High Frequency of Malignant Transformations on Ovarian Mature Teratomas at a Single University Hospital, Jakarta, Indonesia (2015–2018)

Abstract

Mature teratoma (MT) is a cystic or solid tumor consisting of adult tissues with resembling epidermis tissues and its appendages on the border. It is the most common type of benign ovarian mass (58% of all benign ovarian tumors and 27–44% of all ovarian tumors) with malignant transformation rates varying from 1 to 6.6% [1, 2]. The aim of this study was to provide a description of the malignant transformations of MTs at a single university hospital in Jakarta, Indonesia, within 5-year interval (January 2015–December 2018) at a single university hospital in Jakarta, Indonesia. High frequency of malignant transformation MTs was observed (13 over 84MTs, 15.48%). The median age of the patients was 36.5 years (range 26–63) younger than most of the studies shown in Table 1. Patients who were originally from our hospital had a good performance score (ECOG 1) at the time of admission and before an operation. On the contrary, referred patients from other hospitals came with poorer conditions (ECOG 3) and with advanced stage of the disease preoperatively. All patients came with presenting symptoms of an abdominal palpable mass, ranging from 3 to 28 cm (mean 15 cm considerably higher than other studies). Eight over 13 patients were staged as advanced ovarian carcinoma (FIGO IIA 1 patient, IIIC 6 patients, and IVB 1 patient). Five patients presented with stage IA. Chemotherapy was assigned to some advanced ovarian cancer, 1/8 had BEP regimen, 3/8 had CP, and there was only one patient who completed the full course. The histopathology reported some different transformation; squamous cell carcinoma being the common type (4/13 patients), followed by the mucinous type and thyroid type. Pseudomyxoma condition was also reported in 2 patients. Figure 1 shows the MT features and the malignant transformation in one patient (case no. 8). The figure shows the alteration of squamous malignancy among the benign features. Two out of three mucinous carcinoma transformation were complicated with pseudomyxoma. Figure 2 Tofan Widya Utami: Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Cipto Mangunkusumo Hospital, Jakarta, Indonesia. Henny Meitri Andrie Rachmasari Putri: Gyn-oncologist, Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Indonesia Army Hospital (RSPAD Gatot Soebroto), Jakarta, Indonesia. Tantri Hellyanti: Faculty of Medicine, University of Indonesia, Jakarta, Indonesia; Department of Pathological Anatomy, Cipto Mangunkusumo Hospital, Jakarta, Indonesia.