PMC5471592_01
Initial imaging computed tomography of the abdomen and pelvis demonstrating a large pelvic tumor (arrow).
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Pelvic CT (Figure 1) revealed a large pelvic mass.
Initial ovarian teratoma with immature elements. (a) Sections of immature teratoma revealed a neoplasm composed of heterogenous elements that included a dermoid cyst, fibroadipose tissue, cartilage, pigmented choroid, and glial tissue (H&E x100). (b) Cystically dilated glands with enteric differentiation were present (H&E x100), (c) as well as several foci of immature neuroepithelium (H&E x200). (d) Immunohistochemical staining with glial fibrillary acid protein (GFAP) reveled teratoma deposits in the periaortic lymph node (GFAP x200).
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Histologically, all the pathology specimens returned with high grade immature teratoma (Figure 2).
Computed tomography abdomen and pelvis follow-up imaging at 8 months. (a) Large mass occupying the right upper abdominal cavity, revealing multiple new masses containing cystic and necrotic elements surrounding the liver (arrow). Because of tumor growth, the giant mass had compressed the liver parenchyma. (b) Pelvic tumor is demonstrated as well (arrow).
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The CT scan of the chest, abdomen, and pelvis in May 2016 revealed a significant increase in the size of the thoracic masses, as well as the size and a number of abdominal and pelvic masses (Figure 3).
Histology of multiple pelvic lesions following repeat laparotomy demonstrated neoplasms composed of derivatives of all three germ layers, namely, ectoderm, mesoderm, and endoderm consistent with mature teratoma. (a) Mature cartilage and squamous epithelium (H&E x100). (b) Mature neuroglia and vascular proliferation (H&E x200). (c) Cysts lined with mature squamous and ciliated columnar respiratory epithelium and overlying mature neuroglia (H&E x200). (d) Large cyst wall with gastric mucinous epithelium, bundles of smooth muscle, and adjacent cysts lining of the ciliated respiratory epithelium (H&E x200).
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A total of 5 pelvic masses and 3 liver masses were excised, and pathologic analysis indicated mature teratoma (Figure 4).