Research Article
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Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features

Year 2021, Volume: 34 Issue: 2, 167 - 174, 31.05.2021

Ayhan Atıgan Yeliz Arman Karakaya Umit Cabus

https://doi.org/10.5472/marumj.925209

Abstract

Objectives: Mature cystic teratomas (MCT) originate from three germ layers: ectoderm, mesoderm and endoderm. The predictive
significance of tumor markers in mature cystic teratomas is still unclear. In this study, we aimed to evaluate the predictive value of
tumor markers in ovarian MCTs and histopathological contents of tumor.
Materials and Methods: The data of 106 patients who were operated for ovarian MCT between 2015 and 2020 were analyzed
retrospectively. In addition, slides in the pathology archive were re-examined under a microscope to evaluate their histopathological
contents.
Results: The average age of the patients was 35.7; 26.7 in the cystectomy group and 42.1 in the oophorectomy group (p = 0.000). The
ratio of tumor markers exceeding the cut off value for carbohydrate antigen (CA 19-9), lactate dehydrogenase (LDH), cancer antigen
(CA 125), carcinoma antigen (CA 15-3), carcinoembryonic antigen (CEA) were 45.2%; 47.7%; 8.15%; 12.3%; 6.9%, respectively.
Histopathological examination of MCTs revealed 99.1% ectoderm, 45.3% mesodermal, 39.6% endodermal origin.
Conclusion: Mature cystic teratoma is a benign tumor of the reproductive age that contains three germ layers in various proportions.
LDH and CA 19-9 can be a helpful tool in predicting mature cystic teratomas.

Keywords

Mature cystic teratoma Germ layers Tumor markers

References

  • Tewari K, Cappuccini F, Disaia PJ, Berman ML, Manetta A, Kohler MF. Malignant germ cell tumors of the ovary. Obstet Gynecol 2000;95:128‐33. doi:10.1016/s0029-7844(99)00470-6
  • Zalel Y, Piura B, Elchalal U, Czernobilsky B, Antebi S, Dgani R. Diagnosis and management of malignant germ cell ovarian tumors in young females. Int J Gynaecol Obstet 1996;55:1- 10. doi: HYPERLINK “https://doi.org/10.1016/0020- 7292(96)02719-1” \t “_blank” 10.1016/0020-7292(96)02719-1
  • Mohanty MK, Sahu P, Jaiswal AA, et al. A huge immature cervical teratoma, antenatal diagnosis, and its management – an unusual entity. J Clin Neonatol 2013;2:42‐5. doi:10.4103/2249- 4847.109249
  • Peterson CM, Buckley C, Holley S, Menias CO. Teratomas: a multimodality review. Curr Probl Diagn Radiol 2012;41:210-19. doi: HYPERLINK “https://doi.org/10.1067/j. cpradiol.2012.02.001” 10.1067/j.cpradiol.2012.02.001
  • Maharjan S. Mature cystic teratoma of ovary with squamous cell carcinoma arising from it. Clin Case Rep 2019;7:668-71. doi: 10.1002/ccr3.2062
  • 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;84:22-8.
  • Wang WC, Lai YC. Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review. J Ovarian Res 2017;10:17. doi:10.1186/s13048.017.0313-8
  • Al-Salem A. Teratoma. In: An Illustrated Guide to Pediatric Surgery. Cham:Springer International Publishing, 2014;63:491-503. doi: 10.1007/978-3-319-06665-3_63.
  • Rha SE, Byun JY, Jung SE, et al. Atypical CT and MRI manifestations of mature ovarian cystic teratomas. AJR 2004;183:743-50. doi: 10.2214/ajr.183.3.1830743
  • Hoo WL, Yazbek J, Holland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome?. Ultrasound Obstet Gynecol 2010;36:235‐40. doi:10.1002/uog.7610
  • Ustunyurt E, Gungor T, Iskender C, Ustunyurt BO, Bilge U, Mollamahmutoglu L. Tumor markers in mature cystic teratomas of the ovary. Arch Gynecol Obstet 2009;279:145-7. doi: 10.1007/s00404.008.0688-2.
  • Ito K. Significance of CA19-9 in mature cystic teratoma. Nihon Sanka Fujinka Gakkai Zasshi 1992;44:524-28.
  • Mikuni M, Makinoda S, Tanaka T, Okuda T, Domon H, Fujimoto S. Evaluation of tumor marker in ovarian dermoid cyst. Nihon Sanka Fujinka Gakkai Zasshi 1990;42:479-84.
  • Var T, Tonguc EA, Ugur M, Altinbas S, Tokmak A. Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age. Bratisl Lek Listy 2012;113:95-8. doi: HYPERLINK “https://doi.org/10.4149/bll_2012_022” \t “_ blank” 10.4149/bll_2012_022
  • Konishi I, Fujii S, Okamura H, et al. Analysis of serum CA125, CEA, AFP, LDH levels and LDH isoenzymes in patients with ovarian tumors—correlation between tumor markers and histological types of ovarian tumors. Nihon Sanka Fujinka Gakkai Zasshi 1986;38:827-36.
  • 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;88:153-7. doi: HYPERLINK “https://doi.org/10.1016/s0301-2115(99)00141-4” \t “_blank” 10.1016/s0301-2115(99)00141-4
  • Sushma TA, Shashikala K, Sharmila PS, et al. Study of histomorphological changes of teratomas in tertiary care hospital. J Evol Med Dent Sci 2013;2:1771-8.
  • Kikkawa F, Nawa A, Tamakoshi K, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer 1998;82:2249-55. doi: HYPERLINK “https://doi. org/10.1002/(sici)1097-0142(19980601)82:11%3C2249::aidcncr21% 3E3.0.co;2-t” \t “_blank” 10.1002/(sici)1097- 0142(19980601)82:11<2249::aid-cncr21>3.0.co;2-t
  • Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics 2001;21:475-90. doi: HYPERLINK “https://doi.org/10.1148/ radiographics.21.2.g01mr09475” \t “_blank” 10.1148/ radiographics.21.2.g01mr09475
  • Eskicioglu F, Gokmen T. Evaluation of mature ovarian cystic teratomas in our clinic: 110 cases. Tepecik Egit Arast Hast Dergisi 2016;26:23-6. doi:10.5222/terh.2016.023
  • Koonings PP, Campbell K, Mishell DR, Jr, Grimes DA. Relative frequency of primary ovarian neoplasms: a 10 year review. Obstet Gynecol 1989;74:921-6.
  • Partlow WF, Taybi H. Teratomas in infants and children. Am J Roentgenol Radium Ther Nucl Med 1971;112:155-66. doi: HYPERLINK “https://doi.org/10.2214/ajr.112.1.155” \t “_ blank” 10.2214/ajr.112.1.155
  • Schmoll HJ. Extragonadal germ cell tumors. Ann Oncol 2002;13:265-72. doi: 10.1093/annonc/mdf669
  • Stany MP, Hamilton CA. Benign disorders of the ovary. Obstet Gynecol Clin North Am 2008;35:271-84. http://dx.doi. org/10.1016/j.ogc.2008.03.004
  • Caspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women. Fertil Steril 1997;68:501-5. doi: HYPERLINK “https://doi.org/10.1016/s0015-0282(97)00228-8” \t “_blank” 10.1016/s0015-0282(97)00228-8
  • Breen JL, Maxson WS. Ovarian tumors in children and adolescents. Clin Obstet Gynecol 1977;20:607-23. doi: HYPERLINK “https://doi.org/10.1097/00003.081.197709000- 00010” \t “_blank” 10.1097/00003.081.197709000-00010
  • Caruso PA, Marsh MR, Minkowitz S, et al. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer 1971;27:343–48. doi: HYPERLINK“https://doi.org/10.1002/1097- 0142(197102)27:2%3C343::aid-cncr282.027.0215%3E3.0.co;2-b” \t “_blank” 10.1002/1097-0142(197102)27:2<343::aidcncr282.027.0215> 3.0.co;2-b
  • Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S. Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute. Indian J Cancer 2017;54:576-9. doi: 10.4103/ijc.IJC_294_17
  • Shin HJ, Kim KA, Kim B-H, et al. Benign enhancing components of mature ovarian teratoma: magnetic resonance imaging features and pathologic correlation. Clin Imaging 2016;40:1156- 61. https://doi.org/10.1016/j.clinimag.2016.08.005
  • Md Arshad NZ, Ng BK, Md Paiman NA, Abdullah Mahdy Z, Mohd Noor R. Intra-operative frozen sections for ovarian tumors – A tertiary center experience. Asian Pac J Cancer Prev 2018;19:213-18. doi:10.22034/APJCP.2018.19.1.213
  • Chiang AJ, La V, Peng J, Yu KJ, Teng NN. Squamous cell carcinoma arising from mature cystic teratoma of the ovary. Int J Gynecol Cancer 2011;21:466-74.doi: 10.1097/ IGC.0b013e31820d3e5b
  • Pradhan P, Thapa M. Dermoid cyst and its bizarre presentation. JNMA J Nepal Med Assoc 2014;52:837-44.
  • Sahraoui W, Hajji S, Essefi A, et al. Ovary teratoma. Report of 91 cases. Tunis Med 2006;84:349-52.
  • Drolet J, Dubuc-Lisoir J. Guidelines for the laparoscopic management of the adnexal mass. SOGC 1998;76:1-7. HYPERLINK “https://doi.org/10.1016/S0849-5831(98)80059- 1” doi: 10.1016/S0849-5831(98)80059-1
  • Uysal F, Balsak D, Uysal A, Incebiyik A, Muratli A, Yildirim Y. Clinical, diagnostic and anatomical aspects of mature cystic teratomas. Austin J Radiol 2014;1:3.
  • Atabekoğlu C, Bozaci EA, Tezcan S. Elevated carbohydrate antigen 19-9 in a dermoid cyst. Int J Gynaecol Obstet 2005;91:262-3. doi: HYPERLINK “https://doi.org/10.1016/j. ijgo.2005.07.019” \t “_blank” 10.1016/j.ijgo.2005.07.019

Year 2021, Volume: 34 Issue: 2, 167 - 174, 31.05.2021

Ayhan Atıgan Yeliz Arman Karakaya Umit Cabus

https://doi.org/10.5472/marumj.925209

Abstract

References

  • Tewari K, Cappuccini F, Disaia PJ, Berman ML, Manetta A, Kohler MF. Malignant germ cell tumors of the ovary. Obstet Gynecol 2000;95:128‐33. doi:10.1016/s0029-7844(99)00470-6
  • Zalel Y, Piura B, Elchalal U, Czernobilsky B, Antebi S, Dgani R. Diagnosis and management of malignant germ cell ovarian tumors in young females. Int J Gynaecol Obstet 1996;55:1- 10. doi: HYPERLINK “https://doi.org/10.1016/0020- 7292(96)02719-1” \t “_blank” 10.1016/0020-7292(96)02719-1
  • Mohanty MK, Sahu P, Jaiswal AA, et al. A huge immature cervical teratoma, antenatal diagnosis, and its management – an unusual entity. J Clin Neonatol 2013;2:42‐5. doi:10.4103/2249- 4847.109249
  • Peterson CM, Buckley C, Holley S, Menias CO. Teratomas: a multimodality review. Curr Probl Diagn Radiol 2012;41:210-19. doi: HYPERLINK “https://doi.org/10.1067/j. cpradiol.2012.02.001” 10.1067/j.cpradiol.2012.02.001
  • Maharjan S. Mature cystic teratoma of ovary with squamous cell carcinoma arising from it. Clin Case Rep 2019;7:668-71. doi: 10.1002/ccr3.2062
  • 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;84:22-8.
  • Wang WC, Lai YC. Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review. J Ovarian Res 2017;10:17. doi:10.1186/s13048.017.0313-8
  • Al-Salem A. Teratoma. In: An Illustrated Guide to Pediatric Surgery. Cham:Springer International Publishing, 2014;63:491-503. doi: 10.1007/978-3-319-06665-3_63.
  • Rha SE, Byun JY, Jung SE, et al. Atypical CT and MRI manifestations of mature ovarian cystic teratomas. AJR 2004;183:743-50. doi: 10.2214/ajr.183.3.1830743
  • Hoo WL, Yazbek J, Holland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome?. Ultrasound Obstet Gynecol 2010;36:235‐40. doi:10.1002/uog.7610
  • Ustunyurt E, Gungor T, Iskender C, Ustunyurt BO, Bilge U, Mollamahmutoglu L. Tumor markers in mature cystic teratomas of the ovary. Arch Gynecol Obstet 2009;279:145-7. doi: 10.1007/s00404.008.0688-2.
  • Ito K. Significance of CA19-9 in mature cystic teratoma. Nihon Sanka Fujinka Gakkai Zasshi 1992;44:524-28.
  • Mikuni M, Makinoda S, Tanaka T, Okuda T, Domon H, Fujimoto S. Evaluation of tumor marker in ovarian dermoid cyst. Nihon Sanka Fujinka Gakkai Zasshi 1990;42:479-84.
  • Var T, Tonguc EA, Ugur M, Altinbas S, Tokmak A. Tumor markers panel and tumor size of ovarian dermoid tumors in reproductive age. Bratisl Lek Listy 2012;113:95-8. doi: HYPERLINK “https://doi.org/10.4149/bll_2012_022” \t “_ blank” 10.4149/bll_2012_022
  • Konishi I, Fujii S, Okamura H, et al. Analysis of serum CA125, CEA, AFP, LDH levels and LDH isoenzymes in patients with ovarian tumors—correlation between tumor markers and histological types of ovarian tumors. Nihon Sanka Fujinka Gakkai Zasshi 1986;38:827-36.
  • 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;88:153-7. doi: HYPERLINK “https://doi.org/10.1016/s0301-2115(99)00141-4” \t “_blank” 10.1016/s0301-2115(99)00141-4
  • Sushma TA, Shashikala K, Sharmila PS, et al. Study of histomorphological changes of teratomas in tertiary care hospital. J Evol Med Dent Sci 2013;2:1771-8.
  • Kikkawa F, Nawa A, Tamakoshi K, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer 1998;82:2249-55. doi: HYPERLINK “https://doi. org/10.1002/(sici)1097-0142(19980601)82:11%3C2249::aidcncr21% 3E3.0.co;2-t” \t “_blank” 10.1002/(sici)1097- 0142(19980601)82:11<2249::aid-cncr21>3.0.co;2-t
  • Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics 2001;21:475-90. doi: HYPERLINK “https://doi.org/10.1148/ radiographics.21.2.g01mr09475” \t “_blank” 10.1148/ radiographics.21.2.g01mr09475
  • Eskicioglu F, Gokmen T. Evaluation of mature ovarian cystic teratomas in our clinic: 110 cases. Tepecik Egit Arast Hast Dergisi 2016;26:23-6. doi:10.5222/terh.2016.023
  • Koonings PP, Campbell K, Mishell DR, Jr, Grimes DA. Relative frequency of primary ovarian neoplasms: a 10 year review. Obstet Gynecol 1989;74:921-6.
  • Partlow WF, Taybi H. Teratomas in infants and children. Am J Roentgenol Radium Ther Nucl Med 1971;112:155-66. doi: HYPERLINK “https://doi.org/10.2214/ajr.112.1.155” \t “_ blank” 10.2214/ajr.112.1.155
  • Schmoll HJ. Extragonadal germ cell tumors. Ann Oncol 2002;13:265-72. doi: 10.1093/annonc/mdf669
  • Stany MP, Hamilton CA. Benign disorders of the ovary. Obstet Gynecol Clin North Am 2008;35:271-84. http://dx.doi. org/10.1016/j.ogc.2008.03.004
  • Caspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women. Fertil Steril 1997;68:501-5. doi: HYPERLINK “https://doi.org/10.1016/s0015-0282(97)00228-8” \t “_blank” 10.1016/s0015-0282(97)00228-8
  • Breen JL, Maxson WS. Ovarian tumors in children and adolescents. Clin Obstet Gynecol 1977;20:607-23. doi: HYPERLINK “https://doi.org/10.1097/00003.081.197709000- 00010” \t “_blank” 10.1097/00003.081.197709000-00010
  • Caruso PA, Marsh MR, Minkowitz S, et al. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer 1971;27:343–48. doi: HYPERLINK“https://doi.org/10.1002/1097- 0142(197102)27:2%3C343::aid-cncr282.027.0215%3E3.0.co;2-b” \t “_blank” 10.1002/1097-0142(197102)27:2<343::aidcncr282.027.0215> 3.0.co;2-b
  • Varma AV, Malpani G, Agrawal P, Malukani K, Dosi S. Clinicopathological spectrum of teratomas: An 8-year retrospective study from a tertiary care institute. Indian J Cancer 2017;54:576-9. doi: 10.4103/ijc.IJC_294_17
  • Shin HJ, Kim KA, Kim B-H, et al. Benign enhancing components of mature ovarian teratoma: magnetic resonance imaging features and pathologic correlation. Clin Imaging 2016;40:1156- 61. https://doi.org/10.1016/j.clinimag.2016.08.005
  • Md Arshad NZ, Ng BK, Md Paiman NA, Abdullah Mahdy Z, Mohd Noor R. Intra-operative frozen sections for ovarian tumors – A tertiary center experience. Asian Pac J Cancer Prev 2018;19:213-18. doi:10.22034/APJCP.2018.19.1.213
  • Chiang AJ, La V, Peng J, Yu KJ, Teng NN. Squamous cell carcinoma arising from mature cystic teratoma of the ovary. Int J Gynecol Cancer 2011;21:466-74.doi: 10.1097/ IGC.0b013e31820d3e5b
  • Pradhan P, Thapa M. Dermoid cyst and its bizarre presentation. JNMA J Nepal Med Assoc 2014;52:837-44.
  • Sahraoui W, Hajji S, Essefi A, et al. Ovary teratoma. Report of 91 cases. Tunis Med 2006;84:349-52.
  • Drolet J, Dubuc-Lisoir J. Guidelines for the laparoscopic management of the adnexal mass. SOGC 1998;76:1-7. HYPERLINK “https://doi.org/10.1016/S0849-5831(98)80059- 1” doi: 10.1016/S0849-5831(98)80059-1
  • Uysal F, Balsak D, Uysal A, Incebiyik A, Muratli A, Yildirim Y. Clinical, diagnostic and anatomical aspects of mature cystic teratomas. Austin J Radiol 2014;1:3.
  • Atabekoğlu C, Bozaci EA, Tezcan S. Elevated carbohydrate antigen 19-9 in a dermoid cyst. Int J Gynaecol Obstet 2005;91:262-3. doi: HYPERLINK “https://doi.org/10.1016/j. ijgo.2005.07.019” \t “_blank” 10.1016/j.ijgo.2005.07.019
There are 36 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Articles
Authors

Ayhan Atıgan 0000-0002-7257-0593

Yeliz Arman Karakaya This is me 0000-0002-6669-9972

Umit Cabus This is me 0000-0001-5478-5673

Publication Date May 31, 2021
Published in Issue Year 2021 Volume: 34 Issue: 2

Cite

APA Atıgan, A., Arman Karakaya, Y., & Cabus, U. (2021). Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features. Marmara Medical Journal, 34(2), 167-174. https://doi.org/10.5472/marumj.925209
AMA Atıgan A, Arman Karakaya Y, Cabus U. Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features. Marmara Med J. May 2021;34(2):167-174. doi:10.5472/marumj.925209
Chicago Atıgan, Ayhan, Yeliz Arman Karakaya, and Umit Cabus. “Mature Cystic Ovarian Teratomas: Relationship Between Histopathological Contents and Clinical Features”. Marmara Medical Journal 34, no. 2 (May 2021): 167-74. https://doi.org/10.5472/marumj.925209.
EndNote Atıgan A, Arman Karakaya Y, Cabus U (May 1, 2021) Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features. Marmara Medical Journal 34 2 167–174.
IEEE A. Atıgan, Y. Arman Karakaya, and U. Cabus, “Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features”, Marmara Med J, vol. 34, no. 2, pp. 167–174, 2021, doi: 10.5472/marumj.925209.
ISNAD Atıgan, Ayhan et al. “Mature Cystic Ovarian Teratomas: Relationship Between Histopathological Contents and Clinical Features”. Marmara Medical Journal 34/2 (May 2021), 167-174. https://doi.org/10.5472/marumj.925209.
JAMA Atıgan A, Arman Karakaya Y, Cabus U. Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features. Marmara Med J. 2021;34:167–174.
MLA Atıgan, Ayhan et al. “Mature Cystic Ovarian Teratomas: Relationship Between Histopathological Contents and Clinical Features”. Marmara Medical Journal, vol. 34, no. 2, 2021, pp. 167-74, doi:10.5472/marumj.925209.
Vancouver Atıgan A, Arman Karakaya Y, Cabus U. Mature cystic ovarian teratomas: Relationship between histopathological contents and clinical features. Marmara Med J. 2021;34(2):167-74.