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• W2169658398 abstract "Mature cystic teratomas are the most common type of ovarian tumors, accounting for 40% of all primary ovarian tumors. Rarely (1–2%) a malignant neoplasm of adult type arises from a cyst constituent. Approximately 80% of malignant tumors arising in dermoid cysts are squamous cell carcinomas (1). The remaining adult cancers arising from adult tissue include adenocarcinoma, undifferentiated carcinoma, sarcoma, and malignant melanoma. Malignant tumors originating from adult nervous tissue are very uncommon and include neuroblastomas, glioblastomas, primitive neuroectodermal tumors, and neurocytomas (2–5). Even neuroectodermal tumors with different components arising in ovary teratomas have been described (6). We report the histologic and immunohistochemic findings arising within an otherwise mature cystic teratoma of the ovary in a oligodendroglioma. A 29-year-old nulliparous female patient presented with abdominal pain; on physical examination a large palpable mass in the right side of the abdomen was detected. An ultrasound scan showed a monolateral multicystic ovarian mass, and a laparotomy with ovarectomy was performed. On gross examination the right ovary was replaced by a multicystic mass of 14 cm in size with a solid area of 3 cm. Yellow to brown sebaceous material and hair-filled several cystic spaces were also found. At histology most of the cystic spaces were lined by epidermis and underlying skin appendages, some others by respiratory epithelium, and one by choroid plexus (Fig. 1). Indeed, the tumor showed further mature adult-type tissues such as salivary glands, glial and cerebellar, as well as cartilaginous, gastrointestinal and lung tissues. Low magnification of the ovarian teratoma showing, in the right upper corner, a lumen lined by a cylindrical epithelium of endodermal origin, and, in the center, the oligodendroglioma (HE, × 100). The solid area (3 cm) was covered by choroid plexus and consisted of mature nervous tissue in which nodules composed uniquely of monomorphic glial cells were largely represented. The glial cells were embedded in a delicate fibrillary matrix, exhibited uniformly, round nuclei with dispersed chromatin and perinuclear cytoplasmic halos, and resembled ‘fried eggs’ (Fig. 2). No mitotic activity nor vascular hyperplasia or necrosis were identified. The vascular network of the tumor consisted of short capillary segments geometrically arranged such as the patterned angulation of the ‘chicken wire’ network of the oligodendrogliomas (Fig. 2). Moreover, the tumor was associated with microcalcifications either within or in the surrounding cerebral tissue, and some neoplastic cells exhibited perineuronal satellitosis. At immunohistochemistry the tumor cells showed positivity for glial fibrillar acidic protein (GFAP) and neuro filament protein (NFP), whereas they were negative for synaptophysin and neuro-specific enolase (NSE) and focally and weakly positive for Leu 7. These features are consistent with the diagnosis of oligodendroglioma. Oligodendroglial tumors cells embedded in a delicate fibrillary matrix. The vascular network of the tumor consisted of short capillary segments arranged geometrically similar to the patterned angulation of the ‘chicken wire’ network of oligodendrogliomas. Some psammoma bodies are seen (HE, × 100) To our knowledge, there are no previous reports in the literature of an oligodendroglioma arising in an ovary, either de novo or within a teratoma, even if an oligodendroglial component has been described associated with a high-grade neuroectodermal tumor arising in an ovarian teratoma (6). The oligodendroglioma is a malignant glioma consisting of oligodendrocytes typically arising in the cerebral hemispheres of young or middle-aged patients. The diagnosis may be suspected preoperatively when intratumoral or peritumoral calcification on neuroimaging scans are detected. On gross examination, oligodendrogliomas appear as well-circumscribed, gray masses, often with cystic and calcific changes. On histologic examination, the tumor was composed of sheets of regular and uniform cells with round nuclei containing finely granular chromatin, often surrounded by a clear cytoplasmic halo. This feature, reminding one of a ‘fried egg’, is a fixation artifact created by autolytic imbibition with water accompanying delayed fixation. The tumor contained a delicate network of anastomosing capillaries resembling ‘chicken wire’, most of which were associated with calcifications. There is at present no consensus on an available antibody that reliably and specifically identifies oligodendrocytes in paraffin-embedded material (7). Membranous Leu 7 reactivity is characteristic but not specific. Cytoplasmic galactocerebroside reactivity is not cosytant (8). In the present case we found more interesting results with the GFAP and NFP than with the Leu 7 antibodies. Cells resembling those of oligodendroglioma are noted in a variety of brain tumors. They may be seen in a large number of ependymomas of the clear cell type. The main differential diagnosis is central neurocytoma, which may also arise in mature cystic teratoma as published by Hirschowitz and coworkers (9). The similarity between the two tumors includes nuclear roundness and monotony, as well as the presence of perinuclear halos and even tumoral calcification. The diagnosis of central neurocytoma is greatly aided by the immunohistochemic evidence of synaptophysin positivity. The present case showed some features resembling a dysembryoblastic neuroepithelial tumor, i.e. the relative low cellularity observed and a certain nodular pattern (10), but the absence of neuronal-like cells in the nodules and the vascular pattern observed in the tumor supports the diagnosis of oligodendroglioma. The patient has been free from tumor recurrences or metastases for 4 years since surgery. In view of the good prognosis associated with the excision of these tumors we can conclude that the procedure has been curative." @default.
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• W2169658398 date "2002-09-01" @default.
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• W2169658398 title "Oligodendroglioma arising within a mature cystic ovarian teratoma: case report and review of the literature" @default.
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• W2169658398 doi "https://doi.org/10.1034/j.1600-0412.2002.810918.x" @default.
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