Ovarian Teratomas Unveiled: Pathologists' Curiosity Reveals Intriguing Associations in the Enigmatic Realm

Area of Science:

• Gynecologic Pathology
• Oncology
• Pathology

Background:

• Ovarian teratomas, including mature cystic teratomas (MCT) and immature teratomas, can present with rare complications.
• Malignant transformation and coexistence with other neoplasms are significant but infrequent occurrences.

Purpose of the Study:

• To analyze the clinicopathologic features of ovarian teratomas with malignant transformation and other associated neoplasms.
• To highlight the institutional experience with rare teratoma associations over a ten-year period.

Main Methods:

• Retrospective analysis of histopathologically diagnosed ovarian teratoma cases from January 2014 to December 2023.
• Review of clinicopathologic features, including malignant transformation, associated tumors, and gliomatosis peritonei.

Main Results:

• Out of 2858 ovarian tumors, 602 (21%) were teratomas. Immature teratomas occurred in 6.8% of cases, with 7 cases showing gliomatosis peritonei.
• Malignant transformations included squamous cell carcinoma (4 cases), carcinoid tumor (2), small cell neuroendocrine carcinoma (1), and mucinous adenocarcinoma (2).
• Other associations included struma ovarii (18 cases), growing teratoma syndrome (4), and NMDA-associated encephalitis (3). Nine cases showed co-existing neoplasms in the same ovary.

Conclusions:

• Ovarian teratomas can exhibit malignant transformation and coexist with diverse neoplasms, necessitating careful pathological evaluation.
• Awareness of these rare entities and meticulous tumor sampling are crucial for accurate diagnosis and patient management.