Obstet Gynecol Sci.  2014 Jul;57(4):274-280. 10.5468/ogs.2014.57.4.274.

Clinical experience in ovarian squamous cell carcinoma arising from mature cystic teratoma: A rare entity

• Choi EJ
• Koo YJ
• Jeon JH
• Kim TJ
• Lee KH
• Lim KT

• KMID: 1841538
• DOI: http://doi.org/10.5468/ogs.2014.57.4.274

Abstract

OBJECTIVE
We sought to investigate the clinicopathologic features of ovarian squamous cell carcinomas arising from mature cystic teratomas (MCT) and to report our clinical experience and lessons learned.
METHODS
From January 1993 to November 2012, a total of 6,260 women with ovarian MCT were surgically treated at Cheil General Hospital and Women's Healthcare Center. Among them, the cases with malignant transformation to squamous cell carcinoma were included in this analysis. Patient demographic characteristics, surgical findings, and prognosis were evaluated retrospectively.
RESULTS
Of the 6,260 ovarian MCT patients, four (0.06%) had ovarian squamous cell carcinoma arising from MCT. The mean patient age was 43 years (range, 35-51 years), and the mean tumor size was 12 cm (range, 9-16 cm), with two patients in the International Federation of Gynecology and Obstetrics stage I and the other two in stage III. Upon preoperative imaging, all cases were expected to be benign ovarian tumors, but the preoperative squamous cell carcinoma antigen level was elevated from 1.5 ng/mL in stage Ia to 11.3 ng/mL in stage IIIc, suggesting malignancy, while the CA-125 level was normal in two of the three patients who received the test. Optimal debulking surgery was performed and adjuvant chemotherapy was used in all patients, but death from the recurrence of disease occurred in one patient, whose overall survival was 10 months.
CONCLUSION
Ovarian squamous cell carcinoma arising from MCT is extremely rare, and it is rarely diagnosed preoperatively on imaging workups. Measuring the squamous cell carcinoma antigen level might be a useful diagnostic clue, and it might also be predictive of the tumor stage. An adequate staging surgery should be included in the standard treatment, but multicenter studies are needed to confirm this.

Keyword

Malignant transformation; Mature cystic teratoma; Ovary; Squamous cell carcinoma

MeSH Terms

Carcinoma, Squamous Cell*
Chemotherapy, Adjuvant
Delivery of Health Care
Female
Gynecology
Hospitals, General
Humans
Obstetrics
Ovary
Prognosis
Recurrence
Retrospective Studies
Teratoma*

Figure

• 

  Fig. 1 Axial transvaginal ultrasound shows a heterogeneous, echogenic, cystic, and adnexal mass measuring 12 by 8 cm in the right pelvic cavity (patient 4). There were no obvious internal multiple septa or papillary projections. The mass was preoperatively misdiagnosed as mature cystic teratoma. The arrows indicate the margin of the mass.

• 

  Fig. 2 Laparoscopic view showing a round, smooth, and right ovarian tumor that was filling the pelvic cavity (patient 4). Since the tumor contained sebum and hair, it was thought to be a mature cystic teratoma, and a cystectomy was performed as the primary surgery.

Reference

1. Yuen PM, Yu KM, Yip SK, Lau WC, Rogers MS, Chang A. A randomized prospective study of laparoscopy and laparotomy in the management of benign ovarian masses. Am J Obstet Gynecol. 1997; 177:109–114.

2. Ayhan A, Bukulmez O, Genc C, Karamursel BS, Ayhan A. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Reprod Biol. 2000; 88:153–157.

3. Westhoff C, Pike M, Vessey M. Benign ovarian teratomas: a population-based case-control study. Br J Cancer. 1988; 58:93–98.

4. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994; 84:22–28.

5. Singh P, Yordan EL, Wilbanks GD, Miller AW, Wee A. Malignancy associated with benign cystic teratomas (dermoid cysts) of the ovary. Singapore Med J. 1988; 29:30–34.

6. Mekaru K, Kamiyama S, Masamoto H, Yagi C, Hirakawa M, Inamine M, et al. Squamous cell carcinoma arising in an ovarian mature cystic teratoma complicating pregnancy: a case report. Arch Gynecol Obstet. 2008; 278:287–290.

7. Hackethal A, Brueggmann D, Bohlmann MK, Franke FE, Tinneberg HR, Munstedt K. Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data. Lancet Oncol. 2008; 9:1173–1180.

8. Kim MK, Nam EJ, Kim JW, Kim YT, Kim JH, Kim SW, et al. Squamous cell carcinoma arising from mature cystic teratoma of the ovary: a clinicopathologic analysis. Korean J Obstet Gynecol. 2006; 49:1455–1462.

9. Ji HY, Kim TJ, Kim MJ, Lee EJ, Lee YY, Kim CJ, et al. A study for diagnosis of squamous cell carcinoma arising from mature cystic teratoma. Korean J Obstet Gynecol. 2009; 52:1258–1264.

10. Kikkawa F, Nawa A, Tamakoshi K, Ishikawa H, Kuzuya K, Suganuma N, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer. 1998; 82:2249–2255.

11. Kang WD, Yun DS, Lee JY, Kim SM, Choi HS. A clinicopathologic study of 11 cases with malignant transformation arising in mature cystic teratomas. Korean J Obstet Gynecol. 2004; 47:650–655.

12. Chen P, Yeh CC, Lee FK, Teng SW, Chang WH, Wang KC, et al. Squamous cell carcinoma occurring in the pelvis after total hysterectomy and bilateral salpingo-oophorectomy for an ovarian mature teratoma with malignant transformation. Taiwan J Obstet Gynecol. 2012; 51:446–448.

13. Park SB, Cho KS, Kim JK. CT findings of mature cystic teratoma with malignant transformation: comparison with mature cystic teratoma. Clin Imaging. 2011; 35:294–300.

14. Tseng CJ, Chou HH, Huang KG, Chang TC, Liang CC, Lai CH, et al. Squamous cell carcinoma arising in mature cystic teratoma of the ovary. Gynecol Oncol. 1996; 63:364–370.

15. Omura G, Blessing JA, Ehrlich CE, Miller A, Yordan E, Creasman WT, et al. A randomized trial of cyclophosphamide and doxorubicin with or without cisplatin in advanced ovarian carcinoma: a Gynecologic Oncology Group Study. Cancer. 1986; 57:1725–1730.