Case Report
Metachronous Bilateral Ovarian Teratoma: A Germ-line Familial Disorder and Review of Surgical Management Options

https://doi.org/10.1016/j.jpag.2013.02.006Get rights and content

Abstract

Background

Germ cell tumors in females are uncommon, and bilateral metachronous ovarian teratoma is even exceptional, with sporadic cases described in the literature.

Case

We report on a girl in whom a metachronous ovarian teratoma occurred 6 years after the first. The simultaneous onset of germ-line anomalies in other members of the family supports the existence of genetic or environmental factors conferring susceptibility to germ cell lesions.

Summary and conclusion

The case here illustrated reminds the issue of the appropriate follow-up of these patients and of their families.

Introduction

Ovarian teratomas (OT) constitute half of all ovarian neoplasms. Among them, dermoid cysts, or mature cystic teratomas (MCT), are the most common ovarian neoplastic lesions found in adolescents. Up to 12%-15% of cases involve both ovaries.1, 2 The tumor, usually asymptomatic and discovered incidentally, is a slow growing benign lesion, and has an estimated risk of developing a metachronous contralateral OT of 5%-15%. There have been some controversies about treatment strategies for ovarian teratomas, with the methods ranging from ovariosalpingectomy to an ovary-conserving operation.2, 3 We report on a patient with bilateral metachronous OT who developed the second tumor 6 years after the first and was eventually treated with an ovary-conserving surgery. The highly interesting familial scenario enhances the possibility of a germ-cell syndrome.

Section snippets

Case

A 10-year-old girl was referred to our center for abdominal pain, tenderness and palpable lower quadrant mass. Ultrasonography (US) and CT scan confirmed the suspect of a lump arising from the left ovary (13 × 8 × 12 cm). The preoperative work-up included blood tests for aFP and bHGC (normal) and plain chest radiography (normal). Although there was a high probability of a benign tumor, left adnexectomy was unavoidable due to the enormous dimensions and the difficulties in recognizing remaining

Summary and Conclusion

Mature cystic teratomas, or dermoid cysts, are the most common ovarian neoplastic lesions found in women of reproductive age, accounting for more than 95% of all ovarian teratomas. These masses are often unilateral, with an estimated bilaterality rate of 13.2%. MCT is a slow-growing benign lesion with an estimated growth rate of 1.8 mm per year1, 2, 3 The lesion can reach considerable dimensions as well as can become symptomatic when mechanical or functional complications occur. The recurrence

Acknowledgment

The authors thank Dr. Adele Fornelli, Department of Pathology-Ospedale Maggiore (Bologna), for the contribution in histopathologic and photomicroscopic descriptions of all stated tumors.

References (9)

There are more references available in the full text version of this article.

Cited by (10)

View all citing articles on Scopus

The authors indicate no conflicts of interest.

View full text