J Korean Med Sci.  2023 Feb;38(6):e31. 10.3346/jkms.2023.38.e31.

Anti-N-Methyl-D-Aspartate Receptor (NMDAR) Encephalitis Associated With Mediastinal and Ovarian Teratomas: A Case Report

• Lee SH
• Lee CY
• Park HS
• Park J
• Yun JY

• KMID: 2539487
• DOI: http://doi.org/10.3346/jkms.2023.38.e31

Abstract

Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is the most common type of autoimmune encephalitis. Approximately 80% of patients with anti-NMDAR encephalitis are women. Tumors are detected in approximately 50% of female patients with anti-NMDAR encephalitis, of which 96% are ovarian teratomas. We describe the case of a 28-year-old woman diagnosed with anti-NMDAR encephalitis with mediastinal and bilateral ovarian teratomas in July 2019. The patient recovered following surgical management of the mediastinal mass and both ovarian teratomas, and immunotherapy. This case shows that teratomas can be found at multiple sites other than ovaries. Therefore, detecting teratomas using whole-body evaluation may be helpful for diagnosis and treatment.

Keyword

NMDA Encephalitis; Autoimmune EncephalitisTeratoma

Figure

• 

  Fig. 1 Radiologic findings of mediastinal and ovarian masses. (A) Chest X-ray shows an anterior mediastinal mass. (B) Chest computed tomographic scan reveals a large mixed-density mass (9 × 7.5 × 4.7 cm3) (arrow). (C) Ovarian teratomas: abdominopelvic computed tomographic scan reveals mixed-density masses suggestive of mature cystic teratomas. Right (arrow): 6.5 × 4.7 × 1.5 cm3; Left (arrowhead): 4 × 3.7 × 0.7 cm3. The figures are published under agreement of the patient.

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  Fig. 2 Pathological features of the mediastinal mass and right ovarian cyst. (A) The anterior mediastinal mass was a large, solid mass with abundant yellow fat tissue and several cysts. (B) Glial element of anterior mediastinal mass was focally present and contained oligodendroglial cells (lower one-third of the figure) and reactive astrocytes (upper portion) in the background of neutrophils (×200). (C) Neuronal element of right ovarian cyst was minimally identified, including a few neurons (arrows) and some astrocytes (arrowheads, ×200).

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