Makino Yoshiro, Nakayama Ken, Sasaki Yasushi, Ueda Yasuo, Morioka Miki
Department of Obstetrics and Gynecology, Showa Medical University Fujigaoka Hospital, Yokohama, JPN.
Department of Clinical Pathology, Showa Medical University Fujigaoka Hospital, Yokohama, JPN.
Cureus. 2025 Jul 12;17(7):e87765. doi: 10.7759/cureus.87765. eCollection 2025 Jul.
Immature uterine teratoma is an extremely rare extragonadal germ cell tumour with only a small number of reported cases. Given its rarity, standardised treatment guidelines are unavailable, requiring an individualised management approach. Post-treatment assessment remains challenging, particularly in differentiating gliomatosis peritonei, a benign glial implant, from residual malignancy, as this can critically influence subsequent decisions regarding additional surgery or chemotherapy. A 44-year-old woman presented with prolonged genital bleeding and a vaginal mass that was initially suspected to be a prolapsing submucosal fibroid. Surgery confirmed a grade 3 immature teratoma with peritoneal dissemination and ovarian metastasis, necessitating four cycles of bleomycin, etoposide, and cisplatin chemotherapy. Post-treatment imaging suggested a residual tumour; however, a secondary laparotomy revealed gliomatosis peritonei. Treatment decisions were guided by a comprehensive analysis of International Germ Cell Consensus Classification (IGCCC) and modified IGCCC risk stratifications, existing guidelines for gonadal and extragonadal germ cell tumours, and a review of past cases. Although limited by a small number of cases and clinical heterogeneity, findings from previous reports, including the present case, suggest a potential role for adjuvant chemotherapy in reducing recurrence, regardless of the tumour stage. Notably, even after chemotherapy, assessment continues to pose diagnostic difficulties in differentiating residual immature teratomas from gliomatosis peritonei, often requiring surgical confirmation. Optimal management of immature uterine teratomas has yet to be defined. This case underscores the importance of multimodal therapy and precise post-treatment evaluation for recurrence and residual disease. Further case accumulation and collaborative research are crucial to refine treatment strategies and improve outcomes.
未成熟子宫畸胎瘤是一种极其罕见的性腺外生殖细胞肿瘤，仅有少数病例报道。鉴于其罕见性，尚无标准化的治疗指南，需要采取个体化的管理方法。治疗后评估仍然具有挑战性，特别是在区分腹膜胶质瘤病（一种良性神经胶质植入物）和残留恶性肿瘤方面，因为这可能会严重影响后续关于额外手术或化疗的决策。一名44岁女性因长期生殖器出血和阴道肿物就诊，最初怀疑是黏膜下肌瘤脱垂。手术证实为3级未成熟畸胎瘤伴腹膜播散和卵巢转移，需要进行四个周期的博来霉素、依托泊苷和顺铂化疗。治疗后的影像学检查提示有残留肿瘤；然而，二次剖腹探查发现为腹膜胶质瘤病。治疗决策以对国际生殖细胞共识分类（IGCCC）和改良IGCCC风险分层、性腺和性腺外生殖细胞肿瘤的现有指南的综合分析以及对既往病例的回顾为指导。尽管受到病例数量少和临床异质性的限制，但包括本病例在内的既往报告结果表明，辅助化疗在降低复发风险方面可能具有潜在作用，无论肿瘤分期如何。值得注意的是，即使在化疗后，在区分残留的未成熟畸胎瘤和腹膜胶质瘤病时，评估仍然存在诊断困难，通常需要手术确认。未成熟子宫畸胎瘤的最佳管理方法尚未确定。本病例强调了多模式治疗以及对复发和残留疾病进行精确治疗后评估的重要性。进一步积累病例和开展合作研究对于完善治疗策略和改善治疗结果至关重要。
