Journal of Pathology and Translational Medicine

Original Article

Diagnostic Significance of Cellular Neuroglial Tissue in Ovarian Immature Teratoma: Yun Chai, Chang Gok Woo, Joo-Young Kim, Chong Jai Kim, Shin Kwang Khang, Jiyoon Kim, In Ah Park, Eun Na Kim, Kyu-Rae Kim; J Pathol Transl Med. 2017;51(1):49-55. Published online October 14, 2016; DOI: https://doi.org/10.4132/jptm.2016.09.19

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Background
Immature teratoma (IT) is a tumor containing immature neuroectodermal tissue, primarily in the form of neuroepithelial tubules. However, the diagnosis of tumors containing only cellular neuroglial tissue (CNT) without distinct neuroepithelial tubules is often difficult, since the histological characteristics of immature neuroectodermal tissues remain unclear. Here, we examined the significance of CNT and tried to define immature neuroectodermal tissues by comparing the histological features of neuroglial tissues between mature teratoma (MT) and IT.
Methods
The histological features of neuroglial tissue, including the cellularity, border between the neuroglial and adjacent tissues, cellular composition, mitotic index, Ki-67 proliferation rate, presence or absence of tissue necrosis, vascularity, and endothelial hyperplasia, were compared between 91 MT and 35 IT cases.
Results
CNTs with a cellularity grade of ≥ 2 were observed in 96% of IT cases and 4% of MT cases (p < .001); however, CNT with a cellularity grade of 3 in MT cases was confined to the histologically distinct granular layer of mature cerebellar tissue. Moreover, CNT in IT exhibited significantly higher rates of Ki-67 proliferation, mitoses, and necrosis than those in MT (p < .001). Furthermore, an infiltrative border of neuroglial tissue and glomeruloid endothelial hyperplasia were significantly more frequent in IT cases than in MT cases (p < .001).
Conclusions
Our results suggest that if CNT with a cellularity grade of ≥ 2 is not a component of cerebellar tissue, such cases should be diagnosed as IT containing immature neuroectodermal tissue, particularly if they exhibit an infiltrative border, mitoses, necrosis, and increased Ki-67 proliferation.

Citations

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An Atypical Presentation of a Pediatric Mature Teratoma: A Case Report and Review of the Literature
Ahmed M Othman, Abdulaziz A Abu Alnasr, Reem E Kordi, Shahad A Abu Alnasr
Cureus.2024;[Epub] CrossRef
Immature Teratoma: Diagnosis and Management—A Review of the Literature
Liviu Moraru, Melinda-Ildiko Mitranovici, Diana Maria Chiorean, Marius Coroș, Raluca Moraru, Ioan Emilian Oală, Sabin Gligore Turdean
Diagnostics.2023; 13(9): 1516. CrossRef
Congenital Immature Grade ΙΙΙ Teratoma of the Neck: A Case Report
Nazneen Liaqat, Israr Ud Din, Zeeshan Ali, Majid Rashid, Afsheen Liaqat
Cureus.2023;[Epub] CrossRef
Benign ovarian teratoma in the dog with predominantly nervous tissue: A case report
P Makovicky, AV Makarevich, P Makovicky, A Seidavi, L Vannucci, K Rimarova
Veterinární medicína.2022; 67(2): 99. CrossRef
Fascin as a Useful Marker for Identifying Neural Components in Immature Teratomas of Human Ovary and Those Derived From Murine Embryonic Stem Cells
Ryunosuke Umehara, Atsushi Kurata, Masakatsu Takanashi, Hirotsugu Hashimoto, Koji Fujita, Toshitaka Nagao, Masahiko Kuroda
International Journal of Gynecological Pathology.2019; 38(4): 377. CrossRef
Cerebellar Differentiation in Ovarian Teratoma: A Report of 6 Cases
Colin J.R. Stewart, Maxine L. Crook
International Journal of Gynecological Pathology.2018; 37(4): 316. CrossRef
Mitotic activity of epithelia of ectoand entodermal types in spontaneous and experimental teratomas of mice
Pavel A. Dyban
Medical academic journal.2018; 18(4): 42. CrossRef
Ovarian cystectomy in the treatment of apparent early-stage immature teratoma
Ting Zhao, Yan Liu, Xiao Wang, Hao Zhang, Yuan Lu
Journal of International Medical Research.2017; 45(2): 771. CrossRef

Case Studies

Peritoneal and Nodal Gliomatosis with Endometriosis, Accompanied with Ovarian Immature Teratoma: A Case Study and Literature Review: Na Rae Kim, Soyi Lim, Juhyeon Jeong, Hyun Yee Cho; Korean J Pathol. 2013;47(6):587-591. Published online December 24, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.6.587

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Abstract PDF

Gliomatosis peritonei (GP) indicates the peritoneal implantation of mature neuroglial tissue and is usually accompanied by ovarian mature or immature teratoma. Here, we report a case of ovarian immature teratoma associated with gliomatosis involving the peritoneum, lymph nodes and Douglas' pouch, where gliomatosis coexisted with endometriosis. As far as we know, only seven cases of GP have been reported as coexisting with endometriosis. Eight cases with mature glial tissue in the lymph nodes, i.e., nodal gliomatosis, have been published either in association with GP or in its absence. Metaplasia of pluripotent coelomic stem cells has been suggested to be responsible for the pathogenesis of endometriosis and GP rather than implantation metastases of ovarian teratomatous tumor with varying maturation. This theory is also applied to GP independently of ovarian teratomatous tumors. To the best of our knowledge, nodal gliomatosis coexisting with GP and also involving endometriosis has not yet been reported.

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Mimics of primary ovarian cancer and primary peritoneal carcinomatosis – A pictorial review
B. Lawson, I. Rajendran, J. Smith, A. Shakur, V. Sadler, T.J. Sadler, H.C. Addley, S. Freeman
Clinical Radiology.2024; 79(10): 736. CrossRef
Ovarian Immature Teratoma With Nodal Gliomatosis: A Case Report and Literature Review
Marwa Alna’irat, W. Glenn McCluggage, Maysa Al-Hussaini
International Journal of Gynecological Pathology.2023; 42(6): 627. CrossRef
Germ Cell Tumors of the Ovary: A Review
Preetha Ramalingam
Seminars in Diagnostic Pathology.2023; 40(1): 22. CrossRef
Immature Teratoma with Gliomatosis Peritonei Arising in a Young Girl: Report of a Rare Case and Review of Literature
Isheeta Ahuja, Ruchi Rathore, Neerja Bhatla, Sandeep R. Mathur
Indian Journal of Gynecologic Oncology.2023;[Epub] CrossRef
Growing Teratoma Syndrome with Synchronous Gliomatosis Peritonei during Chemotherapy in Ovarian Immature Teratoma: A Case Report and Literature Review
Sijian Li, Na Su, Congwei Jia, Xinyue Zhang, Min Yin, Jiaxin Yang
Current Oncology.2022; 29(9): 6364. CrossRef
Extratesticular gliomatosis peritonei after mesenteric teratoma: a case report and literature review
Jiaqiang Li, Shoulin Li, Dong Xiao, Jiaming Song, Jianxiong Mao, Jianchun Yin
Journal of International Medical Research.2021;[Epub] CrossRef
Germ Cell Tumors of the Female Genital Tract
Elizabeth D. Euscher
Surgical Pathology Clinics.2019; 12(2): 621. CrossRef
Gliomatosis peritonei: a series of eight cases and review of the literature
Dan Wang, Cong-wei Jia, Rui-e Feng, Hong-hui Shi, Juan Sun
Journal of Ovarian Research.2016;[Epub] CrossRef

Sebaceous Carcinoma Arising in Mature Cystic Teratoma of Ovary: Hyo Jeong An, Yong Han Jung, Hye Kyoung Yoon, Soo Jin Jung; Korean J Pathol. 2013;47(4):383-387. Published online August 26, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.383

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Abstract PDF

Roughly 1% of mature cystic teratomas undergo malignant transformation. In particular, cutaneous-type adnexal neoplasms may occur in mature cystic teratomas. Sebaceous carcinomas, which arise from mature cystic teratomas, have rarely been observed, with only seven cases previously reported. Here, we present a case of a 69-year-old female who had pelvic pain for two weeks and who subsequently underwent bilateral salpingo-oophorectomy and hysterectomy. Her left ovary showed a unilocular cyst, measuring 22.0 cm in diameter, filled with sebaceous material and a few hairs. A luminally-protruding solid mass measuring 4.0 cm in diameter was also noted. Microscopic findings revealed lobular or diffusely arranged basophilic, atypical sebaceous cells connected to a typical mature cystic teratoma. Tumor cells demonstrated positive immunoreactivity for high molecular weight cytokeratin, cytokeratin 7, cytokeratin 19, epithelial membrane antigen, and carcinoembryonic antigen. Here, we present a case of sebaceous carcinoma arising from a mature cystic teratoma along with a review of previously published reports.

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How can we best manage ovarian sebaceous carcinomas arising from mature cystic teratomas?
Hong Min Shaye Peng, Sung Hock Chew, Yang Huang Grace Ng, Felicia Hui Xian Chin
BMJ Case Reports.2025; 18(2): e264651. CrossRef
Genetic Profiling of Sebaceous Carcinoma Arising from an Ovarian Mature Teratoma: A Case Report
Sumika Zaitsu, Yoko Aoyagi, Haruto Nishida, Kohei Nakamura, Mitsutake Yano, Eiji Kobayashi
International Journal of Molecular Sciences.2024; 25(12): 6351. CrossRef
Extraocular sebaceous carcinoma arising in a mature cystic teratoma of ovary: A case report and review of literature
Sara Pakbaz, Tanya Chawla, Marcus Q Bernardini, Liat Hogen, Marjan Rouzbahman
Human Pathology Reports.2022; 27: 300592. CrossRef
Sebaceous adenoma occurring within an intracranial dermoid cyst
Takashi Minamisaka, Johji Imura, Keitaro Shiraishi, Kohji Takagi, Takahiko Tomia, Sinichi Tanaka, Akira Noguchi, Takuya Akai, Kyo Noguchi, Satoshi Kuroda
Neuropathology.2022; 42(4): 289. CrossRef
Malignant transformation of mature cystic teratoma of the ovary
Doaa Atwi, Maria Kamal, Michael Quinton, Lewis A. Hassell
Journal of Obstetrics and Gynaecology Research.2022; 48(12): 3068. CrossRef
Sebaceous Carcinoma Arising in Ovarian Teratoma: First Report Associated With Germline Mismatch Repair Gene Mutation
Jacinta Murray, Patrick McIlwaine, Patrick J. Morrison, W. Glenn McCluggage
International Journal of Gynecological Pathology.2022; 41(6): 608. CrossRef
Impact of surgery and adjuvant treatment on the outcome of extraocular sebaceous carcinoma: a systematic review and individual patient's data analysis of 206 cases
Prashanth Giridhar, Lakhan Kashyap, Supriya Mallick, Ashish Dutt Upadhyay, Goura K. Rath
International Journal of Dermatology.2020; 59(4): 494. CrossRef
Mismatch repair deficiency is implicated in carcinoma arising from ovarian teratoma
Alvin Ho-Kwan Cheung, Chit Chow, Mei-Yung Yu, Wendy Wai-Tak Law, Peggy Pui-Ying Law, Paul Cheung-Lung Choi, Wei Kang, Ka-Fai To
Pathology.2019; 51(1): 67. CrossRef
Malignant transformation of an ovary mature cystic teratoma: case report and review of the literature
Elkin Fabián Dorado-Roncancio, Oscar Joel Carrillo-Garibaldi
Obstetrics & Gynecology International Journal.2019;[Epub] CrossRef
A case of ovarian clear cell carcinoma arising from ovarian mature cystic teratoma
Kazuya Maeda, Yoshito Terai, Shinichi Terada, Hiroshi Maruoka, Yuhei Kogata, Keisuke Ashihara, Yoshimichi Tanaka, Tomohito Tanaka, Hiroshi Sasaki, Satoshi Tsunetoh, Takashi Yamada, Masahide Ohmichi
Journal of Ovarian Research.2018;[Epub] CrossRef
Sebaceous carcinoma arising within an ovarian mature cystic teratoma: A case report with discussion of clinical management and genetic evaluation
Alyssa Wield, Melissa Hodeib, Mohammad Khan, Lindsay Gubernick, Andrew J. Li, Shivani Kandukuri
Gynecologic Oncology Reports.2018; 26: 37. CrossRef

Case Reports

Mature Teratoma in the Adrenal Gland.: Eun Jung Cha; Korean J Pathol. 2011;45:S98-S100.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S98

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Abstract PDF: A teratoma is a germ-cell tumor composed of tissue components representing derivatives of three germ layers. A teratoma in the region of adrenal gland is a rare retroperitoneal tumor. We now report a case of a primary adrenal teratoma. A 38-year-old woman presented with an incidentally detected adrenal mass. The computed tomography scan revealed a 9x8x7.5 cm fat density mass with calcification in the left adrenal gland. The surgically resected tumor was round and well circumscribed and the adrenal gland was present at the periphery of the tumor. The cut surface contained fat tissue and a hair containing cyst. Microscopically, the tumor consisted of adipose tissue, hair, skin appendage, nerve, muscle bundle and bone.

Primary Malignant Melanoma Arising in an Ovarian Mature Cystic Teratoma: A Case Report and Literature Review.: Sangho Lee, Ji Hoon Kim, Gyu Rak Chon, Aeree Kim, Baek Hui Kim; Korean J Pathol. 2011;45(6):659-664.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.6.659

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Abstract PDF

Ovarian primary malignant melanoma is very uncommon with only 44 reported cases in the literature. A 71-year-old woman with an ovarian mass and multiple nodules in the liver presented to our hospital. She was treated with bilateral salpingo-oophorectomy, and malignant melanoma was found in the mature cystic teratoma of the ovary. Malignant melanoma cells were also found in the ascitic fluid. She died 5 months later. Here we report a very uncommon case of malignant melanoma arising in an ovarian mature cystic teratoma with a review of the literature.

Citations

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Malignant Transformation of an Ovarian Mature Cystic Teratoma to a Malignant Melanoma
Rita Rathore, Sana Ahuja, Nuneno Nakhro, Pallavi Punhani, Sufian Zaheer
Indian Journal of Surgical Oncology.2024; 15(2): 380. CrossRef
Malignant melanoma arising in mature teratoma with pugnacious spread: A case report
Sumedha Gupta, Shalu Solanki, Saritha Shamsunder, Sana Ahuja, Vinayak Varma
Indian Journal of Obstetrics and Gynecology Research.2024; 11(1): 119. CrossRef
Therapeutic Management of Rare Primary Ovarian Neoplasms: Carcinosarcoma, Leiomyosarcoma, Melanoma and Carcinoid
Mateusz Kozłowski, Katarzyna Nowak, Agnieszka Kordek, Aneta Cymbaluk-Płoska
International Journal of Environmental Research and Public Health.2021; 18(15): 7819. CrossRef
Primary form of malignant melanoma in an ovarian mature cystic teratoma: case report and literature review
Fatemeh Samiee-rad, Amir Abdollah Zangivand, Kamran Soleimanitadi
Comparative Clinical Pathology.2017; 26(4): 989. CrossRef
Malignant melanoma arising in a mature teratoma: A case report with review of the recent literature
Lorna A. Brudie, Faizan Khan, Michael J. Radi, Melissa M. Yates, Sarfraz Ahmad
Gynecologic Oncology Reports.2016; 16: 47. CrossRef
Metastasizing Primary Malignant Melanoma of the Ovary: A Diagnostic Enigma
Narendra Hulikal, Manilal Banoth, Revanth Gangasani, Praveen C. Suresh, Radhika Kottu, Asha Thota
Journal of Gynecologic Surgery.2015; 31(3): 166. CrossRef

Mature Cystic Teratoma of the Fallopian Tube: A Brief Case Report.: Woo Jung Sung, Jun Mo Kim, Mi Jin Kim; Korean J Pathol. 2011;45(3):303-305.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.3.303

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Abstract PDF

Mature cystic teratomas of the fallopian tube are unusual, being almost incidentally identified. Here we describe a case of mature cystic teratoma arising in the fallopian tube, in a 44-year-old female. The mass was found during a regular checkup without complication. Microscopically, components from each germ layer were identified.

Citations

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Mature Cystic Teratoma of the Fallopian Tube in a Postmenopausal Woman: A Case Report and Review of the Literature
Mustafa Erkan Sari, Ozhan Ozdemir, Pinar Kadirogullari, Funda Arpaci Ertugrul, Cemal Resat Atalay
Case Reports in Obstetrics and Gynecology.2015; 2015: 1. CrossRef

Urothelial (Transitional Cell) Carcinoma Arising in Mature Cystic Teratoma: A Case Report.: Ok Jun Lee, Ho chang Lee; Korean J Pathol. 2010;44(6):666-669.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.6.666

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Abstract PDF

Mature cystic teratoma (MCT) is one of the most common benign ovarian tumors, but 1-2% of MCTs are transformed to a malignant neoplasm. Urothelial carcinoma (UC) or transitional cell carcinoma is the most common cancer in the urinary tract. However, UC is a very rare component of transformed malignancy of MCT. Here we report a case of UC arising in an MCT in a 52-year-old woman. Grossly, the ovary was partly cystic and partly solid. Microscopically, the cyst revealed the classic features of MCT and the solid area was papillary UC. By immunohistochemistry using cytokeratins and thrombomodulin, the UC showed a similar expression to that of UC arising in the urinary tract, rather than resembling a primary transitional cell carcinoma of the ovary. When UC is found in a component of MCT, the origin of the carcinoma should be evaluated and urinary tract examinations are required to rule out metastasis.

Citations

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A Rare Urothelial Malignant Transformation in a Mature Cystic Teratoma of the Ovary
Moito Iijima, Iori Kisu, Tetsuro Shiraishi, Rie Irie, Nobumaru Hirao
Cureus.2021;[Epub] CrossRef
Transitional Cell Carcinoma arising in Ovarian Cystic Teratoma: A Rare Case Report
Abhay V. Deshmukh, Vitaladevuni B. Shivkumar, Neha V. Fulzele, Nitin M. Gangane
Indian Journal of Gynecologic Oncology.2020;[Epub] CrossRef
A Rare Malignant Transformation of an Ovarian Cystic Teratoma: A Case Report
Manju Rachel Mathew, Anita Ramdas, Susy S. Kurian, Linu Kuruvilla, Neelima Singh
Case Reports in Pathology.2018; 2018: 1. CrossRef
Urothelial carcinoma arising from an ovarian mature cystic teratoma
Hui-Yu Chuang, Yi-Ting Chen, Tak-Loi Mac, Yu-Chieh Chen, Hung-Sheng Chen, Wan-Shan Wang, Eing-Mei Tsai
Taiwanese Journal of Obstetrics and Gynecology.2015; 54(4): 442. CrossRef

Malignant Fibrous Histiocytoma Arising in a Mature Cystic Teratoma of the Ovary: A Case Report.: Soyoung Im, Sun Mi Lee, Ji Han Jung, Hyun Joo Choi, Jinyoung Yoo, Seok Jin Kang, Kyo Young Lee; Korean J Pathol. 2010;44(3):322-325.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.3.322

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Abstract PDF: A 50-year-old female patient presented with anorexia and weight loss. Pelvic computed tomography revealed a 12.5 x 7.3 cm heterogeneous mass in the left ovary. About 30% of the tumor was occupied by a mature cystic teratoma. The remaining solid portion was composed of fibrous and histiocytic elements, arranged in storiform patterns admixed with bizarre giant cells. The mitotic index was 8 per 10 high power fields, including atypical mitoses. The only immunopositivity was for vimentin. The tumor was diagnosed as a malignant fibrous histiocytoma arising in a mature cystic teratoma. To the best of our knowledge, this is only the third such case in the English language literature.

Mature Teratoma of the Rectum: A Case Report.: Kyung Sun Park, Mi Seon Kang, Young Ju Kim, Chan Hwan Kim, Hye Kyoung Yoon; Korean J Pathol. 2001;35(1):83-85.

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Abstract PDF: Teratoma commonly affects the gonads. Its occurrence in extragonadal sites has also been reported. However, teratoma affecting the gastrointestinal tract is extremely uncommon. Herein, we describe a rare case of rectal teratoma presenting a solid polypoid tumor. A 61-year-old woman with constipation is presented. She had a colonoscopic examination and was noted to have a pedunculated polyp at the rectum, located 15 cm from the anal verge. The 4.2x2.4x2.0 cm polyp arose at the rectal mucosa which had a long stalk and smooth surface. The cut surface showed a solid area with a central yellow area. Microscopically, the polyp was covered with keratinizing stratified squamous epithelium which was abruptly exchanged from the columnar rectal mucosa. Sebaceous glands, sweat glands and hair follicles were mixed in stroma under the surface of the polyp. The central portion of the polyp was composed of mature adipose tissue and collagen fibers. Mature neural elements were noted in the stalk.

Primary Carcinoid Tumor Arising in a Mature Teratoma of the Testis: A Case Report.: Jai Hyang Go; Korean J Pathol. 2001;35(1):86-88.

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Abstract PDF: Primary carcinoid tumor is rarely associated with mature teratoma in the testis. In the few cases reported, the primary carcinoid tumors in the testis were often microscopic in size. Although it has been generally accepted that carcinoids arising in teratomas have an indolent clinical course, some of these tumors have been reported to metastasize and cause death of the patient. Therefore, long term follow up may be warranted for patients having primary testicular carcinoid tumors irrespective of coexisting teratoma. We report a case of primary testicular carcinoid tumor of microscopic size incidentally found in mature cystic teratoma occurring in a 44 year-old male patient.

Benign Teratomas of the Fallopian Tubes: A report of two cases.: Hee Na Kim, Mi Kyung Jee, Ki Hwa Yang, Seok Jin Gang, Eun Joo Seo, Byung Kee Kim, Sun Moo Kim; Korean J Pathol. 1989;23(3):374-378.

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Abstract PDF: Teratomas of the fallopian tubes are very rarely encountered in the western literature, and not a single case has been documented in Korea. The authors experienced two cases of tubal teratomas. Both patients developed a teratoma in an ampullary portion of the right fallopian tubes. One case occured as an incidental finding, and the other case was presented with a tubal mass. The gross and light microscopic features of these teratomas were described, and a brief review of the literature on the tubal teratomas is made.

Adenocarcinoma arising in Sacrococcygeal Teratoma: A case report.: Mi Kyung Kim, Eon Sup Park, Yong Wook Park, Kye Young Song, Eon Woo Lee; Korean J Pathol. 1989;23(3):396-401.

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Abstract PDF: Authors experienced a rare adenocarcinoma arising in presacral sacrococcygeal teratoma in a adult and herein reported. The patient was a 52 year old female admitted because of lower abdominal pain for 5 to 6 months. Past and familial history were unremarkable. On rectal examination a mass was palpated 3 cm above the anal verge. The large bowel was displaced by an extrinsic mass but there was no evidence of intrinsic tumor lesion on barium enema, CT was done and showed a large presacral tumor attached to the sacrum. Clinical impression was sacrococcygeal teratoma. Resected tumor mass was a relatively well circumscribed cystic mass, measuring 11 x 11 cm and the cystic content was previously evacuated. Inner surface showed ragged appearance, and focal nodular solid area was noted. On microscopic examination, the tumor revealed the derivatives of three germ layers and main components were tissues of respiratory tract. Sections from the solid area showed a well differentiated adenocarcinoma and with stromal, capsular and perineural invasion. Borderline malignant epithelial lesions are also noted suggesting the pathogenesis and progression of this tumor. There was no recurrence for one year after surgery in the follow up.

A Case of Intracranial Malignant Teratoma.: Bong Kwon Chun, Hee Kyung Chang, Man Ha Huh; Korean J Pathol. 1990;24(1):85-90.

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Abstract PDF: The authors report a case of malignant teratoma in a 3-year-old girl who suffered from occipital headache and vomiting for about 2 months. The tumor occupied left cerebellopontine angle resulting in a moderate degree of hydorcephalus. Histologically, the tumor consisted mainly of neuroepithelial tissues showing varying degrees of differentiation, with areas of epidermis, mature fat tissue, connective tissue, gastrointestinal glands and smooth muscle bundles containing ganglions. Also noted are groups pf polygonal or spindle cells representing immature mesodermal tissue. In contrast to two malignant intracranial teratomas previously reported in Korean literatures, this case is characterized by the presence of predominent neuroepithelial components and by uncommon tumor location, the posterior fossa far from middle line of the body.

Cystic Struma Ovarii Mimicking Adenomatous Goiter of the Thyroid.: Kee Taek Jang, Je Geun Chi; Korean J Pathol. 1997;31(7):692-694.

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Abstract PDF: Struma ovarii, the most common monodennal teratoma of the ovary, causes diverse problems in differential diagnosis. The literature on the pathology of struma ovarii has focused principally on the problem of formulating criteria of malignancy. In contrast, unusual gross and microscopic features of struma ovarii and its resultant problems in differential diagnosis have received relatively little attention. We report an ovarian teratoma which was almost entirely cystic, causing the diagnosis of struma to be overlooked. The removed ovarian tumor showed all the features of adenomatous goiter of the thyroid gland. The lining epithelium of the cysts was frequently flattened, and the follicles in the cyst wall were few and atrophic. The patient was a 58-year-old woman who was found to have an ovarian tumor by routine monographic examination

Prostatic Tissue in Ovarian Mature Cystic Teratoma: A case report.: Seung Mo Hong, Mi Sun Choe, Eun Mee Han, Hun Kyung Lee, Jae Y Ro; Korean J Pathol. 1999;33(7):525-528.

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Abstract PDF: Ovarian mature cystic teratoma containing benign prostatic tissue is rare and only 11 cases have been reported in the literature to date. We report a case of mature cystic teratoma of the ovary containing prostatic tissue. A 23-year-old female patient came to our hospital complaining of irregular menstruation for 3 months. Her menarche had occurred when she was 13 years old. The patient showed no evidence of virilization nor of endocrinopathy. A goose-egg-sized mass was palpable in the left lower abdomen on physical examination. Ultrasonography revealed a cystic ovarian mass with internal echogenecity. Microscopic finding was consistent with that of usual mature cystic teratoma except for a 1.5 cm focus of prostatic and bladder tissues. Prostatic tissue demonstrated strong immunoreactivity for prostatic specific antigen (PSA), prostatic alkaline phosphatase (PAP) and cytokeratin 7. Basal cells of the prostate glands were positive for high molecular weight cytokeratin (34betaE12). Although ovarian mature cystic teratoma containing prostatic tissue has been reported as a rare occurrence, a careful examination with immunohistochemical staining may increase the detection of prostatic tissue in mature cystic teratoma of the ovary.

Congenital Intracranial Teratoma with Extension into Oral Cavity: An autopsy case.: Young Sill Kim, Kyo Young Lee, Chang Suck Kang, Sang In Shim, Sun Moo Kim; Korean J Pathol. 1990;24(3):326-330.

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Abstract PDF: Intracranial teratomas which were first described by Maier in 1861 are uncommon. Those presenting at birth are very rare and in our knowledge no case has been reported in Korea. In November, 1988, we experience a case of congenital intracrainal teratoma which replaced almost all cerebral tissue, filled out the oral cavity, and was protruded from the mouth. A female fetus was artificially delivered by a 25-year-old primigravida at 22 weeks of gestation, because of marked hydramnios and fetal hydrocephalus which were detected by prenatal ultrasonography. Microscopically, tissues from all three germ layers, including a lot of neuroepithelim and primitive mesenchymal tissue, were shown. A brief review of the literature was done.

Squamous Cell Carcinoma Arising from Mature Cystic Teratoma of the Ovary: A report of three cases .: Mee Joo, Han Nae Min, Yun Kyung Kang, Hye Kyung Lee, Young Chae Cho, Eung Soo Lee; Korean J Pathol. 1999;33(12):1211-1215.

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Abstract PDF: Malignant transformation develops in a little less than 2% of mature cystic teratomas. A wide variety of malignant tumors may arise within benign mature cystic teratomas, and the most common of these is squamous cell carcinoma, which account for 75~85%. In general, the tumors are in an advanced stage and the prognosis is poor as most patients die within a year. However, when the tumor is confined to the ovary, they have a good prognosis and the 5-year survival rate is 63~83%. We experienced three cases of squamous cell carcinoma arising in mature cystic teratoma. Two of the carcinomas occurred in postmenopausal women: 58-(case 1) and 66-(case 2) year-old, and were confined to the ovaries. They were alive 37 months and 18 months after the operation, respectively. The third case was a 45-year-old premenopausal woman who had an extraovarian extension of the tumor and early recurrence within two months. Histologically, cases 1 and 3 were conventional well to moderately differentiated squamous cell carcinomas and case 2 showed a well-differentiated squamous cell carcinoma with exuberant proliferating trichilemmal tumor-like areas.

Original Article

Squamous Cell Carcinoma and Struma Ovarii Arising in Benign Cystic Teratoma.: Eun Sook Nam, Young Seek Kim, Yang Seok Chae, Kap No Lee, Seung Yong Paik; Korean J Pathol. 1991;25(5):462-466.

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Abstract: Malignant tumor is found in 1-2% of ovarian benign cystic teratomas. Among these malignant neoplasms, squamous cell carcinoma is by far the most common malignancy, whereas the incidence of struma ovarii is less than 5% in mature teratoma. As far as concerned the struma ovarii, a very small percentage is associated with carcinoid, mucinous or serous cystadenoma, or Brenner tumor. However, any reports of struma ovarii associated with squamous cell carcinoma in the same ovary could not be found in English literature. Recently we have experienced a case of squamous cell carcinoma and struma ovarii arising in an ovarian benign cystic teratoma in 72 year old female patient.

Case Report

Low-grade Immature Teratoma of the Ovary with Gliomatosis Peritonei: A case report.: Jin Young Yoo, Sang In Shim; Korean J Pathol. 1994;28(3):322-324.

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Abstract: Immature teratoma accounts for less than I percent of all ovarian teratomas and occurs commonly in young individuals, the peak incidence being in the second decade. It contains a variable mixture of mature and immature tissues in which neuroectodermal elements almost always predominate. Gliomatosis peritonei, miliary implants of mature glial tissues on the peritoneum or omentum, is an infrequently reported complication of mature or immature ovarian teratomas. We describe the first case in Korea of a 12-year-old girl with an immature teratoma and numerous glial peritoneal implants.

Original Article

Malignant Teratoma in the Mediastinum Associated with Endodermal Sinus Tumor and Squamous Cell Carcinoma.: Keun Hong Kee, Ho Jong Chun, Chae Hong Suh, Hae Sook Song; Korean J Pathol. 1988;22(1):82-87.

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Abstract PDF: Anterior mediastinal teratoma was removed from the right hemithorax of a 15-year-old male patient presenting initially with right chest discomfort and hemoptysis. He was died following precipitous clinical deterioration, 2 months after open thoracotomy. The true malignant nature of this tumor, that there are endodermal sinus tumor and squamous cell carcinoma, was apparent on resection specimen. The former had metastasized to right supraclavicular lymph node. A similar case has not been reported previously on the review of the pertinent literature on malignant mediastinal teratoma.

Case Reports

Adenocarcinoma Arising in Sacrococcygeal Teratoma: A case report.: Hae Jeong Choi, Mi Jin Gu, Yeong Kyung Bae, Joon Hyuk Choi, Jae Hwan Kim; Korean J Pathol. 1998;32(4):315-317.

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Abstract PDF: We experienced a case of adenocarcinoma arising in sacrococcygeal teratoma. The patient was a 52-year-old woman. She was admitted due to one month of sacral pain. She had a sacral mass since birth. On physical examination, anal fistula was present at the perianal area and pus drainage was noted. MR image showed multiple variable-sized cysts with inhomogeneous density. Resected specimen, mesuring 12.5 7.0 cm in diameter, showed multiple variable-sized cystic lesions admixed with grayish solid portion. The cysts contained mucoid material. The microscopic examination showed mature teratoma composed of cysts lined by pseudostratified ciliated columnar epithelium, intestinal mucosa, mature cartilage, bone, and fat tissue. A moderately differentiated adenocarcinoma developed from the cystic area in the mass.

Malignant Struma Ovarii: A case report.: Ki Jung Yun, Hyang Jeong Jo, Weon Cheol Han, Hyung Bae Moon; Korean J Pathol. 1994;28(4):436-438.

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Abstract PDF: Malignant struma ovarii is a rare tumor of the ovary. This can be diagnosed by histologically when carcinomas of the thyroid gland are excluded. We present a case of malignant struma ovarii arising from cystic teratoma. A 42-year-old female was admitted for evaluation of lower abdominal mass. Hysterectomy and both adnexectomy were performed on the basis of a clinical impression of uterine leiomyoma and an ovarian mass. The uterus revealed intramural leiomyoma, measuring 8 cm in diameter. Ovarian mass was predominantly cystic and partly solid. Microscopically, thyroid tissue with papillary structures were found in the solid area Papillae were complex, branching and randomly oriented. These papillae were infiltrated in the adjacent fibrous capsule, Clinical evidence of a primary thyroid carcinoma was not found.

Original Articles

Sebaceous Gland Tumor Arising in Cystic Teratoma of the Ovary: An unique form of monodermal teratoma.: Dae Joong Kim, So Young Jin, Dong Wha Lee; Korean J Pathol. 1992;26(1):82-87.

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Abstract PDF: Although cystic teratoma is the most common benign tumor of the ovary, the association of sebaceous gland tumor with cystic teratoma is rare. We have recently experienced a case of sebaceous gland tumor, arising in the cystic teratoma of the ovary in a 78-year-old Korean woman. Histologically, the tumor was characterized by an organoid lobular architectures of the sebaceous glands which are exculsively composed of germinative and mature sebaceous cells. Although it is difficult to come to a valid conclusion due to the presence of atypical mitosis and necrosis, this tumor was regarded as benign from the viewpoint of preserved organoid structures, and absence of capsular invasion or metastasis.

Ovarian mature cystic teratoma with histologic features of chronic thyroiditis: Histologic analysis of 4 cases.: Doo Hyun Chung, Weon Seo Park, Soo Min Kang, Eun Sil Yu, Seong Hoe Park; Korean J Pathol. 1992;26(3):209-214.

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Abstract PDF: We have reviewed ovarian mature cystic teratomas with features of chronic thyroiditis that were diagnosed at the department of pathology, Seoul National University Hospital during 7 years, 1984-1991. Twenty three case(8%) containing thyroid tissue among 285 ovarian mature teratomas were available for histopathologic examination. Among these, 4 cases(1.4%) showed lymphocytic infiltration with lymphoid follicle formation. These four cases were examined according to the strict histologic criteria of autoimmune thyroiditis and reactive non-autoimmune thyroiditis for the purpose of differentiation of pathogenesis. Two cases were similar to autoimmune in nature and the other two cases simply seemed to reflect reactive features to adjacent stimulating elements. In conclusion, thyroid tissue present in ovarian cystic teratoma may have histologic features of chronic thyroiditis of either autoimmune or non-autoimmune origin.

Case Report

Mature Cystic Teratoma of the Fallopian Tube: A case report.: Kye Weon Kwon, Jong Yup Bae, Hee Jung Ahn, Yoon Jung Ahn, Bok Soo Kim; Korean J Pathol. 1996;30(10):951-953.

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Abstract PDF: Teratomas of the fallopian tube are extremely rare, and only about 50 cases have reported in the world literature. Most cases of mature cystic tubal teratoma are asymptomatic and are discovered as an incidental finding on physical or radiologic examination, or at the time of laparatomy. We report a case of mature cystic teratoma of the right fallopian tube which was discovered during pelvic ultrasonogram for antenatal care in a 28 year old woman. Right salpingectomy was performed during cesarean section for cephalo-pelvic distortion at IUP 39 weeks. Gross examination of the right fallopian tube reveals a distended fallopian tube, measuring 8cm in length and 2cm in diameter. On section, it is filled with several small pedunculated nodules and cysts containing sebaceous materials. Microscopically the tumor was seen in continuity with the lining epithelium of mucosal folds. The majority of the tumor was composed of well differentiated mature elements of three germ layers with skin and skin appendages, mature brain tissue, bone, breast tissue, intestinal mucosa and bronchial epithelium.

Original Article

Squamous Cell Carcinoma Arising in Mature Cystic Teratoma of the Ovary: a Report of Six Cases and Immunohistochemistry of the p53 Protein and p21WAF1/CIP1.: Kyung Hee Kim, Kwang Sun Suh, Joo Heon Kim, Dong Wook Kang, Dong Hoon Kim, Seong Ho Kim, Jong Ho Back, Mee Ja Park; Korean J Pathol. 2003;37(5):316-319.

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Abstract: BACKGROUND
Mature cystic teratoma is a common type of ovarian tumor. Although squamous cell carcinoma (SCC) is the most common carcinoma in malignant transformations of ovarian mature cystic teratomas, SCC arising in a mature teratoma is rare.
METHODS
This paper reports four cases of invasive SCC, a case of an adenosquamous cell carcinoma and a case of a pure in situ SCC arising in a mature cystic teratoma including a clinicopathological evaluation and an immunohistochemical study of the p53 protein and p21WAF1/CIP1.
RESULTS
The mean age of the patients was 60 years. The sizes of the mature cystic teratomas in all cases were greater than 7.5 cm in the largest diameter. Five cases showed the nuclear accumulation of the p53 protein with no p21WAF1/CIP1 immunoreactivity. The other case showed the nuclear accumulation of p21WAF1/CIP1 without p53 expression. There was a significant inverse relationship between the p53 protein level and p21WAF1/CIP1 expression.
CONCLUSION
A clinicopathological evaluation showed that a SCC arising from a mature cystic teratoma must be included in a differential diagnosis when the patient is over 42 years of age and the size of a mature cystic teratoma is greater than 75 mm in the largest diameter. It is suggested that p53 overexpression is implicated in the malignant transformation, and the p21WAF1/CIP1 expression level is dependent on alterations in the level of the p53 protein in these tumors.

Case Reports

Primitive Neuroectodermal Tumor Associated with Mature Cystic Teratoma of the Ovary: A case report.: Young Ju Kim, Mi Yeong Jeon, Mi Sun Kang, Chan Hwan Kim; Korean J Pathol. 1996;30(12):1150-1154.

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Abstract PDF: Malignant transformation of benign cystic teratomas of the ovary is rare, with an incidence rate of 1-3%. The most common malignancy associated with benign cystic teratoma of the ovary is squamous cell carcinoma, which represents 90% of malignant transformations, followed by adenocarcinoma and carcinoid. Primary malignant neuroectodermal tumor in a mature cystic teratoma is extremely rare and microscopically can be subclassified as differentiated, primitive, and anaplatic. We experienced a case of primitive neuroectodermal tumor (PNET) associated with mature cystic teratoma of the ovary in a 11-year-old girl. Grossly, the ovary was a unilocular cyst which contained sebum material and disclosed several large, yellow to gray-tan polypoid excresences attached to the inner cystic wall. Except a large, fish-flesh, soft mass, the other polypoid masses were covered with sebum and contained small pieces of cartilage and tooth, and microscopically represented as mature teratoma. The large, fish-flesh, soft mass disclosed sheets and lobules of closely packed small cells with thin fibrovascular septa, which frequently replacing and encroaching the mature cystic teratoma. The small tumor cells were uniform and made up of round to oval nuclei with coarse chromatin and prominent nucleoli, very similar to those of PNET of the central nervous system.

Pure Immature Teratoma with Increase of Serum alpha-fetoprotein: A Case Report.: Bohng Hee Kim; Korean J Pathol. 2007;41(1):63-65.

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Abstract PDF: In the immature teratoma with increased serum alpha-fetoprotein (AFP), a complete pathologic examination is especially required because coexistence with other germ cell tumors is associated with a poor prognosis. If the case is proved to be a pure immature teratoma in spite of a thorough examination, the source of AFP should be found as an AFP-producing pure immature teratoma is not associated with a poor prognosis. In this case of a grade III-immature teratoma in an ovary of a 12-year old girl, serum AFP was increased. On pathologic examination, there was no evidence of a yolk sac tumor or embryonal carcinoma. On an AFP immunohistochemical stain, immature liver tissue, digestive and respiratory epitheliums were positive.

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