Prostatic Tissue in Mature Cystic Teratomas of the Ovary: A Report of Four Cases, Including One with Features of Prostatic Adenocarcinoma, and Cytogenetic Studies

Abstract

Four cases of mature cystic teratoma that contained prostatic tissue are reported. The ovarian tumors occurred in patients from 17 to 38 (mean 31) years of age and had no unusual clinical or gross aspects. The microscopic findings for the most part were typical of a mature cystic teratoma, but they also contained foci of prostatic tissue that ranged from 0.2 to 1.9 cm in greatest dimension. In these areas there was a lobular arrangement of medium-sized acini lined by cuboidal to columnar cells with pale cytoplasm and round nuclei with inconspicuous nucleoli except focally in one case as noted below. Basal cells were seen focally. The prostatic acini lay in a paucicellular fibromuscular stroma. In two cases thick layers of disorganized smooth muscle covered by transitional-like pseudostratified epithelium, resulting in an appearance resembling fetal bladder wall, were present next to the prostatic glands. One tumor also contained prostatic-type acini, which haphazardly infiltrated the stroma over an area approximately 5 mm in maximal dimension. The acini, a few of which contained intraluminal flocculent eosinophilic material, were lined by cells with eosinophilic to amphophilic focally granular cytoplasm and had nuclei that were enlarged compared with the benign-appearing, prostatic-type acini in the four cases and had focally prominent nucleoli. Basal cells were not identified in these infiltrating glands. Grading this focus according to the approach in the prostate, the morphology was that of a Gleason grade 3 of 5 adenocarcinoma. Immunohistochemical stains of the putative prostatic epithelial cells confirmed their nature by showing immunoreactivity for prostatic-specific antigen in the lining epithelial cells in all four cases and for prostatic-specific acid phosphatase in the one case tested. The high molecular cytokeratin stain, 34betaE12, highlighted basal cells to a variable extent in the three cases containing only benign prostatic tissue. Material was not available to immunostain for basal cells in the case with carcinoma. Cytogenetic studies were performed in two cases and showed that the great majority of the nuclei of the nonprostatic and prostatic tissue had an XX karyotype but from 3% to 5% of the nuclei displayed trisomy for the X chromosome. A small number of cases of prostatic tissue in ovarian teratomas have previously been documented but none had morphologic features of carcinoma.

Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues

“…Paradoxically, prostatic tissue infrequently occurs in ovarian teratomas but is even rarer in the testis. 24,25 Meninges are a described but rare finding in testicular teratomas, 26 with one reported case of a microcystic meningioma of teratomatous origin. 27 …”

“…On the other hand, for those rare ovarian teratomas with malignant elements, 39,40 malignant transformation occurs after the development of the teratoma ('post-teratomatous' malignant transformation). This applies to those dermoid cysts that develop malignant somatic neoplasms, most commonly squamous cell carcinoma 41,42 but rarely other types such as malignant melanoma, 43 adenocarcinoma 24,44 and various forms of sarcoma, 42 a phenomenon seen in 0.2-1.4% of mature ovarian teratomas. 39,40 The homozygous nature of the malignant elements in these cases, which is similar to the benign elements, supports derivation of the former from the latter, 17 as do similar cytogenetic changes in the two components.…”

Tejido prostático en teratoma quístico maduro del ovario: Caso clínico

“…El hallazgo de tejido prostático en un teratoma quístico maduro del ovario es poco frecuente, sin embargo, podría estar subdimensionado ya que, Vadmal y cols 5 después de un examen y muestreo cuidadoso de la lesión, encontraron glándulas prostáticas hasta en 12% de los teratomas ováricos y otros autores reconocen confusión con otras glándulas como las sudoríparas 6 . La Tabla 1 resume la veintena de publicaciones en la literatura internacional, la mayoría de ellos se descubren en mujeres en edad fértil (edad promedio 35 años y rango 15-73 años), generalmente como hallazgo en el estudio de dolor o masa pélvi-ca.…”

“…La Tabla 1 resume la veintena de publicaciones en la literatura internacional, la mayoría de ellos se descubren en mujeres en edad fértil (edad promedio 35 años y rango 15-73 años), generalmente como hallazgo en el estudio de dolor o masa pélvi-ca. Fue más frecuente en teratomas que afectaban al ovario izquierdo, que promediaban 7,3 cm y 153 g. El tamaño promedio de los focos glandulares prostáticos que se han publicado es de 1,2 cm y en el cual, algunos autores incluso han reportado neoplasia in situ 19 y adenocarcinoma invasor 6 , transformando así, un hallazgo interesante, en un fenómeno clínicamente significativo.…”

“…De la embriología se sabe que el desarrollo prostático es dependiente de la dihidrotestosterona, secretada dentro del seno urogenital. La presencia de urotelio en nuestro caso y en otros, apoya una de las tres teorías que se han propuesto, que apunta hacia una anormalidad del desarrollo 6 y expresa que este epitelio y el tejido prostático en teratomas, surge de remanentes embrionarios de brotes endodérmicos del seno urogenital, estimulado por andrógenos locales producidos por células luteinizadas vecinas al teratoma y que se han encontrado en cuatro casos [6][7][8]13 . Una segunda teoría, basándose en hallazgos de tejido prostático en ovario, cuello uterino y vagina que surgen de remanentes mesonéfricos, plantea una explicación exclusivamente metaplásica a este fenómeno, también estímulado por un microambiente androgénico 6,22 .…”