Immature Teratoma Of The Ovary And Pregnancy

##plugins.themes.academic_pro.article.sidebar##

Published Jun 22, 2010
Download
pdf
Vol. 88 No. 7 (2010): Issue Jul 2010

##plugins.themes.academic_pro.article.main##

Mechaal Mourali
Amine Ben Haj Hassine
Chiraz El Fekih
Jihen Essoussi-Chikhaoui
Naoufel Binous
Nabil Ben Zineb
M Ayadi
Faouzi Mezni

Abstract

Background : Composing of less than 1% of all ovarian cancers, immature teratoma is a malignancy that mainly affects the young. Immature teratoma of the ovary together with pregnancy is rare. To our knowledge, this association was reported only in twelve cases.
Aim : We Report two cases of immature teratoma of the ovary diagnosed during pregnancy and their respective issue.
Observation : 1st case. A 28 years old woman gravida 1 with an immature teratoma of the ovary discovered during delivery by caesarean section. The treatment was conservative including salpingo-oophorectomy, omentectomy, aortic lymph node dissection and appendectomy. This patient had a second pregnancy with a good outcome. She delivered by caesarean section in order to perform radical treatment: hysterectomy and oophorectomy of the remaining
ovary. 2nd case. A 22 years old woman gravida 1 with adnexal mass
diagnosed during an ultrasonography exam at 15 weeks gestation. A conservative treatment was indicated, including salpingooophorectomy, omentectomy, aortic lymph node dissection, appendectomy and biopsy of the remaining ovary. The patient had a normal vaginal delivery.
Conclusion : Immature teratoma is graded from 1 to 3. The management of this association is discussed, but it takes in consideration the surgical staging, the grade and the secretion of aFP. Conservative treatment without associating chemotherapy can be tempted in tumours with a stade AI and a low grade.

Keywords:

Malignant ovarian germ cell tumour, immature teratoma, pregnancy, alpha-fetoprotein, surgical staging

##plugins.themes.academic_pro.article.details##

References

  1. Thurlbeck WM, Scully RE. Solid teratoma of the ovary. A clinicopathological analysis of 9 cases. Cancer 1960; 13 : 804-11.
  2. Le Goarant de Tromelin J, Deruelle P, Lucot JP, Collinet P. Évaluation de la prise en charge des tératomes immatures de l'ovaire. À propos de trois cas et revue de la littérature. Gynécologie obstétrique & fertilité 2005; 33 : 594-9.
  3. Norris JH, O'Connor MD. “Pathology of malignant germ cell tumors of the ovary”. second edition. In: Coppleson M, editor. “Gynaecologic oncology”. Hong Kong: Longman Group (FE) Ltd; 1992.
  4. Quirk J, Natarajan. Ovarian cancer incidence in the United States, 1992-1999 N Gynecologic Oncology 2005; 97: 519 - 523.
  5. World Health Organization Classification of Tumours (2003). Pathology and genetics of tumours of the breast and female genital organs.
  6. Nogales FF, Favara BE, Major FJ, Silverberg SG. Immature teratoma of the ovary with a neural component (solid teratoma). Hum Pathol 1976; 7 : 625 - 42.
  7. Sutton CL, McKinney CD, Jones JE, Gay SB. Ovarian masses revisited: radiologic and pathologic correlation. Radiographics 1992; 12 : 853-77.
  8. Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics 2001; 21 : 475-90.
  9. Yamaoka T, Togashi K, Koyama T, Fujiwara T, Higuchi T, Iwasa Y, et al. Immature teratoma of the ovary: correlation of MR imaging and pathologic findings. Eur. Radiol. 2003; 13 : 313-9.
  10. Kawata M, Sekiya S, Hatakeyama R, Takamizawa H. Neuronspecific enolase as a serum marker for immature teratoma and dysgerminoma. Gynecol Oncol 1989; 32 : 191-7
  11. Trabelsi A, Conan-Charlet V, Lhomme C, Morice P, Duvillard P, Sabourin JC. Glioblastome péritonéal: récidive d'un tératome immature de l'ovaire (à propos d'un cas). Ann Pathol 2002; 22 : 130-133.
  12. Norris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary : a clinical and pathologic study of 58 cases. Cancer 1976; 37 : 2359-72.
  13. Matsuyama T, Tsukamoto N, Matsukuma K, Kamura T. Malignant ovarian tumors associated with pregnancy: Report of six cases International Journal of Gynecology & Obstetrics 1989; 28 : 61-6.
  14. Christman J, Teng N, Lebovic G. Delivery of a normal infant following cisplatin, vinblastine, and bleomycin (PVB) chemotherapy for malignant teratoma of the ovary during pregnancy. Gynecol Oncol 1990 May; 37 : 292-5.
  15. Querleu D, Leblanc E. Masses annexielles. Montrouge, John Libbey Eurotext, 2002 : 46-50.
  16. Montz F, Horenstein J, Platt L, d'Ablaing G. The diagnosis of immature teratoma by maternal serum alpha-fetoprotein screening. Obstet Gynecol 1989; 73 : 522-5.
  17. Gallion H, van Nagell JR, Donaldson ES, Hanson MB, Powell DF. Immature teratoma of the ovary. Am J Obstet Gynecol 1983; 146 : 361-5.
  18. Charles G, Marhic C, Ponties JE. Cancer avancé de l'ovaire et grossesse. A propos de 2 cas. Journal Gynécologie obstétrique Biol Reprod. 1989; 18 : 61-8.
  19. Lenglet Y, Roman H, Rabishong B, Bourdel N. Traitement coelioscopique des kystes de l'ovaire au cours de la grossesse Laparoscopic. Gynécologie Obstétrique & Fertilité 2006 ; 34 : 101-6.
  20. Al Fozan H, Tulandi T. Safety and risks of laparoscopy in pregnancy. Curr Opin Obstet Gynecol 2002; 14 : 375-9.
  21. Canis M, Botchorishvili R, Manhes H, Wattiez A, Mage G, Pouly JL, et al. Management of adnexal masses: role and risk of laparoscopy. Semin Surg Oncol 2000; 19 : 28-35.
  22. Low JJ, et al. Conservative surgery to preserve ovarian function in patients with malignant ovarian germ cell tumors. A review of 74 cases. Cancer 2000; 89 : 391-8.
  23. Zhao X, Hug H, Lian L, Lang J. Ovarian cancer in pregnancy : a clinicopathologic analysis of 22 cases and review of the literature. International Journal of Gynecological Cancer. 2006; 16 : 8-15.
  24. Karimi Zarchi M, Behtash N, Modares Gilani M. Good pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for ovarian immature teratoma: a case report and literature review. Arch gynecol obstet 2007 Jan; 277 : 75-8.
  25. Bakri Y, Ezzat A, Akhtar, Dohami. Malignant germ cell tumors of the ovary: Pregnancy considerations. European Journal of Obstetrics & Gynecology and Reproductive Biology 2000; 90 : 87-91.
  26. Smith JP, Rutledge F. Advances in chemotherapy for gynecologic cancer. Cancer 1975; 36 : 669-74
  27. Nishio S, Ushijima K, Fukui A, Fujiyoshi N, Kawano K. Fertilitypreserving treatment for patients with malignant germ cell tumors of the ovary J. Obstet. Gynaecol. Res. 2006; 32: 416-21.
  28. Einhorn LH, Donohue J. cis-Diamminedichloroplatinum, vinblastine and bleomycin combination chemotherapy in disseminated testicular cancer. Ann Intern Med 1977; 87 : 293-8.
  29. Williams SD, Blessing JA, Moore DH, Homesley HD, Adcock L. Cisplatin, vinblastine, and bleomycin in advanced and recurrent ovarian germ-cell tumors. A trial of the Gynecologic Oncology Group. Ann Intern Med 1989; 111: 22-7.
  30. 30] Roth BJ, Greist A, Kubilis PS, Williams SD, Einhorn LH. Cisplatin- based combination chemotherapy for disseminated germ cell tumors: Long-term follow-up. J Clin Oncol 1988; 6 : 1239-47.
  31. Williams S, Blessing JA, Liao SY, Ball H, Hanjani P. Adjuvant,therapy of ovarian germ cell tumors with cisplatin, etoposide,,and bleomycin: A trial of the Gynecologic Oncology Group. J Clin Oncol 1994; 12: 701-6.
  32. Gershenson DM, Morris M, Cangir A, Kavanagh JJ, Stringer CA, Edwards CL. Treatment of malignant germ cell tumors of the ovary with bleomycin, etoposide, and cisplatin. J Clin Oncol 1990; 8: 715-20.
  33. Sait K, Simpson C. Ovarian teratoma diagnosis and management: case presentations. J. Obstet. Gynaecol. Can. 2004; 26 : 137-42.