Malignant transformation arising from mature cystic teratoma of the ovary presenting as ovarian torsion: a case report and literature review

Abstract

Objective : Ovarian torsion is an acute gynecological condition. Torsion is more likely to occur with benign rather than malignant tumors. Mature cystic teratoma of the ovary (MCTO) is frequent in women of reproductive age ; however, the incidence of malignant transformation is approximately 2%. We report a case of malignant transformation of MCTO presenting as ovarian tumor torsion. Case report : A 51 -yearold premenopausal woman was diagnosed with mature cystic teratoma in the left ovary 7 years ago. The patient visited our hospital because she had been experiencing of pain in left lower abdomen for the past two days. She was diagnosed with ovarian tumor torsion and underwent emergency surgery. The left ovarian tumor was twisted, and left salpingooophorectomy was performed. Histopathological examination revealed squamous cell carcinoma arising from the MCTO. We carefully followed the patients without performing staging laparotomy. On postoperative day 112, multiple lymph node metastases in the pelvic and paraaortic areas were found by positronemission tomography and computed tomography. After referral to a university hospital, total hysterectomy, right salpingooophorectomy, partial omentectomy, and pelvic and paraaortic lymphadenectomy were performed. Metastases of squamous cell carcinoma were confirmed in the pelvic and paraaortic lymph nodes. Six courses of adjuvant chemotherapy with paclitaxel and carboplatin were given following radical surgery to prevent the recurrence of malignant transformation of MCTO. No recurrence of the disease has been observed during 2 years of followup. Conclusion : When physicians diagnose large ovarian tumor torsion cases, preoperative examinations should be performed, with the possibility of malignancy in mind.

A rare case of squamous cell carcinoma transformation in a mature cystic teratoma of the ovary

“…8 However, a low level of SCC antigen does not rule out carcinoma. 6,15 In this case, CA 125 was the only tumor marker being evaluated, and it was increased. Unfortunately, in our case, due to the technical impossibility of routine clinical practice, SCC antigen was not measured.…”

“…Bloating, loss of appetite, and weight loss are other symptoms reported previously. 6,8 MT-MCTO tumors are typically located in one ovary but can involve both ovaries in 10%-17% of the cases. The tumor mass size is usually large (10-20 cm in diameter), 8 and larger than benign tumors, possibly due to the presence of additional areas of necrosis or hemorrhage.…”

Adnexal Torsion of a Mature Cystic Ovarian Teratoma With Hemorrhagic Infarction Misdiagnosed As Pelvic Inflammatory Disease in a Perimenopausal Patient: A Case Report

“…Preoperative differential diagnosis between pelvic inflammatory disease and adnexal torsion with mature cystic ovarian teratoma in our patient was challenging. Rare cases of malignant transformation of mature cystic ovarian teratoma have been described in the literature, in which abdominal pain and vomiting were incorrectly attributed to adnexal torsion [ 13 , 14 ]. In addition, in rare isolated cases, mature cystic teratoma may coexist with ovarian lymphangioma or plasmablastic lymphoma with all the difficulties related to the correct diagnosis [ 15 , 16 ].…”

Malignant transformation arising from mature ovarian cystic teratoma

“…The incidence of malignant transformation varies from case report to case series, accounting for 1–3% of all the MCT cases. [ 3 , 8 ] Over a period of 40 years, only 2 case series have reported that the frequency of MT-MCT was as high as 6.67% [ 9 ] and 5%, [ 10 ] respectively. In our study, the incidence was 2.4%, which is consistent with the reported literature.…”