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CASE REPORT |
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Year : 2015 | Volume
: 5
| Issue : 3 | Page : 174-176 |
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Bilateral synchronous mature ovarian teratoma and mucinous cystadenoma
Alfa Alhaji Sule, Ochicha Ochicha, Ibrahim Yusuf
Department of Pathology, Aminu Kano Teaching Hospital, Bayero University Kano, Kano, Nigeria
Date of Web Publication | 19-Oct-2015 |
Correspondence Address: Dr. Alfa Alhaji Sule Department of Pathology, Aminu Kano Teaching Hospital, Bayero University Kano, PMB 3452, Kano Nigeria
Source of Support: None, Conflict of Interest: None | Check |
DOI: 10.4103/2278-9596.167514
Published reports of different synchronous tumours in both ovaries are scanty, and the few reported cases are mostly malignant. This report of synchronous benign tumors in both ovaries occurred in a 26 year old female who presented with one year history of painless abdominal swelling and two large multicystic masses on ultrasound scan. She had bilateral oophorectomy and histology revealed right sided benign cystic teratoma and left sided mucinous cystadenoma. Conclusion: Both tumours were benign and therefore potends no adverse consequences for the patient. Nonetheless, given the unusual presentation, she is being followed up. Keywords: Mucinous cystadenoma, ovarian teratoma, synchronous tumors
How to cite this article: Sule AA, Ochicha O, Yusuf I. Bilateral synchronous mature ovarian teratoma and mucinous cystadenoma. Arch Int Surg 2015;5:174-6 |
Introduction | | |
Synchronous neoplasms refers to the presence of two or more histologically distinct primary tumors within a patient simultaneously or diagnosed not more than 6 months apart. [1],[2] Metachronous tumors, a closely related term refers to diagnosis of the second tumor after 6 months. [1],[2] Such tumors are said to account for about 10% of neoplasms, most of which are malignant. [1],[2],[3] Inherited predisposition to cancer such as Li-Fraumeni syndrome More Details and neurofibromatosis, immunodeficiency, hyperestrinism, anti-cancer radiotherapy, and chemotherapy are some of the known causes. However, in most cases, there is no identifiable etiologic factor. [1],[2],[3],[4]
In the female genitalia, the most common synchronous tumors involve the ovaries and endometrium, reflecting the fact that these are the predominant gynecologic malignancies globally. [4] Up to 80% of synchronous gynecological tumors involves these two organs, and they are overwhelmingly malignant. [5]
Uterine leiomyomas are so common, particularly among black women that they are not usually considered synchronous when they coexist with other benign or malignant tumors. Synchronous tumors of both ovaries are rare, and again most documented cases are malignant. [1],[4] They must be distinguished from metastases and bilateral tumors of the same histology such as serous cystadenoma, and a benign cystic teratoma. Published reports of synchronous gynecological tumors are scanty here in Sub-Saharan Africa, more so from Nigeria. We, therefore, document the case of a young adult female with mature cystic teratoma and mucinous cystadenoma, occurring in left and right ovaries, respectively.
Case Report | | |
A 26-year-old nulliparous Nigerian female presented at our gynecology clinic with a 1-year history of painless, progressive abdominal swelling. There was no history of irregular vaginal bleeding or discharge. She attained menarche at 15 years and had a normal 28-day menstrual cycle with normal flow. Physical examination revealed distended abdomen containing two palpable masses arising from the pelvis. The larger right-sided mass extends to the xiphisternum while the left mass was just above the umbilicus. A ultrasound scan showed two large multicystic masses, but with no fluid collection. Uterus and other pelvic and abdominal organs were normal. Chest X-ray and biochemical results were essentially normal. A clinical diagnosis of the malignant ovarian tumor was made.
Bilateral oophorectomy was done and the patient fully recovered without complications. Pathologic examination of the resected ovarian masses revealed multilocular ovarian cystic tumors. The left cyst measured 25 cm × 25 cm × 20 cm and weighed 2.3 kg. Transection showed mucoid fluid. The right cyst measured 50 cm × 50 cm × 20 cm and weighed 3.7 kg. It contained sebum and hair tufts. After taken fifteen samples from each ovary, histology revealed benign cystic teratoma [Figure 1] in the right and mucinous cystadenoma [Figure 2] in the left ovaries respectively. | Figure 1: Mucinous cystadenoma. Note the epithelium contains prominent vacuoles containing mucin (H and E, ×10)
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| Figure 2: Mature cystic teratoma. Note the squamous epithelium, skin adnexa, and adipose tissue (H and E, ×10)
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Discussion | | |
Pathologic examination showed that this patient had two distinct histological types of tumors in both ovaries - benign cystic teratoma on the right and mucinous cystadenoma on the left. Bilateral benign ovarian tumors are not uncommon, about 25% of serous cystadenomas, 10-15% of benign teratomas and 5% of mucinous cystadenomas are bilateral. [5] However, the presence of two different tumors in both ovaries is rare, and most such synchronous tumors are malignant. [4],[6] Mature teratomas are known to coexist with mucinous tumors, and about 2-11% of benign ovarian teratomas are associated with benign mucinous cystadenomas. [7] This is not entirely surprising given that teratomas are a tumor of totipotential germ cells that can differentiate into tissues derived from any of the three germ layers. Thus, it is quite plausible that teratomatous germ cells differentiate into the celomic epithelium that give rise to mucinous cystadenomas.
Immunohistochemical and morphological studies, however suggest that mucinous tumors within mature teratomas most likely derived from gut tissue within the teratoma. [8] A report by Tang et al. [9] documents a colonic segment attached to mucinous cystadenoma arising from mature teratoma while another report [10] found almost an entire gut (esophagus to colon) arising in a mature teratoma. However, in our case the patient had two different tumors in both ovaries rather than mucinous cystadenoma arising within a teratoma as reported in other studies. [6],[7],[8],[9],[10] It is possible though that adequate sampling did not capture the teratomatous component in the left ovarian tumor. However, this is unlikely because the mucinous cystadenoma component outgrew the mature teratoma from which it may have arisen. Monodermal teratomas are thought to arise in this manner.
Furthermore, the age of our patient (26 years) is more in keeping with the diagnosis of mature teratoma rather than mucinous cystadenoma which is most frequently diagnosed in the fourth to sixth decades.
Conclusion | | |
Intriguing as this case may be, it portends no adverse consequences for the patient as both tumors were benign, and she recovered fully postoperatively without complications. Nonetheless, given the unusual presentation, she is being followed up.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References | | |
1. | National Cancer Institute. SEER Program Code Manual. 3 rd ed. Bethesda (MD): National Cancer Institute; 1998. |
2. | Howe HO, Editor. A Review of Definition of Multiple Primary Cancers in the United State. Workshop Proceedings for December 4-6, 2002. Princeton, New Jersey: NAACCR. North American Association of Cancer Registrar; 2002. |
3. | Bittorf B, Kessler H, Merkel S, Brückl W, Wein A, Ballhausen WG, et al. Multiple primary malignancies: An epidemiological and pedigree analysis of 57 patients with at least three tumours. Eur J Surg Oncol 2001;27:302-13. |
4. | Mehdi I, Shah AH, Moona MS, Verma K, Abussa A, Elramih R, et al. Synchronous and metachronous malignant tumours expect the unexpected. J Pak Med Assoc 2010;60:905-9. |
5. | Ellenson LH, Pirog EC. Ovarian tumours. In: Kumar V, Abass AK, Fausto N, Aster JC, editors. Robbins & Cotran Pathologic Basis of Disease. 8 th ed. Philadelphia: Saunders-Elsevier; 2010. p. 1041-5. |
6. | Sethi D, Ahluvalia C, Sharma U, Khetarpal S. A synchronous presentation of two different ovarian tumors: A rare occurrence. Ann Med Health Sci Res 2013;3:268-70. [ PUBMED] |
7. | Talerman A, Vang R. Germ cell tumours of the ovary. In: Blaustein′s Pathology of Female Genital Tract. 6 th ed. New York: Springer-Verlag; 2011. p. 847-907. |
8. | Vang R, Gown AM, Zhao C, Barry TS. Ovarian mucinous tumours associated with mature cystic teratoma: Subset with features of lower GIT mucinous tumors. Am J Surg Pathol 2007;31:854-69. |
9. | Tang P, Soukkary S, Kahn E. Mature cystic teratoma of the ovary associated with complete colonic wall and mucinous cystadenoma. Ann Clin Lab Sci 2003;33:465-70. |
10. | Woodfield B, Katz DA, Cantrell CJ, Bogard PJ. A benign cystic teratoma with gastrointestinal tract development. Am J Clin Pathol 1985;83:236-40. [ PUBMED] |
[Figure 1], [Figure 2]
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