Ovarian Immature Teratoma Detected During Pregnancy

Year 2016, Volume: 3 Issue: 1, 1 - 6, 15.01.2016

Pinar Hasdemir , Tevfik Guvenal , Serkan Menekse Ulas Solmaz , Ali Kandiloglu , Faik Koyuncu Ali Ayhan

https://doi.org/10.17546/msd.39076

Abstract

Ovarian Immature Teratoma Detected During Pregnancy

Abstract

Objective: Malignant ovarian immature teratomas should be considered in differantial diagnosis of adnexal masses detected during pregnancy. This paper is reviewing the clinicopathologic and prognostic characteristics and therapeutic options for treatment of immature teratoma during pregnancy in the context of a case of pregnancy complicated with immature teratoma.

Materials and Methods: A PubMed and Scopus search was conducted with the key words ‘ovarian immature teratoma’ and ‘pregnancy’ and all related published articles assessed. A total of 24 cases, included our case were included in the study. Age at presentation, clinical findings, histologic grades and stages, treatment options and the prognosis of both mothers and fetuses was analysed.

Results: The median age of the patients in the published reports was 27.0± 4.2 ( range 21-36) years. The main presenting symptom was adnexal mass followed by abdominal or pelvic pain. Chemotherapy was added to the surgical treatment in 68.2% of the patients; a Bleomycin, Etoposide and Cisplatin protocol was the preferred treatment option. Prognosis for both mother and fetus were good.

Conclusion: Immature teratoma during pregnancy should be treated immediately with surgery ± chemotherapy especially in high grade patients.

Keywords

chemotherapy, germ cell tumors, immature teratoma, pregnancy

References

• Norris HJ, Zirkin HJ, Benson WL. Immature (malignant) teratoma of the ovary: a clinical and pathologic study of 58 cases. Cancer 1976; 37: 2359-72.
• Christman JE, Teng NN, Lebovic GS, Sikic BI. Delivery of a normal infant following cisplatin, vinblastine, and bleomycin (PVB) chemotherapy for malignant teratoma of the ovary during pregnancy. Gynecol Oncol 1990; 37: 292-5.
• Vicus D, Beiner ME, Clarke B, Klachook S, Le LW, Laframboise S, et al. Ovarian immature teratoma: treatment and outcome in a single institutional cohort. Gynecol Oncol 2011; 123: 50-3.
• Zhang R, Sun YC, Zhang GY, Wu LY, Zuo J. Treatment of malignant ovarian germ cell tumors and preservation of fertility. Eur J Gynaecol Oncol 2012; 33: 489-92.
• Young RH, Dudley AG, Scully RE. Granulosa cell, Sertoli-Leydig cell, and unclassified sex cord-stromal tumors associated with pregnancy: a clinicopathological analysis of thirty-six cases. Gynecol Oncol 1984; 18: 181-205.
• Mancari R, Tomasi-Cont N, Sarno MA, Azim HA Jr, Franchi D, Carinelli S, et al. Treatment options for pregnant women with ovarian tumors. Int J Gynecol Cancer 2014; 24: 967-72.
• Hassan AA, Amr SS, Omari M, Moumani AW. Immature teratoma with gliomatosis peritonei associated with pregnancy. Eur J Obstet Gynecol Reprod Biol 1984; 18: 155-60.
• Matsuyama T, Tsukamoto N, Matsukuma K, Kamura T, Kaku T, Saito T. Malignant ovarian tumors associated with pregnancy: report of six cases. Int J Gynaecol Obstet 1989; 28: 61-6.
• Montz FJ, Horenstein J, Platt LD, d'Ablaing G, Schlaerth JB, Cunningham G. The diagnosis of immature teratoma by maternal serum alpha-fetoprotein screening. Obstet Gynecol 1989; 73: 522-5.
• Frederiksen MC, Casanova L, Schink JC. An elevated maternal serum alpha-fetoprotein leading to the diagnosis of an immature teratoma. Int J Gynaecol Obstet 1991; 35: 343-6.
• Poremba C, Dockhorn-Dworniczak B, Merritt V, Li CY, Heidl G, Tauber PF, et al. Immature teratomas of different origin carried by a pregnant mother and her fetus. Diagn Mol Pathol 1993; 2: 131-6.
• Bakri YN, Ezzat A, Akhtar, Dohami, Zahrani. Malignant germ cell tumors of the ovary. Pregnancy considerations. Eur J Obstet Gynecol Reprod Biol 2000; 90: 87-91.
• Kishimoto K, Ito K, Furukawa M, Ogasawara N, Matsunaga N, Nawata S, et al. Immature teratoma with gliomatosis peritonei associated with pregnancy. Abdom Imaging 2002; 27: 96-9.
• Agarwal N, Parul, Kriplani A, Bhatla N, Gupta A. Management and outcome of pregnancies complicated with adnexal masses. Arch Gynecol Obstet 2003; 267: 148-52.
• Han JY, Nava-Ocampo AA, Kim TJ, Shim JU, Park CT. Pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for malignant ovarian germ cell tumors: report of 2 cases. Reprod Toxicol 2005; 19: 557-61.
• Zhao XY, Huang HF, Lian LJ, Lang JH. Ovarian cancer in pregnancy: a clinicopathologic analysis of 22 cases and review of the literature. Int J Gynecol Cancer 2006; 16: 8-15.
• Daponte A, Kostopoulou E, Zavos A, Skentou H, Kallitsaris A, Koukoulis G, et al. Immature teratoma in pregnancy: a case report and literature review. Eur J Gynaecol Oncol 2008; 29: 300-4.
• Poujade O, Pujade-Lauraine E, Levardon M, Luton D. Ovarian malignant immature teratoma associated with pregnancy--a case report. Eur J Gynaecol Oncol 2008; 29: 649-50.
• Karimi Zarchi M, Behtash N, Modares Gilani M. Good pregnancy outcome after prenatal exposure to bleomycin, etoposide and cisplatin for ovarian immature teratoma: a case report and literature review. Arch Gynecol Obstet 2008; 277: 75-8.
• Ghaemmaghami F, Abbasi F, Abadi AGN. A favorable maternal and neonatal outcome following chemotherapy with etoposide, bleomycin, and cisplatin for management of grade 3 immature teratoma of the ovary. Journal of Gynecologic Oncology 2009; 20: 257-259.
• Mourali M, Ben Haj Hassine A, El Fekih C, Essoussi-Chikhaoui J, Binous N, Ben Zineb N, et al. Immature teratoma of the ovary and pregnancy. (In French). Tunis Med 2010; 88: 507-12.
• Helage S, Borghese B, Depinay C, Alexandre J, Chopin N. Ovarian immature teratoma during pregnancy. (In French). Presse Medicale 2011; 40: 102-105.
• Clinkard DJ, Khalifa M, Osborned RJ, Bouffet E. Successful management of medulloblastoma arising in an immature ovarian teratoma in pregnancy. Gynecol Oncol 2011; 120: 311-2.
• Mendivil AA, Brown III JV, Abaid LN, Rettenmaier MA, Micha JP, Wabe MA, et al. Robotic-assisted surgery for the treatment of pelvic masses in pregnant patients: A series of four cases and literature review. Journal of Robotic Surgery 2013; 7: 333-337.
• Gershenson DM, del Junco G, Silva EG, Copeland LJ, Wharton JT, Rutledge FN. Immature teratoma of the ovary. Obstet Gynecol 1986; 68: 624-9.
• Mangili G, Scarfone G, Gadducci A, Sigismondi C, Ferrandina G, Scibilia G, et al. Is adjuvant chemotherapy indicated in stage I pure immature ovarian teratoma (IT)? A multicentre Italian trial in ovarian cancer (MITO-9). Gynecol Oncol 2010; 119: 48-52.
• Pectasides D, Pectasides E, Kassanos D. Germ cell tumors of the ovary. Cancer Treat Rev 2008; 34: 427-41.
• Elit L, Bocking A, Kenyon C, Natale R. An endodermal sinus tumor diagnosed in pregnancy: case report and review of the literature. Gynecol Oncol 1999; 72: 123-7.