Mature Cystic Teratoma with Squamous Cell Carcinoma-Rare Case Presentation

Abstract

Introduction: Mature cystic teratomas are part of a subclass of ovarian germ-cell tumour believed to arise from the primordial germ cells. Ovarian germ-cell tumours account for around 20–25% of ovarian neoplasms and 5% of ovarian cancers. A secondary malignant transformation of the various tissue components of mature cystic teratoma can occur, typically in postmenopausal women.  More than 80% of malignant transformations are squamous-cell carcinomas arising from the ectoderm; the rest are carcinoid tumours or adenocarcinomas. Methods and Methodology, Case Report: A 40-year-old postmenopausal patient came with lower abdominal pain past 2 months. The patient was submitted to a gynecological examination and to transvaginal ultrasound, which confirmed the presence of right adnexal mass measuring 11×8x 2 cm; the mass proved to have cystic features in association with intracystic fat, raising the suspicion of an ovarian teratoma. In addition, areas of acoustic shadowing were discovered, raising the suspicion of a Rokitansky nodule exhibiting solid components such as hair and teeth. Pelvic CT scan demonstrated right adnexal dermoid cyst causing mild hydroureteronephrosis. A total hysterectomy with bilateral adnexectomy was performed, and the specimen was submitted for histopathological examination. Histopathological examination revealed Mature Cystic Teratoma with Squamous Cell Carcinoma. Discussion: Ovarian teratoma develops from germ cells and might present different cellular types originating from one or more of the germ layers, represented by endoderm, ectoderm and mesoderm.  Of this malignant transformation is about 1- 2 %. Malignant transformation of ovarian teratoma can arise from any type of germ cell that is present at the level of these tumors; therefore, adenocarcinomas, squamous cell carcinomas, sarcomas, melanomas, adenosquamous carcinomas or even carcinoid tumors might occur. Of this squamous cell carcinoma is common. Conclusion: Although ovarian teratomas are frequently encountered, a small proportion of them will develop further complications, such as infection or malignancy. In cases in which malignant transformation occurs, squamous cell carcinoma is the most commonly encountered type of malignancy. Novelty: Malignant transformation of mature cystic ovarian teratoma is a scarce eventuality, only rare cases being reported so far. Furthermore, the development of this transformation in the setting of an abscessed tumor is even scarcer.