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An unusual case of squamous cell cancer in dermoid cystM. Chakrabarti1, P. Keating2, M. J. Willett1,

1Lancashire Women and Newborn Centre, 2Lancashire Teaching Hospitals, UK

Objectives and Background

• To find out suitable management option of uncommon primary malignancy in matured cystic teratoma (MCT) in young women with fertility wishes.

• Discuss the absence of reliable preoperative prognostic indicator of malignancy.

Presentation

A 25 year old nulliparous woman presented with lower abdominal pain. Ultrasound findings showed unilateral ovarian mass suggestive of ‘dermoid cyst’. Biochemical tumour markers (AFP, CEA) were normal except CA125 which was slightly elevated. She was treated with cystectomy and ovarian reconstruction. A relief was sensed that the treatment was complete.

Results

• The recovery was uneventful.• The histopathology result showed a

surprising diagnosis of squamous cell carcinoma (SCC) transformation of teratoma.

• The patient was devastated because of this unexpected diagnosis.

• Ipsilateral salpingo-oophorectomy, omentectomy and para-aortic lymphadenectomy were performed in a second laparotomy.

• This showed complete excision of disease.

• Investigations were undertaken to exclude any other focus of SCC as primary cancer is rare.

• She is currently having follow up after an ovarian cancer.

Conclusions

References

• Follow up protocol and long term prognosis are also not clear in these cases.

• Cases like this are rare but contributes to considerable physical and psychological morbidity of patients.

• Because of paucity of adequate number of cases no sound scientific studies could be done yet.

• Further detailed worldwide reporting and registry of such cases is of utmost importance and research is needed to analyse the predictive and prognostic indicators.

Histopathology is mandatory as all ovarian masses should be considered malignant until proved otherwise. Patients should be adequately counselled preoperatively. The days of feeling reassured with an ultrasound suggestion of dermoid is over.

OPTIONALLOGO HERE

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1. Andreas Hackethal, Doerthe Brueggmann, Michael K Bohlmann, Folker E Franke, Hans-Rudolf Tinneberg, Karsten Münstedt: Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data. Lancet Oncol 2008; 9: 1173–80

2. An-Jen Chiang, MD, Victor La, BS, Jiaqi Peng, BS, Ken-Jen Yu, Nelson N.H. Teng, : Squamous Cell Carcinoma Arising From Mature Cystic Teratoma of the Ovary. Int J Gynecol Cancer. 2011;21: 466—474

The photo is from ‘open source creative commons’, not from this case

What is a Dermoid cyst

A dermoid cyst is a cystic teratoma that contains developmentally mature skin complete with hair follicles and sweat glands, sometimes clumps of long hair, and often pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue. Because it contains mature tissue, a dermoid cyst is almost always benign.

An example of mature cystic teratoma extracted from a left ovary showing mature teeth, skin and hair

Conclusions

• In common practice ‘Dermoid cysts’ are thought to be generally benign.

• Few preoperative predictors were discussed in literature [1],[2]. e.g. • elderly age, • bigger tumour size, • ultrasound characteristics, • sonar tumour vessel wave form, • levels of SCC antigen and CA125 tumour

markers, but none of them are conclusive

• This case suggests the usual threshold of 30 years of age [1] for more preoperative work up is debatable.