Imprint cytology of high‐grade immature ovarian teratoma: A case report, literature review, and distinction from other ovarian small round cell tumors

Ramalingam, Preetha; Teague, Daniel J.; Reid-Nicholson, Michelle

doi:10.1002/dc.20849

Cited by 5 publications

(7 citation statements)

References 14 publications

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“…Sensitivities of frozen section diagnosis for benign, malignant and borderline ovarian epithelial tumors have been reported as 98, 88.7 and 61%, respectively [5]. The literature contains very few reports that have included information regarding ovarian germ cell tumors [8,13,14]. Pavlakis et al [11] reported that most immature teratomas were incorrectly diagnosed on frozen section examination in their study.…”

Section: Discussionmentioning

confidence: 99%

“…Few reports have detailed cytology of ovarian germ cell tumors [13,14]. In cases of low-grade immature teratoma, some frozen sections were assessed as false-negatives due to poor cellularity and poor preservation of the immature part.…”

Section: Discussionmentioning

confidence: 99%

“…Sensitivity rates of frozen section diagnosis for benign, malignant and borderline ovarian epithelial tumors were 98, 88.7 and 61%, respectively [5]. However, very few reports have provided information in relation to ovarian germ cell tumors [8,13,14]. …”

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confidence: 99%

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Usefulness of Intraoperative Imprint Cytology in Ovarian Germ Cell Tumors

Abe

Sugiyama²,

Furuta³

et al. 2013

Acta Cytologica

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Objective: This study retrospectively investigated the usefulness of intraoperative diagnosis based on imprint cytology and frozen sections for ovarian germ cell tumor. Study Design: Intraoperative studies were reviewed for 23 cases with ovarian germ cell tumor treatment for which both frozen sections and imprint cytology were available. Final histopathologic diagnoses were compared with those based on intraoperative examinations. Results: Underlying pathologies included dysgerminoma (n = 6), yolk sac tumor (n = 1), non-gestational choriocarcinoma (n = 1), mature cystic teratoma with malignant transformation (n = 1), immature teratoma (n = 11), and mixed germ cell tumor (n = 3). Discrepancies between intraoperative imprint cytology and definitive histologic diagnosis were seen in 6 of the 23 cases. Accuracy was 54.5% (6/11) for immature teratoma and 91.7% (11/12) for other tumors. Cytologic examination facilitated accurate diagnosis in both of our cases, and intraoperative diagnosis by frozen section proved inaccurate. Conclusion: These results demonstrate that intraoperative assessment based on imprint cytology for immature teratoma has a relatively lower sensitivity, but an acceptable sensitivity for other germ cell tumors. Diagnostic approaches combining frozen sections and imprint cytology are advisable to improve the yield for intraoperative diagnosis.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Usefulness of Intraoperative Imprint Cytology in Ovarian Germ Cell Tumors

Abe

Sugiyama²,

Furuta³

et al. 2013

Acta Cytologica

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“…Immaturity is usually manifested as neuroepithelium occurring either solely or in combination with immature cellular glia. 2 In adults, quantification of neural tissue is the most important factor in tumor grading and has been shown to correlate with patient's survival. 2 Immature teratoma grows rapidly, pen-etrates its capsule, and forms adhesion to surrounding structure.…”

Section: Cytologic Findingsmentioning

confidence: 99%

“…2 In adults, quantification of neural tissue is the most important factor in tumor grading and has been shown to correlate with patient's survival. 2 Immature teratoma grows rapidly, pen-etrates its capsule, and forms adhesion to surrounding structure. It metastasizes first to para aortic and pelvic lymph node and later to lung, liver, and other organ.…”

Section: Cytologic Findingsmentioning

confidence: 99%

Metastatic of mature component in a treated case of immature teratoma diagnosed on fine‐needle aspiration cytology of the liver

Barwad

Dey

Shivalingam

2010

Diagnostic Cytopathology

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Immature teratoma of the ovary is an uncommon tumor, comprising of <1% of teratomas of ovary. 1 In contrast to the mature cystic teratoma, which occurs in reproductive age group, the immature teratoma occurs most commonly in first two decades of life. Immature teratomas are composed of tissue derived from the three germ layers and contain immature and embryonal structure. Immature teratoma grows rapidly, penetrates its capsule, and forms adhesion to surrounding structure. It metastasizes first to para aortic and pelvic lymph node and later to lung, liver, and other organ. Excision of tumors is often followed by local recurrence, usually within first year of primary therapy.Here, we present a case of immature teratoma that presented with isolated liver metastasis and was confirmed in FNAC from the liver as metastasis of mature elements.A 26-year female pregnant patient was referred to the department of gynecology in September 2009 at eighth month of gestation with left adenexal mass detected on ultrasonography. No other mass lesion was identified in other organs. Patient was subsequently managed with elective lower uterine cesarian section with the removal of left ovarian mass. Grossly, the tumor was well encapsulated. Cut surface showed solid as well as small cystic areas of maximum size 5-mm diameter. Histological sections showed a neoplasm composed of an admixture of mature and immature teratomatous elements. The immature elements were mainly in the form of neuroectodermal rosettes and tubules (Fig. 1). Rosettes were lined by small round basophilic cells with high-mitotic activity. Mature element was mainly composed of respiratory and intestinal epithelium. No other germ-cell components were identified despite extensive sampling. Based on histological findings and amount of immature element, diagnosis of immature teratoma grade 2 was given. Based on the diagnosis, patient was treated with postoperative chemotherapy with six cycles of bleomycin, etopoxide, and cisplatin (BEP) regimens.Three months after completion of chemotherapy, patient on follow-up presented with dull aching pain in right hypochondrium. On CT scan, single large subcapsular mass having fat density was identified in the segments 7 and 8 of right lobe of liver measuring 10 3 9.5 3 7.8 cm (Fig. 2). On ultrasonography examination, the lesion showed heterogeneous intensity with predominantly solid areas. Standard FNAC procedure was performed under ultrasonography guidance. Three passes were taken from different areas of the lesion. The cytological diagnosis of metastatic teratoma with mature elements was given in FNAC. Cytologic FindingsFNA stained by the May-Grunwald-Giemsa, hematoxyline and eosin, and papanicolaou method revealed cellular smears composed of multiple clusters and single cells admixed with chodro-myxoid stromal fragments (Fig. 3). The cell clusters exhibited abundant nuclear overlap, thereby producing a three-dimensional appearance. The cells were large, round to oval with abundant pale vacuolated cytoplasm, and round monomorphic n...

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Ovaries, fallopian tubes and associated lesions

Manek¹,

Mahovlić²

2010

Diagnostic Cytopathology

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Imprint cytology of high‐grade immature ovarian teratoma: A case report, literature review, and distinction from other ovarian small round cell tumors

Cited by 5 publications

References 14 publications

Usefulness of Intraoperative Imprint Cytology in Ovarian Germ Cell Tumors

Usefulness of Intraoperative Imprint Cytology in Ovarian Germ Cell Tumors

Metastatic of mature component in a treated case of immature teratoma diagnosed on fine‐needle aspiration cytology of the liver

Ovaries, fallopian tubes and associated lesions

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