1887
Volume 2024, Issue 3
  • ISSN: 0253-8253
  • EISSN: 2227-0426

Abstract

Background: Mature cystic teratomas, also known as dermoid cysts, are the most prevalent form of ovarian germ cell tumors. While they typically manifest in women of reproductive age, they can also occur in pediatric patients. These tumors are generally benign and comprise a diverse array of tissue types. However, large lesions, particularly those exceeding 10 cm in diameter, are infrequent and can present diagnostic and therapeutic challenges. Notably, elevated tumor markers, such as cancer antigen 19-9 (CA 19-9), are not commonly associated with mature cystic teratomas, rendering this case particularly unusual.

Case presentation: The clinical case involved an 8-year-old female patient who presented with an exceptionally large ovarian teratoma, measuring 13 × 12 cm. While the prepubertal presentation of such tumors is not uncommon, the remarkable size of the lesion was an extraordinary occurrence. Preoperative evaluation revealed markedly elevated levels of CA 19-9, a tumor marker, at 297 U/mL—an atypical finding for mature cystic teratomas. Imaging studies identified a complex cystic adnexal mass, indicative of a teratoma. Consequently, a laparotomy was performed, revealing an intact, benign lesion that was successfully resected via cystectomy, with preservation of the ovary. Histopathological examination confirmed the diagnosis of a mature cystic teratoma, without any evidence of malignant transformation. Notably, following the surgical intervention, the elevated CA 19-9 levels normalized, suggesting a potential association between the teratoma and the abnormal tumor marker levels.

Discussion: This report delineates the surgical management and clinical course of an exceptionally large ovarian teratoma in a pediatric patient with abnormal preoperative tumor markers. Despite atypical features, the excellent prognosis following fertility-sparing resection underscores the significance of conservative treatment in young females.

Conclusion: This case highlights the occurrence of a large mature cystic teratoma with elevated CA-19-9 in a pediatric patient with no complications such as torsion, rupture, or malignancy. The elevation in CA-19-9 likely relates directly to the teratoma itself. A conservative, fertility-sparing surgical approach proved effective, emphasizing the importance of careful preoperative evaluation and management in similar cases.

Loading

Article metrics loading...

/content/journals/10.5339/qmj.2024.47
2024-09-16
2024-10-03
Loading full text...

Full text loading...

/deliver/fulltext/qmj/2024/3/qmj.2024.47.html?itemId=/content/journals/10.5339/qmj.2024.47&mimeType=html&fmt=ahah

References

  1. Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN. Pathology and classification of ovarian tumors. Cancer. 2003; 97:(Suppl. 10):2631-42. https://doi.org/10.1002/cncr.11345
    [Google Scholar]
  2. Cong L, Wang S, Yeung SY, Lee JHS, Chung JPW, Chan DYL. Mature cystic teratoma: An integrated teview. Int J Mol Sci. 2023; 24:(7):6141. https://doi.org/10.3390/ijms24076141
    [Google Scholar]
  3. 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. https://doi.org/10.1016/s0301-2115(99)00141-4
    [Google Scholar]
  4. Kido A, Togashi K, Konishi I, Kataoka ML, Koyama T, Ueda H, et al.. Dermoid cysts of the ovary with malignant transformation: MR appearance. Am J Roentgenol. 1999; 172:445-9. https://doi.org/10.2214/ajr.172.2.9930800
    [Google Scholar]
  5. Gadducci A, Pistolesi S, Guerrieri ME, Cosio S, Carbone FG, Naccarato AG. Malignant transformation in mature cystic teratomas of the ovary: Case reports and review of the literature. Anticancer Res. 2018; 38:3669-75. https://doi.org/10.21873/anticanres.12644
    [Google Scholar]
  6. 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:(2):153-7. https://doi.org/10.1016/s0301-2115(99)00141-4
    [Google Scholar]
  7. Saleh M, Bhosale P, Menias CO, Ramalingam P, Jensen C, Iyer R, et al.. Ovarian teratomas: Clinical features, imaging findings and management. Abdom Radiol (NY). 2021; 46:(6):2293-307. https://doi.org/10.1007/s00261-020-02873-0
    [Google Scholar]
  8. Jha S, Goel G, Sinha HH, Anant M, Agarwal M. Effects of intraoperatively ruptured Ovarian dermoid cysts. J Gynecol Surg. 2022; 38:221-5. https://doi.org/10.1089/gyn.2021.0125
    [Google Scholar]
  9. Tanaka Y, Hori H, Gorai I. Chemical peritonitis caused by an iatrogenic rupture of mature cystic teratoma of the ovary during labor: A report of a case didactic to all the maternity health care workers. J Matern Fetal Neonatal Med. 2011; 24:(2):388-90. https://doi.org/10.3109/14767058.2010.482626
    [Google Scholar]
  10. Tan P, Willatt J, Lindsell D. The ability of ultrasound to detect gynaecological neoplasms and their ultrasound morphological features. Australas Radiol. 2007; 51:260-6. https://doi.org/10.1111/j.1440-1673.2007.01723.x
    [Google Scholar]
  11. Hertzberg BS, Kliewer MA. Sonography of benign cystic teratoma of the ovary: Pitfalls in diagnosis. Am J Roentgenol. 1996; 167:1127-33. https://doi.org/10.2214/ajr.167.5.8911163
    [Google Scholar]
  12. Kite L, Uppal T. Ultrasound of ovarian dermoids—Sonographic findings of a dermoid cyst in a 41-year-old woman with an elevated serum hCG. Australas J Ultrasound Med. 2011; 14:19-21. https://doi.org/10.1002/j.2205-0140.2011.tb00119.x
    [Google Scholar]
  13. Friedman AC, Pyatt RS, Hartman DS, Downey EF Jr, Olson WB. CT of benign cystic teratomas. AJR Am J Roentgenol. 1982; 138:(4):659-65. https://doi.org/10.2214/ajr.138.4.659
    [Google Scholar]
  14. Atallah GA, Kampan NC, Chew KT, Mohd Mokhtar N, Zin RR, Shafiee MNB, et al.. Predicting prognosis and platinum resistance in ovarian cancer: Role of immunohistochemistry biomarkers. Int J Mol Sci. 2023; 24:(3):1973. https://doi.org/10.3390/ijms24031973
    [Google Scholar]
  15. Chiang AJ, Chen MY, Weng CS, Lin H, Lu CH, Wang PH, et al.. Malignant transformation of ovarian mature cystic teratoma into squamous cell carcinoma: A Taiwanese gynecologic oncology group (TGOG) study. J Gynecol Oncol. 2017; 28:(5):e69. https://doi.org/10.3802/jgo.2017.28.e69
    [Google Scholar]
  16. Scarà S, Bottoni P, Scatena R. CA 19-9: Biochemical and clinical aspects. Adv Exp Med Biol. 2015; 867:247-60. https://doi.org/10.1007/978-94-017-7215-0_15
    [Google Scholar]
  17. Ustunyurt E, Gungor T, Iskender C, Iskender C, Ustunyurt BO, Bilge U, et al.. Erratum to: Tumor markers in mature cystic teratomas of the ovary. Arch Gynecol Obstet. 2015; 291:231. https://doi.org/10.1007/s00404-014-3501-4
    [Google Scholar]
  18. Sampaio J, Sarmento-Gonçalves I, Barros JM, Felix J, Tiago-Silva P. Mature cystic teratoma of Ovary with abnormally high levels of Ca19-9: A case report. Rev Bras Ginecol Obstet. 2016; 38:(7):365-7. https://doi.org/10.1055/s-0036-1586161
    [Google Scholar]
  19. Ulkumen BA, Goker A, Pala HG, Ordu S. Abnormal elevated Ca 19–9 in the dermoid cyst: A sign of the ovarian torsion? Case Rep Obstet Gynecol. 2013; 20:(13):860505. https://doi.org/10.1155/2013/860505
    [Google Scholar]
  20. Mahe E, Sur M. Squamous lesions of the ovary. Arch Pathol Lab Med. 2011; 135:(12):1611-4. https://doi.org/10.5858/arpa.2010-0640-RS
    [Google Scholar]
  21. Sinha A, Ewies AA. Ovarian mature cystic teratoma: Challenges of surgical management. Obstet Gynecol Int. 2016; 2016:2390178. https://doi.org/10.1155/2016/2390178
    [Google Scholar]
  22. Sahin H, Abdullazade S, Sanci M. Mature cystic teratoma of the ovary: A cutting edge overview on imaging features. Insights Imaging. 2017; 8:(2):227-41. https://doi.org/10.1007/s13244-016-0539-9
    [Google Scholar]
  23. Multani J, Kives S. Dermoid cysts in adolescents. Curr Opin Obstet Gynecol. 2015; 27:(5):315-9. https://doi.org/10.1097/GCO.0000000000000206
    [Google Scholar]
  24. Srisajjakul S, Prapaisilp P, Bangchokdee S. Imaging features of unusual lesions and complications associated with ovarian mature cystic teratoma. Clin Imaging. 2019; 57:115-23. https://doi.org/10.1016/j.clinimag.2019.05.013
    [Google Scholar]
  25. Atwi D, Kamal M, Quinton M, Hassell LA. Malignant transformation of mature cystic teratoma of the ovary. J Obstet Gynaecol Res. 2022; 48:(12):3068-76. https://doi.org/10.1111/jog.15409
    [Google Scholar]
  26. Yoshioka T, Tanaka T. Immunohistochemical and molecular studies on malignant transformation in mature cystic teratoma of the ovary. J Obstet Gynaecol Res. 1998; 24:(2):83-90. https://doi.org/10.1111/j.1447-0756.1998.tb00057.x
    [Google Scholar]
  27. Dede M, Gungor S, Yenen MC, Alanbay I, Duru NK, Haşimi A. CA19-9 may have clinical significance in mature cystic teratomas of the ovary. Int J Gynecol Cancer. 2006; 16:(1):189-93. https://doi.org/10.1111/j.1525-1438.2006.00284.x
    [Google Scholar]
  28. Cho HY, Kim K, Jeon YT, Kim YB, No JH. CA19-9 elevation in ovarian mature cystic teratoma: Discrimination from ovarian cancer - CA19-9 level in teratoma. Med Sci Monit. 2013; 19:230-5. https://doi.org/10.12659/MSM.883865
    [Google Scholar]
  29. Frimer M, Seagle BLL, Chudnoff S, Goldberg GL, Shahabi S. Role of elevated cancer antigen 19-9 in women with mature cystic teratoma. Reprod Sci. 2014; 21:(10):1307-11. https://doi.org/10.1177/1933719114525274
    [Google Scholar]
  30. Suh DS, Moon SH, Kim SC, Joo JK, Park WY, Kim KH. Significant simultaneous changes in serum CA19-9 and CA125 due to prolonged torsion of mature cystic teratoma of the ovary. World J Surg Oncol. 2014; 12:353. https://doi.org/10.1186/1477-7819-12-353
    [Google Scholar]
/content/journals/10.5339/qmj.2024.47
Loading
/content/journals/10.5339/qmj.2024.47
Loading

Data & Media loading...

  • Article Type: Case Report
Keyword(s): CA-19-9 antigencysticDermoid cystovarianteratoma and ultrasonography
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error