Qian Xue-Qian, Chen Li-Li, Zhu Chang-Kun, Chen Ya-Xia, Wan Xiao-Yun
Department of Gynecologic Oncology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou, China.
Front Surg. 2023 Jun 28;10:1193994. doi: 10.3389/fsurg.2023.1193994. eCollection 2023.
Malignant transformation of mature ovarian teratoma is a rare phenomenon, mainly occurring in postmenopausal period. Squamous cell carcinoma accounts for 80% of all malignant transformations. Sarcoma transformation is much less common and tends to imply a poorer prognosis and aggressiveness.
We report a case of undifferentiated sarcoma with squamous cell carcinoma in a mature cystic teratoma of the ovary in a 36-year-old woman. The tumor shows epithelial and stromal components. This is a unique report of a benign teratoma of the ovary with malignant transformation, showing epithelial and sarcomatous components. This young woman presented with abdominal distension and a rapidly enlarging ovario-derived pelvic mass with a slightly elevated CA199 tumor marker of 115.9 U/ml. The woman underwent transabdominal excision of the left ovarian cyst on October 20, 2020. During the operation, rapid freezing pathological examination did not indicate malignancy. The postoperative paraffin pathology revealed undifferentiated sarcoma with squamous cell carcinoma (from mature cystic teratoma malignancy), and she finally received comprehensive staging surgery. Postoperative paraffin pathology showed no residual cancer in uterus and other tissues, and all lymph nodes were negative. The patient was finally diagnosed with ovarian malignant tumor IC1 stage (high-grade spindle cell sarcoma complicated with squamous cell carcinoma). Chemotherapy was completed three times after surgery, and no signs of recurrence were found after follow-up.
The preoperative diagnosis and intraoperative rapid freezing examination of malignant transformation of mature teratoma of ovary are challenging.
成熟卵巢畸胎瘤恶变是一种罕见现象，主要发生在绝经后。鳞状细胞癌占所有恶变类型的80%。肉瘤样变则更为少见，且往往提示预后较差和侵袭性更强。
我们报告一例36岁女性成熟囊性卵巢畸胎瘤发生未分化肉瘤并伴有鳞状细胞癌的病例。肿瘤显示有上皮和间质成分。这是一例卵巢良性畸胎瘤恶变并显示上皮和肉瘤成分的独特报告。该年轻女性表现为腹胀，卵巢来源的盆腔肿物迅速增大，CA199肿瘤标志物轻度升高至115.9 U/ml。2020年10月20日该女性接受了经腹左卵巢囊肿切除术。术中快速冷冻病理检查未提示恶性。术后石蜡病理显示未分化肉瘤并伴有鳞状细胞癌（源于成熟囊性畸胎瘤恶变），她最终接受了全面分期手术。术后石蜡病理显示子宫及其他组织无残留癌，所有淋巴结均为阴性。患者最终被诊断为卵巢恶性肿瘤IC1期（高级别梭形细胞肉瘤合并鳞状细胞癌）。术后完成了三次化疗，随访后未发现复发迹象。
卵巢成熟畸胎瘤恶变的术前诊断及术中快速冷冻检查具有挑战性。
