A Case of Autoimmune Hemolytic Anemia Associated with an Ovarian Teratoma

Abstract

Autoimmune hemolytic anemia associated with an ovarian teratoma is a very rare disease. However, treating teratoma is the only method to cure the hemolytic anemia, so it is necessary to include ovarian teratoma in the differential diagnosis of autoimmune hemolytic anemia. We report herein on a case of a young adult patient who had severe autoimmune hemolytic anemia that was induced by an ovarian teratoma. A 25-yr-old woman complained of general weakness and dizziness for 1 week. The hemoglobin level was 4.2 g/dL, and the direct and indirect antiglobulin tests were all positive. The abdominal computed tomography scan revealed a huge left ovarian mass, and this indicated a teratoma. She was refractory to corticosteroid therapy; however, after surgical resection of the ovarian mass, the hemoglobin level and the reticulocyte count were gradually normalized. The mass was well encapsulated and contained hair and teeth. She was diagnosed as having autoimmune hemolytic anemia associated with an ovarian teratoma. To the best of our knowledge, this is the first such a case to be reported in Korea.

Imaging Findings of Complications and Unusual Manifestations of Ovarian Teratomas

“…Coliform bacteria are the organisms most commonly implicated (14,37). Autoimmune hemolytic anemia has been associated with mature cystic teratomas in rare cases (38)(39)(40). In these cases, removal of the tumor resulted in complete symptom resolution.…”

Ovarian Teratoma Mimicking Features of Juvenile Dermatomyositis in a Child

“…Mature teratomas are benign and usually composed of 3 germ-cell layers (ectoderm, mesoderm, and endoderm). 7 Benign teratomas have been associated with a variety of paraneoplastic syndromes including limbic encephalitis, 8,9 opsoclonus-myoclonus syndrome, 10 seronegative polyarthritis, tenosynovitis, 11 and autoimmune hemolytic anemia, 12 but the association with JDM reported here is, to our knowledge, a novel observation. The MRI with fat suppression of the patient's proximal lower extremities, which revealed an increased T2-weighted signal in many of the muscles of the thighs bilaterally.…”

Warm antibody autoimmune haemolytic anaemia associated with ovarian teratoma

“…The haemolysis mechanism has not yet been clarified and further research would be of interest as available data has mainly reported on the past 4 – 7 , 9 – 11. The mechanisms proposed are: (1) liberation of the substance by the tumour, which alters the red cell surface rendering it antigenic to the host; (2) the tumour or its contents may contain material antigenic to the host, stimulating the production of antibodies that cross-reacts with host erythrocytes; (3) the ovarian tumour itself produces red cell antibody providing it is immunologically competent.…”

“…Although rare, AIHA can be an early paraneoplasic phenomenon of non-lymphoid neoplasm-like dermoid cysts and ovarian teratoma, Kaposi sarcoma and carcinoid. Few cases of AIHA associated with ovarian neoplasm have been described, almost always associated to dermoid cysts, and treatment involves the surgical removal of the lesion 3 – 7. We report a case of AIHA associated with an ovarian teratoma with haemolytic regression after ooforectomy plus splenectomy.…”