Mature Ovarian Teratoma: Neurological Implications in a Young Woman

Schiavi, Michele Carlo; Manganelli, Fabio; Morgani, Claudia; Cignini, Pietro; Yacoub, Veronica; Carletti, Valerio; Grilli, Debora; Pinto, Anna Di; Bisogni, Francesco; Ligato, Azzurra; Galanti, Francesco; Valensise, H.; Palazzetti, P

doi:10.1155/2021/3085559

Cited by 5 publications

(12 citation statements)

References 9 publications

(14 reference statements)

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“…Overall, 43% of patients with ovarian teratomas complicated with encephalitis did not recover or improve. However, the prognosis of patients with anti-NMDAR encephalitis tends to be relatively better than that of patients with other types of encephalitis [5]. The condition of several patients has been reported to improve promptly after teratoma removal.…”

Section: Discussionmentioning

confidence: 99%

“…However, a signi cantly higher percentage of patients aged > 45 years required daily assistance [4]. Age is another important parameter, with onset being most common in the late teens and 20s [5]. Normal ovaries (oocytes) might also contain NMDARs, indicating that the ovaries are antigen-presenting tissues.…”

Section: Discussionmentioning

confidence: 99%

“…Its effectiveness usually increases in combination with plasma exchange, which effectively removes in ammatory mediators and antibodies. Rituximab is used as a second-line drug and is effective in reducing the levels of central nervous system antibodies, including those against B cells [5,9]. We omitted cases treated with rituximab, as there were only ve cases.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and medical practices of hospitalized patients with anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma in Japan: a retrospective cohort study

Aoyama,

Kinjo,

Hoshino

et al. 2023

Preprint

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Background The incidence of anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis and the proportion of patients with ovarian teratoma with complications are unclear. The proportion of those who become severely ill and the percentage of those undergoing medical treatment for severe cases are also unknown. Therefore, in this study, we aimed to investigate the characteristics and medical practice of hospitalized patients with ovarian teratomas complicated by NMDAR encephalitis in Japan. Results Patients with ovarian teratoma and encephalitis had a lower median age than those without encephalitis. The group with ovarian teratoma complicated with anti-NMDAR encephalitis was more likely to be transported by ambulance and had more transfers from other hospitals than the group without the complication. Among the target hospitalized patients, the 15 − 19 age group had the highest incidence rates. The median age was lower for steroid pulse therapy, intravenous immunoglobulin therapy, and plasma exchange therapy in that order. Additionally, younger patients underwent more invasive treatments. Conclusion Anti-NMDAR encephalitis associated with ovarian tumors often occurs in young people in their late teens and 20s, and younger patients are more likely to be severely ill.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Characteristics and medical practices of hospitalized patients with anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma in Japan: a retrospective cohort study

Aoyama,

Kinjo,

Hoshino

et al. 2023

Preprint

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“…[ 1 15 16 ] Occasionally, immunotherapy was administered as the first line, but no recovery was demonstrated. [ 17 18 ] Importantly, the prognosis depends on the timing of appropriate intervention, resources of health-care settings, and the medical status of the patient. [ 2 ] Between 80% and 90% of patients respond to treatment which includes immunotherapy and removal of the tumor when applicable.…”

Section: Discussionmentioning

confidence: 99%

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Pham

Nguyen

2023

Gynecology and Minimally Invasive Therapy

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A previously fit and healthy 39-year-old woman was admitted to our tertiary referral hospital with coexisting autoimmune encephalopathy and ovarian tumor. Due to the presence of anti-N-methyl-d-aspartate receptor (anti-NMDAR) in the cerebrospinal fluid, a diagnosis of anti-NMDAR encephalitis was first suggested after ruling out other etiologies. Thus, a laparoscopy was promptly performed to remove the ovarian tumor. The histological endpoint revealed an ovarian teratoma. Consequently, the patient recovered completely in good health condition after 2 months in a coma status. Herein, we report an uncommon case of anti-NMDAR encephalitis associated with ovarian teratoma at our hospital, thus raising awareness of physicians.

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“…Types of surgical treatment range from selective removal of lesions by ultrasound-guided laparoscopy [21], cystectomy, uni/bilateral ovariectomy and uni/bilateral adnexectomy. Although some studies emphasize that cystectomy and adnexectomy have similar outcomes [22,23], we decided to perform a unilateral adnexectomy. As a possible limitation of the type of treatment in this case, we can mention the extent of the surgical procedure, which is not in accordance with the previous statements about preserving the fertility of young women.…”

Section: Discussionmentioning

confidence: 99%

Mature ovarian teratoma-associated encephalitis

et al. 2022

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Introduction. Autoimmune encephalitis associated with ovarian teratoma is a serious and potentially fatal pathology. While this clinical entity is known to neurologists, the available literature rarely mentions the role of a gynecologist in diagnostic imagining and treatment. Although several months have passed from the appearance of the symptoms to surgical treatment, this case shows that even then a complete recovery is possible. Case presentation. The patient was a 28-year-old female, brought to the hospital because a sudden onset of unusual behavior - an acute psychosis with suicidal thoughts and auditory hallucinations. Soon after the admission she became delirious, uncooperative and agitated. Blood check, neurological assessment and cranial computed tomography yielded normal results. Therefore, a psychiatric disorder was suspected. Electroencephalogram revealed a diffuse encephalitic insufficiency. As cerebrospinal fluid was negative for infections, the autoimmune etiology of the disease was suspected. Abdominal computer tomography showed a complex right ovarian mass measuring 50 x 40 x 30 mm, confirmed by vaginal ultrasound. Laparoscopy with right adnexectomy was performed. The pathohistological finding showed a mature teratoma. In the meantime, the result of the cerebrospinal fluid test came positive for anti NMDAR antibodies. Six months after surgery, the patient was in a good mental and neurological status without symptoms. Conclusion. Gynecologists should be aware of the presence of ovarian tumors in encephalitis cases. A timely diagnosis of the underlying gynecological cause of a neurological condition, allows for prompt treatment and can remarkably improve clinical conditions and, thus, be lifesaving.

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Mature Ovarian Teratoma: Neurological Implications in a Young Woman

Cited by 5 publications

References 9 publications

Characteristics and medical practices of hospitalized patients with anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma in Japan: a retrospective cohort study

Characteristics and medical practices of hospitalized patients with anti-N-methyl-D-aspartate receptor encephalitis associated with ovarian teratoma in Japan: a retrospective cohort study

Timely Laparoscopic Intervention for Ovarian Tumor-related Autoimmune Encephalitis: A Challenging Pathology at Tu Du Hospital in Vietnam and Literature Review

Mature ovarian teratoma-associated encephalitis

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