Rate of Anti-NMDA Receptor Encephalitis in Ovarian Teratomas

Background The rate of anti-N-methyl-D-aspartate receptor encephalitis (NMDARE) in ovarian teratomas is unknown. We aim to identify the prevalence of NMDARE as well as volumetric and histopathologic characteristics of ovarian teratomas in patients with versus without. Methods We performed a retrospective cohort study to identify patients with confirmed ovarian teratomas and the characteristics of teratomas in NMDARE compared with non-NMDARE patients. Patients aged between 0 and 21 years with confirmed histopathological diagnosis of ovarian teratoma after resection were included. The rate of NMDARE in ovarian teratomas was identified. Moreover, volumes of ovarian teratomas and the frequency of neuronal glial elements on histopathology in NMDARE versus non-NMDARE patients were assessed. Results Five out of one-hundred-and-sixty-three (3.07%) patients with histopathology confirmed ovarian teratomas were diagnosed with NMDARE. Age was not different between the NMDARE (mean: 13.8 years, standard deviation: 3.9) and non-NMDARE groups (median: 14, interquartile range [IQR]: 5). Teratoma volumes from NMDARE patients were smaller than those of non-NMDARE patients (median 28.3 cm3 with IQR of 431.2 and median 182.8 with IQR of 635.0, respectively). Both age and NMDARE diagnosis were statistically significant variables in the analysis of variance on a multiple linear regression model. Age (p = 0.013) had a positive correlation with teratoma size, whereas presence of NMDARE had a negative correlation (p = 0.008). Conclusion The rate of NMDARE in ovarian teratomas is low and NMDARE patients have smaller teratomas than non-NMDARE. Further studies are needed to understand the timing of anti-NMDA receptor antibodies in teratomas and the development of NMDARE.

Ovarian Germ Cell Tumor with Myasthenia Gravis: Co-incidence or a Possible link?

Teratomas are a common form of germ cell tumor. Teratomas are commonly found in the gonadal organs, such as the ovaries and testes. Treatment of choice for ovarian teratomas is complete surgical excision, which exhibits a good prognosis in benign teratomas; however, chemotherapy treatment is needed for malignant components. Neurological paraneoplastic presentation of gynecological tumors is rare; however, ovarian tumors account for 10% of this presentation. In literature, paraneoplastic limbic encephalitis, anti-N-methyl-D-aspartate receptor encephalitis, and paraneoplastic cerebellar degeneration have been reported in ovarian teratomas and tumors; however, myasthenia gravis has been reported only twice. In both of those cases, manifestation of myasthenia gravis was preceding the diagnosis of ovarian cancer. We describe the first case of a 21-year-old female who presented with new-onset myasthenia gravis after finishing chemotherapy for ovarian teratoma. Another unusual aspect of our case is the rare co-occurrence of gliomatosis peritonei with mature teratoma.

The Association of Ovarian Teratoma and Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Updated Integrative Review

Ovarian teratomas are by far the most common ovarian germ cell tumor. Most teratomas are benign unless a somatic transformation occurs. The designation of teratoma refers to a neoplasm that differentiates toward somatic-type cell populations. Recent research shows a striking association between ovarian teratomas and anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a rare and understudied paraneoplastic neurological syndrome (PNS). Among teratomas, mature teratomas are thought to have a greater relevance with those neurological impairments. PNS is described as a neurologic deficit triggered by an underlying remote tumor, whereas anti-NMDAR encephalitis is characterized by a complex neuropsychiatric syndrome and the presence of autoantibodies in cerebral spinal fluid against the GluN1 subunit of the NMDAR. This review aims to summarize recent reports on the association between anti-NMDAR encephalitis and ovarian teratoma. In particular, the molecular pathway of pathogenesis and the updated mechanism and disease models would be discussed. We hope to provide an in-depth review of this issue and, therefore, to better understand its epidemiology, diagnostic approach, and treatment strategies.

Prostatic tissue: an unexpected finding in a mature ovarian teratoma

Purpose Prostatic tissue in an ovarian teratoma is an unusual finding, whose initiation in a 46, XX karyotype tissue is yet to be clarified. We present a case from our files and review the literature for this intriguing finding. Methods Unstained histology sections of the ovarian teratoma containing prostatic tissue were evaluated using immunohistochemistry for PSA and androgen receptor. Results Both PSA and androgen receptor immunostainings were positive in the prostatic tissue. From the literature review, it appears that most of the patients (74%) with similar findings were either pregnant or experiencing a miscarriage, menopausal or infertile at presentation, showing that an imbalanced hormone status is frequently associated with the presence of male structures in ovarian teratomas.

Ovarian teratomas in bimodal age groups- Case report

Ovarian teratomas are the most common germ cell tumors and are classified as mature, immature and malignant.Mature cystic teratomas, also called dermoid cysts, are the most common germ cell tumour, accounting for upto 70% of benign ovarian masses in the reproductive years and 20% in postmenopausal women.Immature ovarian teratoma affects primarily younger patients and mature cystic teratomas seen in reproductive age groups. This case report provides a brief summary of the clinicopathological features of the ovarian teratomas such as, the immature teratoma which being a rare tumour was diagnosed in a 15 year old adolescent girl, managed surgically by laparotomy followed by chemotherapy, and the other case of a benign mature cystic teratoma in an elderly 52 year old postmenopausal woman, managed surgically although benign cystic teratomas are rare in the postmenopausal age group.

Morphological Spectrum of Ovarian Teratomas: A 6 Years Experience at a Specialized Diagnostic Institute

Introduction: Ovarian teratomas include mature cystic teratoma (MCT), immature teratoma (IT) and monodermal teratoma (MoT). Malignant transformation (MT) can occur in MCT and MoT, which remains a diagnostic challenge. Aims & Objectives: To discuss the morphological spectrum of ovarian teratomas reported during the last six years at our specialized diagnostic institute and determine the frequency of MT in MCT and MoT. Place and duration of study: The study was carried out at Chughtai Institute of Pathology from January 2015 to December 2020. Material & Methods: A retrospective study was performed by retrieving 1018 cases of ovarian teratomas reported in last 6 years. SPSS version 20 was used for data analysis. Results: MCT was most frequent ovarian teratoma with frequency of 95.6% (n=973), 2.26% (n=23) being IT and 2.16% (n=22) being MoT. IT were mostly seen in pediatric age group. MT in benign MCT was seen in 0.72% of MCT (n=7). Squamous cell carcinoma was most frequent malignancy 71.4% (n=5). One case of MoT also showed MT into papillary thyroid carcinoma, classic type, with frequency of MT in Mot being 4.76% (n=1). All MT in MCT had age >30 years which was a significant finding (p <0.001). Conclusion: Ovarian masses in postmenopausal patients with suspicious radiological features, irrespective of lesional size warrant a thorough gross examination, extensive sampling and a careful microscopic evaluation.

Can Removal of Dermoid Cyst Increase Expression of AMH?

Dermoid cysts are the most common form of all the ovarian teratomas and are usually benign in nature. They are also known as mature cystic teratoma.