Squamous cell carcinoma (SCC) of the ovary is extremely rare and usually arises in a mature cystic ovarian teratoma 2. As only parts of the lesion are composed of malignant tissue, it is difficult to diagnose malignant transformation of a teratoma preoperatively, unless invasion into adjacent structures is present.
Malignant transformation in a mature cystic teratoma is relatively rare. When malignant transformation is encountered, it is usually in postmenopausal women and carries a worse prognosis than primary malignant neoplasms of the ovary 1.
The mean age at diagnosis is at ~55 years which is significantly older than the mean age of patients diagnosed with routine mature cystic teratoma (~37.5 years) 4. Thus advanced patient age is useful in raising the suspicion of malignant transformation of a mature cystic teratoma.
The reported incidence of malignant transformation of mature cystic ovarian teratoma is approximately 2% and squamous cell carcinoma is the most common histology (followed by adenocarcinoma and melanoma) 2-3.
Patients present with grossly distended abdomen with pressure effects on the bladder and bowel.
Squamous cell carcinomas arise from the squamous epithelial component of a mature ovarian teratoma. For a general discussion of ovarian teratomas please refer to the parent article: benign mature ovarian teratoma.
Due to the heterogeneity of ovarian teratomas, identification of a malignant component can be difficult preoperative, in the absence of obvious tumor invasion or metastases. In many instances, appearances are indistinguishable from those of a benign mature ovarian teratoma, and their radiographic appearance is discussed separately. A number of features are helpful in increasing suspicion.
A large solid component, especially if irregular or with the suggestion of tissue infiltration is most useful.
Tumor size is also an important factor. Generally, malignant ovarian tumors are larger than benign ovarian tumors. In a study done by Fumitaka Kikkawa et al. 4 the mean size of a benign mature cystic teratoma of the ovary was ~88 mm (92 cases) whereas, squamous cell carcinoma arising from MCT measured ~152 mm (37 cases). These findings suggest that large overall tumor size is useful in differentiating squamous cell carcinoma arising in MCT.
Treatment and prognosis
- 1. Lai PF, Hsieh SC, Chien JC et-al. Malignant transformation of an ovarian mature cystic teratoma: computed tomography findings. Arch. Gynecol. Obstet. 2005;271 (4): 355-7. doi:10.1007/s00404-004-0676-0 - Pubmed citation
- 2. Peterson WF. Malignant degradation of benign cystic teratomas of the ovary: A collective review of the literature. Obstet Gynecol Surv 1957;12:793-830
- 3. Gupta V, Sood N. Squamous cell carcinoma arising in a mature cystic teratoma. Indian J Pathol Microbiol 2009;52:271-3
- 4. Kikkawa F, Ishikawa H, Tamakoshi K, Ishikawa H, Kuzuya K, Suganuma N, et al. . Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of ovary. Cancer 1998;82:2249-55
- 5. Buy JN, Ghossain MA, Moss AA et-al. Cystic teratoma of the ovary: CT detection. Radiology. 1989;171 (3): 697-701. Radiology (abstract) - Pubmed citation
- 6. Iwasa A, Oda Y, Kaneki E et-al. Squamous cell carcinoma arising in mature cystic teratoma of the ovary: an immunohistochemical analysis of its tumorigenesis. Histopathology. 2007;51 (1): 98-104. doi:10.1111/j.1365-2559.2007.02727.x - Pubmed citation
- 7. Kahraman K, Cetinkaya SE, Kankaya D et-al. Squamous cell carcinoma arising from mature cystic teratoma of the ovary with synchronous endometrial adenocarcinoma. J. Obstet. Gynaecol. Res. 2011;37 (2): 146-50. doi:10.1111/j.1447-0756.2010.01323.x - Pubmed citation
- 8. Chiang AJ, La V, Peng J et-al. Squamous cell carcinoma arising from mature cystic teratoma of the ovary. Int. J. Gynecol. Cancer. 2011;21 (3): 466-74. doi:10.1097/IGC.0b013e31820d3e5b - Pubmed citation