Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: a Taiwanese Gynecologic Oncology Group (TGOG) study

Abstract

ObjectiveThe malignant transformation (MT) of ovarian mature cystic teratoma (MCT) to squamous cell carcinoma (SCC) is very rare. This study analyzed cases from multiple medical centers in Taiwan to investigate the clinicopathologic characteristics, treatment, and prognostic factors of this disease and reviewed related literature.MethodsPathological reports of 16,001 patients with primary ovarian cancer who were treated at Taiwan medical centers from 1990 to 2011 were reviewed. In total, 52 patients with MT of MCT to SCC were identified.ResultsAmong all ovarian MCTs, the incidence of MT to SCC is 0.2%. The median age of patients was 52 years (range, 29–89 years), and the mean tumor size was 10.5 cm (range, 1–40 cm). We analyzed the patients in our study and those in the literature and determined that early identification and complete surgical resection of the tumor are essential for long-term survival. In addition, adjuvant chemotherapy or concurrent chemoradiotherapy can be used to treat this malignancy. Old age, large tumor size (≥15.0 cm), and solid components in MCTs are suitable indicators predicting the risk of MT of MCT to SCC.ConclusionSimilar to general epithelial ovarian cancers, the early detection of MT of MCT to SCC is critical to long-term survival. Therefore, older patients with a large tumor or those with a tumor containing a solid component in a clinically diagnosed MCT should be evaluated to exclude potential MT to SCC.

Adenocarcinoma of intestinal type arising in mature cystic teratoma of ovary: A diagnostic dilemma

“…However, a fat‐suppressed MRI may be helpful in the diagnosis of mature cystic teratomas even in tumors of <5 cm. Malignant transformation tends to have more solid components . Serum tumor markers carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) may also be predictive of a malignant transformation.…”

“…Malignant transformation tends to have more solid components. 3 Serum tumor markers carcinoembryonic antigen (CEA) and squamous cell carcinoma antigen (SCC) 3 may also be predictive of a malignant transformation.…”

Malignant Transformation of a Mature Ovarian Teratoma: A Case Report and Review of the Literature

“…Due to the different components of a teratoma, there can be various malignant transformations, such as squamous cell carcinomas (75%-80%), adenocarcinomas (7%), sarcomas (7%), basal cell carcinomas, sebaceous gland carcinomas, malignant melanomas, small cell lung cancers, transitional cell carcinomas, clear cell carcinomas, and gliomas [1,[3][4][5][6] . The patholog-ical diagnosis confirmed that this case was a teratoma accompanied by the malignant transformation of a sebaceous gland carcinoma, which is very rare.…”

“…Human papillomavirus (HPV) particles may retrograde to the ovaries via the ascending pathways of the cervix, uterus, and fallopian tubes, and the HPV capsid protein and HPV16/18E6 protein can be detected in patients with teratomas accompanied by malignant transformations of squamous cell carcinomas, while the detection rate is low in cystic teratomas. Therefore, a high risk HPV infection may play a role in inducing the transformation of the teratoma to a squamous cell carcinoma [3,7] . In this case, the malignant transformation of a sebaceous gland carcinoma negative for HPV was detected, but the possibility of a false negative is not negligible.…”

“…Therefore, the role of HPV in the malignant transformation requires further exploration. Mature teratomas occur mainly in women of childbearing age (around 30 years old), whereas malignant changes are more common in menopausal women, which may be related to the presence of the teratoma and the long-term exposure to various malignant factors in the pelvic cavity [3] . Therefore, it is suggested that postmenopausal women undergo the active surgical treatment of ovarian tumors in order to prevent the malignant transformation caused by persistent ovarian tumors and the long-term exposure to malignant factors.…”