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European Journal of Gynaecological Oncology  2020, Vol. 41 Issue (3): 484-488    DOI: 10.31083/j.ejgo.2020.03.5146
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Malignancy-transformed mature cystic teratoma surgical treatment requires comprehensive staging procedures including pelvic/para-aortic lymphadenectomy
B. Barczyński1(), K. Frąszczak1, M. Bilski2, J. Szumiło3, I. Wertel1, M. Sobstyl4, G. Polak1, L. Grzybowska-Szatkowska5, J. Kotarski1
1I Department of Oncological Gynaecology and Gynaecology, Medical University of Lublin, Lublin, Poland
2Nu-med, Center of Oncology Diagnostics and Therapy, Zamość, Poland
3Department of Clinical Pathomorphology, Medical University of Lublin, Lublin, Poland
4Department of Gynaecology and Gynaecological Endocrinology, Medical University of Lublin, Lublin, Poland
5I Department of Radiation Therapy, Center of Oncology of the Lublin Region St. John from Dukla, Lublin, Poland
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Abstract  

This report presents the case of squamous cell cancer (SCC) originating from a mature cystic teratoma (MCT) diagnosed in pregnant women, in whom retroperitoneal spread to para-aortic lymph nodes was confirmed as the only evidence of extraovarian disease in a relatively short time after primary tumor excision. The 35-year-old multipara was diagnosed in early pregnancy with an ovarian tumor. The patient qualified for elective caesarean section with left ovarian cystectomy. Pathological result proved SCC in MCT and the patient underwent debulking surgery without total pelvic and para-aortic lymphadenectomy. Final staging confirmed ovarian malignancy FIGO IA, and no adjuvant treatment was recommended. Early imaging examination during routine follow-up demonstrated enlarged para-aortic lymph nodes and the patient qualified for total pelvic and para-aortic lymphadenectomy. Postoperative pathology result confirmed metastases in para-aortic lymph nodes and standard adjuvant chemotherapy was administered.

Key words:  Malignancy-transformed mature cystic teratoma      Para-aortic lymphadenectomy     
Submitted:  27 January 2019      Accepted:  01 April 2019      Published:  15 June 2020     
Fund: DS 120/2019/Medical University of Lublin
*Corresponding Author(s):  B. Barczyński     E-mail:  bbarczynski@poczta.onet.pl

Cite this article: 

B. Barczyński, K. Frąszczak, M. Bilski, J. Szumiło, I. Wertel, M. Sobstyl, G. Polak, L. Grzybowska-Szatkowska, J. Kotarski. Malignancy-transformed mature cystic teratoma surgical treatment requires comprehensive staging procedures including pelvic/para-aortic lymphadenectomy. European Journal of Gynaecological Oncology, 2020, 41(3): 484-488.

URL: 

https://ejgo.imrpress.com/EN/10.31083/j.ejgo.2020.03.5146     OR     https://ejgo.imrpress.com/EN/Y2020/V41/I3/484

Figure 1.  — Axial and sagittal MRI showing left ovarian fluid cyst with a two-phase liquidfat system. Centrally inside the cyst, a sphericallesion with heterogeneous signal intensity and a diameter of about 40 mm (most likely a thrombus) is identified.

Figure 2.  — Gross examination of resected ovary revealed cystic tumor sized 70 × 70 × 60 mm composed of squamous cell carcinoma originating from a mature teratoma (A). The cyst is filled with hairs and sebaceous masses. Microscopic examination of the solid part of the tumor shows partly necrotic squamous cell carcinoma G2 with no features of tunica albuginea infiltration (B). The cyst is covered by normal keratinised squamous epithelium partly with features of carcinoma in situ (C). At the edges of the tumor mature teratoma elements are identified (D) (H+E staining).

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