Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being apluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
The Eyes Do Not See What the Mind Does Not Know: An Underreported Feature in Mature Cystic Teratoma of the Ovary
Abstrak
Teratoma sista matang adalah tumor sel germa ovari yang paling biasa, menyumbang kepada 70% daripada semua neoplasma ovari jinak dalam kumpulan umur reproduktif. Sebagai tumor sel germa pluripotent, teratoma sista matang mempunyai sekurang-kurangnya dua daripada tiga komponen sel germa embrio yang matang: ektoderma, mesoderma dan endoderma. Kehadiran ruang sista berbilang di dalam dinding tumor, yang juga dikenali sebagai cystoides pneumatosis jarang dijelaskan tetapi merupakan salah satu ciri teratoma sista ovari. Pada masa ini, terdapat sedikit maklumat mengenai mekanisme pembentukannya. Di sini, kami menyifatkan satu kes teratoma sista matang ovari yang luar biasa yang kami temui di wanita hamil berusia 31 tahun dengan histologi ovarinya mengandungi kawasan menyerupai cystoides pneumatosis dalam usus. Pemeriksaan makroskopik dan mikroskopik ovari pesakit mendedahkan ciri-ciri diagnostik teratoma sista matang. Yang menariknya, terdapat pelbagai ruang sista yang berbeza-beza saiznya ditemui di dinding sista. Ruang-ruang sista tersebut dilapisi sebahagian atau sepenuhnya oleh makrofaj busa dan sel datia, yang menunjukkan immunoreactiviti yang kuat terhadap CD68. Penanda immunohistokimia vaskular (CD31 dan CD34) dan penanda sel epitelium (cytokeratin AE1/AE3) adalah negatif. Diagnosis teratoma sista matang dengan ciriciri menyerupai pneumatosis cystoides telah dibuat. Pesakit dibenarkan pulang tanpa sebarang gejala atau tanda-tanda bersalin awal. Etiopatogenik ciri histologi yang menarik ini turut dibincangkan secara ringkas dalam artikel ini.
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