teratoma has received 2 courses of lymphoblastoid IFN and 1 course of recombinant leukocyte A IFN (Roche Products Ltd.) lasting 5 1/2, 8 and 8+ months respectively. He has had a mixed response in his differentiated tumour which on each occasion has been maintained for the duration that he received IFN. Rising HCG levels during his second course of interferon required additional cytotoxic chemotherapy. Lymphoblastoid IFN does not appear to be active against anaplastic germ cell tumours but both lymphoblastoid and recombinant leukocyte A IFN may be useful in the treatment of unresectable differentiated teratoma.

Malignant change in benign cystic teratoma of the ovary

In a clinico-pathological study of malignant disease of the ovary in the former North East Metropolitan Region, malignant transformation of benign cystic teratoma has emerged as the commonest malignancy of "germ cell" origin. The clinical and pathological details of 12 patients are reported.