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OVARIAN MATURE TERATOMA EVOLVING WITH MULTIPLE PERITONEAL METASTASIS – A CASE REPORT
Apresentação do caso
Woman, 22 years old, was admitted to the oncology service in 1988 with ascites. Exploratory laparotomy (EL) showed ascites, bilateral ovarian tumors, and peritoneal metastases. Performed cytoreduction with bilateral oophorectomy, omentectomy, and resection of peritoneal metastases. Anatomopathological (AP) revealed mature teratoma. Performed chemotherapy with carboplatin and paclitaxel for six cycles. In follow-up until 1997, when there was an elevation of CA-125, and US showed liver injury suspected of metastasis. Started a new chemotherapy with carboplatin and paclitaxel for 6 cycles. At the end of the cycles, EL showed multiple implants in the peritoneum, liver, and diaphragm, unresectable, but performing biopsies. AP showed mature teratoma. In 2014, CT showed heterogeneous amorphous tissue formation, irregularities in the liver contour, with multiple calcification foci. Expectant conduct adopted. In 2018, a new CT identified permanence of amorphous tissue formation, calcifications, and fat foci in the peritoneum, suggesting peritoneal dissemination. EL showed peritoneal and pelvic carcinomatosis; retroperitoneal lymph nodes; multiple lesions on liver and spleen; a large tumor on the right diaphragm to suprahepatic veins confluences, infiltrating hepatic capsule; mesoappendix, and omentum implants. Performed a complete cytoreduction with hysterectomy, omentectomy, appendectomy, splenectomy, retroperitoneal and pelvic lymphadenectomy, enucleation of liver metastases, resection of the tumor in the right diaphragm, right and pelvic subdiaphragmatic peritonectomy. AP revealed metastatic teratomas. Currently in follow-up, asymptomatic and normal tumor markers.
Germ cell tumors are the most common ovarian neoplasms among young women, with teratoma being the most frequent form. Teratomas can be mature or immature. Mature teratoma is composed of well-differentiated tissues derived from mesoderm, ectoderm, and endoderm. As it is considered a benign tumor, reports of metastasis of these lesions are rare. The present case shows an unusual evolution of mature ovarian teratoma with recurrent intraperitoneal metastases despite surgical and chemotherapy treatment.
Most mature teratomas have a benign behavior. However, in rare situations, they can evolve with intraperitoneal metastases of large tumor volume, increasing morbidity and mortality due to local complications and malignant degeneration of the mature teratoma.
Mature teratomas, Ovarian neoplasms, Neoplasm metastasis
ANDRÉ LUIZ COSTA E SILVA, JOSÉ AMÉRICO DOS SANTOS COSTA NETO, LAURA CRISTINA COSTA E SILVA, ANA LUISA SILVA MAIA, EDUARDA MORGANA ANDRADE ALMEIDA, MARINA ÁLVARES PRUDÊNCIO, INGRID PINHEIRO MOLINA, GUSTAVO TORRES LOPES SANTOS, THIAGO COSTA PIRES