Indian Journal of Pathology and Microbiology

HISTOPATHOLOGY SECTION - CASE REPORT
Year
: 2008  |  Volume : 51  |  Issue : 1  |  Page : 81--82

Coexistence of squamous cell carcinoma with dermoid cyst of ovary


PM Santwani, DP Trivedi, JH Vachhani, NJ Trivedi 
 Department of Pathology, Shri M.P. Shah Medical College, Jamanagar, India

Correspondence Address:
P M Santwani
C/3 Medical Campus, Behind G.G. Hospital, Jamanagar - 361 008
India

Abstract

A 40-year-old female presented with pain and enlargement of abdomen since last 6 months. A mass was felt over right iliac fossa. Ultrasonography showed partly cystic and solid area in mass arising from ovary. A tooth-like structure was also seen. Dermoid cyst was the diagnosis offered. Laparotomy was performed. Ovarian mass with hair, a tooth and putty-like material was present. Solid white area with thickened wall was found. Histopathology confirmed the findings of dermoid cyst and the thickened area showed squamous cell carcinoma with areas showing keratinous material and giant cell reaction which was also seen at the periphery of tumor areas. Left ovary was normal and no deposits of tumor were seen. Postoperative period was uneventful.



How to cite this article:
Santwani P M, Trivedi D P, Vachhani J H, Trivedi N J. Coexistence of squamous cell carcinoma with dermoid cyst of ovary.Indian J Pathol Microbiol 2008;51:81-82


How to cite this URL:
Santwani P M, Trivedi D P, Vachhani J H, Trivedi N J. Coexistence of squamous cell carcinoma with dermoid cyst of ovary. Indian J Pathol Microbiol [serial online] 2008 [cited 2022 Dec 6 ];51:81-82
Available from: https://www.ijpmonline.org/text.asp?2008/51/1/81/40409


Full Text

 Introduction



Benign cystic teratoma (dermoid cyst) contains tissues that develope from ectoderm, endoderm, and mesoderm in an organized manner. [1] As reported by Okada et al . [2] Squamous cell carcinoma is commoner than adenocarcinoma, incidences are rare and that of primary squamous cell carcinoma is a rarity. Kikawa et al . [3] in his study of 37 cases of squamous cell carcinoma arising from mature cystic teratoma of ovary observed certain features like mean age of squamous cell carcinoma was 55.2 years as compared to 37.5 years in patients with benign cystic teratoma.

 Case Report



A 40-year-old female presented with pain and enlargement of abdomen of 6 months duration. Her obstetric history was normal and she was having seven live children. No history of loss of weight, loss of appetite and no bowel/bladder symptoms.

Clinical examination showed a lump palpable in right iliac fossa arising from pelvic cavity of 14-week size. No free fluid was detected in the pelvic cavity. A provisional diagnosis of dermoid cyst was made.

Ultrasonography showed 12 x 8 cm 2 sized ovarian mass with partly cystic and solid areas with opacity-like tooth. Exploratory laparotomy was done to remove the mass. Some adhesions were observed to mesosalpinx and salpingoophorectomy was done. No residual fluid was seen in the cavity. Right ovary and uterus were normal. Liver, spleen, and lymph nodes were normal. An ovarian mass measuring 12 x 8 cm 2 in size with smooth surface was removed.

 Gross Examination



Cystic mass of 12 x 8 cm 2 size with some solid areas in its wall. Cut surface showed tuft of hair and putty-like material with tooth impacted in the wall of the cyst. Some solid white areas with necrosis and yellowish white areas at outer surface were seen [Figure 1].

 Histopathological Examination



Sections showed areas of atypical squamous cells and cystic areas lined by stratified squamous epithelium [Figure 2]A and B. Some were glandular and respiratory type. Some smooth muscle tissue and adipose tissue were seen. An area of atypical squamous cells in sheets with keratinized material was seen [Figure 3]A. There were areas of necrosis, inflammation and giant cell reaction [Figure 3]B. Her cervix was unremarkable clinically and no other sites were found to be having any evidence of squamous cell lesion. So final diagnosis of dermoid cyst with squamous cell carcinoma was concluded.

 Discussion



Mature cystic teratoma of ovary comprises 25% or more of all ovarian tumors. [1] They are mostly multiloculated containing grummulous putty-like material and various organized mature tissues. Malignant transformation is rare, occurring in 2% of cases. [3] The first general review regarding secondary cancer arising in mature cystic teratoma of ovary was the work of Peterson in 1951 and Clinae in 1968 . Malignant transformation can occur from any germ layer. [3] Kikawa et al . [4] in his study observed 37 cases of squamous cell carcinoma referred to their center in 17-year period (1979-1996). A total of 92 patients with mature cystic teratoma (benign) were observed over their study of 3 year-period (1993-1996). The mean size of malignant dermoid was 152.3 mm compared to 88.4 mm in benign dermoids. Women older than 45 years and a tumor size greater than 99 mm were the criteria considered for malignancy. Serum tumor markers (SCC-Ag and CEA) were mandatory for all such lesions even after complete removal.

Primary squamous cell carcinoma of ovary is a rare entity. Its occurrence is roughly 0.7-2% of mature cystic teratoma. [3] Pure squamous cell carcinoma arising from metaplasia of surface epithelium of ovary and malignant transformation of ovarian endometriosis is still rare. [5] Metastasis from cervical squamous cell carcinoma is again an uncommon occurrence, the incidences being 0.5%. [6] An interesting occurrence of synchronous cervical, endometrial, tubal and ovarian squamous cell carcinoma and cervical intra epithelial neoplasia due to HPV infection has been reported. [7]

Reviewing the literature, the case presented was considered as squamous cell carcinoma arising from dermoid cyst (MCT), so due to its rarity is reported here.

References

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2Okada S, Ohaki Y, Ogura J, Ishiha M, et al . Imaging finding in cases of Dermoid cysts coexisting with surface epithelial tumours in same ovary. J. Comput Assist Mogr 2004;28:169-73.
3Wu RT, Torng PL, Chang DY, et al . Mature cystic teratoma of ovary: a Clinical pathological analysis of 253 cases: Chung Hua I Hsich Tsa chih (Taipei) 1996;58:269-74.
4Kikawa F, Nawa A, Tamakashik, et al . Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of ovary. Cancer 1998;82:2249-55.
5Wu HS, Yen MS, Lai CR, Ng HT. Ovarian metastasis from cervical squamous cell carcinoma. Int J Gynaecol obstet 1997;57:173-8.
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