Billod Jimmy A, Manangan-Wong Rhesa Michelle
Department of Obstetrics and Gynecology, Baguio General Hospital and Medical Center.
Department of Pathology, Baguio General Hospital and Medical Center.
Acta Med Philipp. 2024 Aug 30;58(15):55-60. doi: 10.47895/amp.vi0.8023. eCollection 2024.
Malignant transformation (MT) in mature cystic teratoma of the ovary (MCTO) is rare. This descriptive study primarily aims to determine the prevalence rate of MT in MCTO and describe clinicopathologic features, management, and prognosis of patients who developed this rare type of tumor and likewise deliver a review in the light of recent literature.
This is a descriptive observational study of 22 patients with MT in MCTO at a Level 3 Tertiary Public Hospital in Baguio City, Philippines. The clinical and pathological records of each patient were reviewed. Descriptive statistics were used.
Between January 2016 to December 2020, of the 369 cases of mature cystic teratoma, 22 cases with malignant transformation were reported with an incidence of 6%. The mean age of diagnosis was 52 years, of which 70% are aged 50 years old and above. Fifty-nine percent (13/22) and 32% (7/22) of the cases were squamous cell carcinoma and mucinous adenocarcinoma, respectively. Very rarely, malignant transformations were carcinoid tumors (1) and follicular carcinoma (1). The most common reason for consult among patients is a palpable abdominal/pelvic mass (45.5%). Around 60% percent of cases have an elevated CA-125 value with a mean level of 180 U/ml. Seventy-two percent of cases with malignant transformation measured 10 cm or more with the largest mean diameter of 13 cm. Five patients underwent fertility-sparing surgery. Fourteen had staging procedures. Twelve patients were at Stage I. Three were at Stage II. Four and three patients were at Stage III and IV, respectively. Ten patients received adjuvant platinum-based chemotherapy and nine patients warrant no treatment after surgery. The median survival time is 14 months.
Although not common, malignant transformation in MCT should be considered in older patients with large tumor sizes and elevated CA-125 assessed as MCT in preoperative and intraoperative assessment. This ovarian malignancy suggests an aggressive behavior but complete resection with systematic staging and indicated adjuvant platinum-based chemotherapy may improve survival.
卵巢成熟囊性畸胎瘤（MCTO）发生恶性转化（MT）的情况较为罕见。本描述性研究主要旨在确定MCTO中MT的发生率，描述发生这种罕见肿瘤类型的患者的临床病理特征、治疗及预后，并结合近期文献进行综述。
这是一项对菲律宾碧瑶市一家三级公立医院中22例MCTO发生MT的患者进行的描述性观察研究。对每位患者的临床和病理记录进行了回顾。采用描述性统计方法。
2016年1月至2020年12月期间，在369例成熟囊性畸胎瘤病例中，报告了22例发生恶性转化，发生率为6%。诊断时的平均年龄为52岁，其中70%为50岁及以上。病例中分别有59%（13/22）和32%（7/22）为鳞状细胞癌和黏液腺癌。极少见的恶性转化为类癌肿瘤（1例）和滤泡癌（1例）。患者就诊的最常见原因是可触及的腹部/盆腔肿块（45.5%）。约60%的病例CA-125值升高，平均水平为180 U/ml。发生恶性转化的病例中有72%测量值为10 cm或更大，最大平均直径为13 cm。5例患者接受了保留生育功能手术。14例进行了分期手术。12例患者处于I期。3例处于II期。分别有4例和3例患者处于III期和IV期。10例患者接受了铂类辅助化疗，9例患者术后无需治疗。中位生存时间为14个月。
尽管不常见，但在术前和术中评估为MCT且肿瘤较大、CA-125升高的老年患者中，应考虑MCT发生恶性转化的情况。这种卵巢恶性肿瘤提示具有侵袭性，但完整切除并进行系统分期及必要的铂类辅助化疗可能会提高生存率。
