Malignant Alteration in Benign Teratomas

Waxman, Marian; Deppisch, Ludwig M.

doi:10.1007/978-1-4612-5628-1_5

Cited by 4 publications

(1 citation statement)

References 68 publications

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“…If a patient is 70 years of age or older and has a dermoid cyst, there is a 15 percent chance that it will contain a malignant tumor. 17 May we have information on the follow-up course, Dr. Fidias? D R .…”

Section: R a Rlan F F Uller J R ' S D Iagnosesmentioning

confidence: 99%

Case 18-1995

Fuller¹,

Fleischhacker²

1995

N Engl J Med

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A 59-year-old woman was admitted to the hospital because of increasing constipation, abdominal pain, and a rectosigmoid mass.The patient had been well until three months earlier, when pain in the right lower quadrant and constipation developed and gradually worsened; she passed mucus in her stools, without blood. Three weeks before admission colonoscopic examination at the gastrointestinal clinic showed a concentric mass, approximately 8 cm in diameter, in the sigmoid colon, with nearly complete obstruction. A pediatric endoscope was passed into the ascending colon with difficulty. No further abnormalities were observed. It was noted that the mucosa overlying the mass appeared normal. Microscopical examination of six biopsy specimens of the lesion revealed mildly edematous colonic mucosa with patchy eosinophilic infiltration of the lamina propria and glandular epithelium; no eosinophilic abscesses or microorganisms were identified. A barium-enema examination ( Fig. 1), performed with the air-contrast technique, showed a constricting lesion, 8 cm in length, of the distal sigmoid colon with an apple-core appearance; the remainder of the colon appeared normal. A computed tomographic (CT) scan of the abdomen and pelvis (Fig. 2) revealed a right extrarenal pelvis, a calculus (7 by 4 mm) in the upper pole of the right kidney, and another calculus (7 mm) in the lower pole of the left kidney. The rectosigmoid colon was constricted, with diffuse thickening of its wall and strands of soft-tissue density that extended into the pericolonic fat. A heterogeneous, rounded, fat-containing, soft-tissue mass (7 cm in diameter) was contiguous with the rectosigmoid wall. No lymphadenopathy was detected, and the bladder, liver, gallbladder, pancreas, spleen, and adrenal glands appeared normal.During the week before admission, a cough produc-tive of purulent sputum developed, accompanied by low-grade fever and dysuria. Radiographs of the chest disclosed an infiltrate in the right middle lobe and another in the right upper lobe; the right cardiac border was poorly delineated. The urine was normal. A culture of sputum yielded moderate growth of Streptococcus pneumoniae and Branhamella catarrhalis. The patient was admitted to the hospital. The patient was a housewife. She had a five-year history of non-insulin-dependent diabetes mellitus. She had eaten less than usual in recent months and had lost 9.1

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Section: R a Rlan F F Uller J R ' S D Iagnosesmentioning

confidence: 99%

Case 18-1995

Fuller¹,

Fleischhacker²

1995

N Engl J Med

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Pathology of ovarian cancer precursors

Scully¹

1995

J. Cell. Biochem.

226

168

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Ninety percent of ovarian cancers in the Western world are epithelial cancers derived from the surface epithelium of the ovary and its inclusion cysts. The so-called surface epithelium is mesothelium that comes to resemble epithelium as it is reflected over the surfaces of the ovaries. At various ages, but particularly in women in the reproductive, menopausal, and postmenopausal age groups, this epithelium migrates into the ovarian stroma to form inclusion cysts. These cysts probably result from a dynamic interplay of surface epithelium and underlying ovarian stroma, but can also develop as a result of periovarian adhesions. There is abundant evidence that their formation is not related to repair of ovulation. It is generally accepted that benign and malignant ovarian epithelial tumors arise from surface epithelium and its cystic derivatives because they both, but particularly the latter, have a potential to differentiate into epithelia similar to those of normal mullerian derivation (tubal, endometrial, and endocervical epithelia) and their tumors resemble those of the fallopian tube, endometrium, and endocervix. Also, both intraepithelial carcinomas and precarcinomatous lesions can be observed in the surface epithelium and its cystic derivatives. These carcinomas may arise de nooo or as a transformation of pre-existing benign tumors and non-neoplastic lesions of similar derivation. Surface epithelial inclusion cysts have a greater propensity to undergo neoplasia than does the surface epithelium itself. This difference has been recognized for many years because most epithelial ovarian tumors are intraparenchymal, rather than being located on the ovarian surface. More recent evidence includes the immunohistochemical demonstration of various ovarian carcinoma antigens far more frequently in inclusion cyst epithelium than in surface epithelium; and the much more frequent presence of tubal metaplasia in the cyst epithelium than in the surface epithelium. Tuba1 metaplasia is encountered in non-neoplastic ovaries contralateral to ovarian carcinomas two to three times as frequently as in control ovaries, suggesting that the metaplastic epithelium is more prone to the development of carcinoma that non-metaplastic epithelium. Carcinoma precursors occur in the ovary, as in the cervix and endometrium, but have been reported only rarely because they are easily overlooked and have not been searched for by pathologists. 0 1995 Wiley Liss, Inc.Key words: Carcinoma, ovary, pathology, precursor lesions, surface epithelium Surface epithelial carcinomas account for approximately 90% of ovarian cancers in the Western world. These tumors are thought to arise either directly from the surface epithelium of the ovary and its intraparenchymal inclusion cysts or

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Teratomas excluding monodermal teratomas

Clement

Young

1995

Current Diagnostic Pathology

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Malignant Alteration in Benign Teratomas

Cited by 4 publications

References 68 publications

Case 18-1995

Case 18-1995

Pathology of ovarian cancer precursors

Teratomas excluding monodermal teratomas

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