Abstract
Amaç: Çalışmamızda, dermoid kistlerin cerrahi tedavisindeki deneyimlerimiz
ile tümör markerleri arasındaki ilişkinin araştırılması.
Materyal ve Metod: 2005–2011 yılları arasında kliniğimizde dermoid
kist ön tanısıyla laparoskopi veya laparotomi uygulanan ya da
değişik nedenlerle sezaryen operasyonu yapılıp aynı anda dermoid
kistektomi uygulanan 122 olgunun verileri retrospektif olarak değerlendirildi.
Arşiv kayıtlarından olguların yaşları, preoperatif ultrasonografik
kist boyutu, bilateralite durumu, tümör belirteçleri, intraoperatif
yapılan işlem ve kesin patolojik tanıları kaydedildi. Verilerin de-
ğerlendirilmesinde tanımlayıcı istatistik kullanıldı ve değişkenler %
ve ortalama±standart sapma olarak kullanıldı.
Bulgular: Cerrahi olarak müdahale edilen dermoid kist boyutları
3-25 cm arasında olup, ortalama boyut 7,38±3,69 cm idi. 92 hastaya laparoskopik
girişimle kistektomi uygulanmış, 30 hastaya ise laparotomi
yapılmıştır. Laparotomi yapılan hastaların 10 tanesi postmenopozal
dönemde olup myoma uteri veya çeşitli servikal neoplastik lezyonlara
sahipti. 6 hasta tümör boyutlarının 15 cm’i aşması nedeniyle
laparotomiye alınmış ve 14 hastaya ise çeşitli obstetrik endikasyonlarla
yapılan sezaryen operasyonu sırasında kistektomi yapılmıştır. Bakılan
tümör belirteçlerinden CA125 değeri, bilateral kist bulunan olgularda
ve CA 19-9 değeri kist boyutunun 15 cm’yi aştığı durumlarda,
istatistiksel olarak anlamlı şekilde yüksek bulunmuştur.
Sonuç: Dermoid kistler çok büyük boyutlara ulaşabilmekte ve kesin
tedavileri cerrahi yolla yapılmaktadır. Dermoid kist düşünülen olgularda
özellikle CA 125 yüksekliğinde kistin bilateral olabileceği ve
15 cm’yi aşan kistlerde CA 19-9 düzeyinin artabileceği göz önünde
bulundurulmalıdır.
Keywords
References
- 1. Lee JM, Kim JW, Song JY, Lee JK, Lee NW, Kim SH, Lee KW. Adenocarcinoma arising in mature cystic teratoma: a case report. J Gynecol Oncol. 2008;19(3):199-201.
- 2. Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol 2005; 18(12): 61 - 79.
- 3. Comerci JT Jr, Licciardi F, Bergh PA, et al. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994; 84(1): 22-28.
- 4. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol 1998; 171:1061–1065.
- 5. Ferrari, M.M., Mezzopane, R., Bulfoni, A., Grijuela, B., Carminiti, R., Ferrazzi, E., Pardi, G.: Surgical treatment of ovarian dermoid cysts : A comparison between laparoscopic and vaginal removal Eur. J. Obstet. Gynecol. reprod. Biol. 2003;109 (1): 88-91.
- 6. Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. RadioGraphics 2001; 21: 475–490.
- 7. Maiti S, Fatima Z, Anjum ZK, Hopkins RE. Ruptured ovarian cystic teratoma in pregnancy with diffuse peritoneal reaction mimicking advanced ovarian malignancy: a case report. J Med Case Reports. 2008 ;2: 203.
- 8. Ayhan A, Bukulmez O, Genc C, et al. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Reprod Biol. 2000; 88(2): 153-7.
- 9. Chadha S, Schaberg A. Malignant transformation in benign cystic teratomas: Dermoids of the ovary. Eur J Obstet Gynecol Reprod Biol 1988; 29: 329-38.
- 10. Mecke, H., Savvas, V. : Laparoscopic surgery of dermoid cyst-intraoperative spillage and complications. Eur. J. Obstet. Gynecol Reprod. Biol. 2001; 96(1): 80-4,.
- 11. Buy JN, Ghossain MA, Moss AA, Bazot M, Doucet M, Hugol D, et al. Cystic teratoma of the ovary: CT detection. Radiology. 1989; 171(3): 697-701.
- 12. Hoo WL, Yazbek J, Holland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol. 2010; 36(2): 235-40.
- 13. Hackethal A, Brueggmann D, Bohlmann MK. et all. Squamous-cell carcinoma in mature cystic teratoma of the ovary:systematic review and analysis of published data. Lancet Oncol 2008; 9 (12): 1173 – 80.
- 14. Yüksel MA, Abal› R, Aras Ö, Temel ‹, Ünal F, Boran AB, Purisa S. Ovaryan Dermoid Kistlerde CA 19-9 Seviyesinin De¤erlendirilmesi. Türkiye Klinikleri Jinekoloji-Obstetrik Dergisi. 2011; 21(3): 190-4.
- 15. Günay E, Kalender HS, Cengizo¤lu B, Turan C, Ünal O. Adneksiyal Kitlelerde Tümör ‘’Marker’’lar› ve Cerrahi Sonuçlar›. Kartal e¤itim Arafl. Hast. T›p Dergisi. 2002; 3: 179-181.
- 16. Malik E, Bohm W, Stoz F, Nitsch CD, Rossmanith WG. Laparoscopic management of ovarian tumors. Surg Endosc. 1998; 12: 1326-33.
- 17. Mori Y, Nishii H, Takabe K, Shinozaki H, Matsumoto N, Suzuki K, et al. Preoperative diagnosis of malignant transformation arising from mature cystic teratoma of the ovary. Gynecol Oncol. 2003; 90: 338-41.
- 18. Kikkawa F, Nawa A, Tamakoshi K, Ishikawa H, Kuzuya K, Suganuma N, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer. 1998; 82: 2249-55.
- 19. Rim SY, Kim SM, Choi HS. Malignant transformation of ovarian mature cystic teratoma. Int J Gynecol Cancer. 2006; 16: 140-4
Abstract
Purpose: The aim of this study is to overview our experience in
surgical treatment of mature cystic teratomas (dermoid cysts) and to
examine the relation with tumor markers .
Material and Method: We retrospectively analysed the results of
122 patients who underwent laparoscopy or laparotomy due to dermoid
cysts and in whom dermoid cysts were diagnosed during
cesarean section incidentally between the years 2005 and 2011 in our
clinic. From the records; the age of the patients, preoperative size of
the cysts, bilaterally or unilaterally, tumour markers, operation type
and pathologic results are abtained. Descriptive statistics were used to
assess the data and variables used in% and the mean ± standard deviation.
Findings: Surgically treated dermoid cysts were between 3-25 cm
and mean size was 7.38±3.69 cm. In 92 patients, laparoscopy performed
and in 30 patients laparotomy was the method of operation.
Among patients underwent laparotomy; 10 patients were in postmenopausal
period and had additional problems since myoma uteri
or different cervical neoplastic lesions. 6 patients underwent laparatomy
because of the large tumour size (>15 cm). In 14 patients dermoid
cysts were observed incidentally during cesarean sections and were
extirpated.
CA 125 levels are found high in statisticially significant levels in
bilateral tumours. It is also found that CA 19-9 levels increase to statisticially
significant levels in tumours bigger than 15 cm in diameter.
Conclusion: Mature cystic teratomas can reach to very big sizes
and treatment can be done surgically. It must be remembered in mind
that in cases with high CA 125 levels, the dermoid cyst may be bilateral
and CA 19-9 levels may be high in dermoid cysts bigger than 15
cm.
References
- 1. Lee JM, Kim JW, Song JY, Lee JK, Lee NW, Kim SH, Lee KW. Adenocarcinoma arising in mature cystic teratoma: a case report. J Gynecol Oncol. 2008;19(3):199-201.
- 2. Ulbright TM. Germ cell tumors of the gonads: a selective review emphasizing problems in differential diagnosis, newly appreciated, and controversial issues. Mod Pathol 2005; 18(12): 61 - 79.
- 3. Comerci JT Jr, Licciardi F, Bergh PA, et al. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994; 84(1): 22-28.
- 4. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol 1998; 171:1061–1065.
- 5. Ferrari, M.M., Mezzopane, R., Bulfoni, A., Grijuela, B., Carminiti, R., Ferrazzi, E., Pardi, G.: Surgical treatment of ovarian dermoid cysts : A comparison between laparoscopic and vaginal removal Eur. J. Obstet. Gynecol. reprod. Biol. 2003;109 (1): 88-91.
- 6. Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. RadioGraphics 2001; 21: 475–490.
- 7. Maiti S, Fatima Z, Anjum ZK, Hopkins RE. Ruptured ovarian cystic teratoma in pregnancy with diffuse peritoneal reaction mimicking advanced ovarian malignancy: a case report. J Med Case Reports. 2008 ;2: 203.
- 8. Ayhan A, Bukulmez O, Genc C, et al. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Reprod Biol. 2000; 88(2): 153-7.
- 9. Chadha S, Schaberg A. Malignant transformation in benign cystic teratomas: Dermoids of the ovary. Eur J Obstet Gynecol Reprod Biol 1988; 29: 329-38.
- 10. Mecke, H., Savvas, V. : Laparoscopic surgery of dermoid cyst-intraoperative spillage and complications. Eur. J. Obstet. Gynecol Reprod. Biol. 2001; 96(1): 80-4,.
- 11. Buy JN, Ghossain MA, Moss AA, Bazot M, Doucet M, Hugol D, et al. Cystic teratoma of the ovary: CT detection. Radiology. 1989; 171(3): 697-701.
- 12. Hoo WL, Yazbek J, Holland T, Mavrelos D, Tong EN, Jurkovic D. Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome? Ultrasound Obstet Gynecol. 2010; 36(2): 235-40.
- 13. Hackethal A, Brueggmann D, Bohlmann MK. et all. Squamous-cell carcinoma in mature cystic teratoma of the ovary:systematic review and analysis of published data. Lancet Oncol 2008; 9 (12): 1173 – 80.
- 14. Yüksel MA, Abal› R, Aras Ö, Temel ‹, Ünal F, Boran AB, Purisa S. Ovaryan Dermoid Kistlerde CA 19-9 Seviyesinin De¤erlendirilmesi. Türkiye Klinikleri Jinekoloji-Obstetrik Dergisi. 2011; 21(3): 190-4.
- 15. Günay E, Kalender HS, Cengizo¤lu B, Turan C, Ünal O. Adneksiyal Kitlelerde Tümör ‘’Marker’’lar› ve Cerrahi Sonuçlar›. Kartal e¤itim Arafl. Hast. T›p Dergisi. 2002; 3: 179-181.
- 16. Malik E, Bohm W, Stoz F, Nitsch CD, Rossmanith WG. Laparoscopic management of ovarian tumors. Surg Endosc. 1998; 12: 1326-33.
- 17. Mori Y, Nishii H, Takabe K, Shinozaki H, Matsumoto N, Suzuki K, et al. Preoperative diagnosis of malignant transformation arising from mature cystic teratoma of the ovary. Gynecol Oncol. 2003; 90: 338-41.
- 18. Kikkawa F, Nawa A, Tamakoshi K, Ishikawa H, Kuzuya K, Suganuma N, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer. 1998; 82: 2249-55.
- 19. Rim SY, Kim SM, Choi HS. Malignant transformation of ovarian mature cystic teratoma. Int J Gynecol Cancer. 2006; 16: 140-4
Details
| Other ID | JA55JY97NH |
|---|---|
| Journal Section | Research Article |
| Authors | |
| Publication Date | January 1, 2013 |
| Submission Date | January 1, 2013 |
| Published in Issue | Year 2013 Volume: 16 Issue: 1 |