Tzu Chi Medical Journal

CASE REPORT
Year
: 2019  |  Volume : 31  |  Issue : 3  |  Page : 192--194

Trabecular carcinoid tumor arising from a mature cystic teratoma


Hsiao-Chen Chiu, Yi-Lin Chen 
 Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei, Taiwan

Correspondence Address:
Dr. Yi-Lin Chen
Department of Obstetrics and Gynecology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, 289 Jianguo Road, New Taipei
Taiwan

Abstract

Mature cystic teratomas (MCTs) are common benign tumors of the ovary. Coexistence of a carcinoid tumor inside an MCT is extremely rare. We present a 40-year-old woman who had intermittent abdominal pain and urinary frequency. An adnexal mass was detected during physical examination. Ultrasound indicated a 12.3 cm × 10.7 cm left ovarian mass. Surgical excision of the mass was performed, and histopathological examination revealed an MCT with three germ layers. The microcarcinoid tumor arising from an MCT showed a cord to trabecular pattern. The pathological diagnosis was a trabecular carcinoid tumor arising in an MCT. The patient did not present with carcinoid syndrome, and no recurrence was observed after 12 months of follow-up.



How to cite this article:
Chiu HC, Chen YL. Trabecular carcinoid tumor arising from a mature cystic teratoma.Tzu Chi Med J 2019;31:192-194


How to cite this URL:
Chiu HC, Chen YL. Trabecular carcinoid tumor arising from a mature cystic teratoma. Tzu Chi Med J [serial online] 2019 [cited 2019 Jul 17 ];31:192-194
Available from: http://www.tcmjmed.com/text.asp?2019/31/3/192/235913


Full Text

 Introduction



Mature cystic teratomas (MCTs) are the most common benign tumors in ovary. Malignant transformation of teratomas (TMT) occurs in 1%–3% of all MCTs [1], usually in postmenopausal women. Squamous cell carcinoma is the most common tumor type. Primary carcinoid tumors of the ovary are relatively rare, representing only 0.3% of all carcinoid tumors and [2]. There are four histologic subtypes of carcinoid tumors: insular, trabecular, mucinous and mixed. Compared to other types of carcinoid tumors, trabecular carcinoid tumor has a relatively benign disease course. Clinically, it seldom relates to carcinoid syndrome which typically presents with flushing of arms and face, wheezes, and diarrhea in patients with carcinoid tumors.

We present a rare case of a primary trabecular carcinoid tumor arising from a large mature ovarian cystic teratoma in a 40-year-old nulliparous premenopausal woman.

 Case Report



A 40-year-old nulliparous woman presented with intermittent abdominal pain and urinary frequency for 2 months. An adnexal mass was located during the physical examination. The woman was with regular menstrual cycle, and she had hyperthyroidism and had no abnormalities in her gynecological history. Transabdominal ultrasonography confirmed a 12.3 cm × 10.7 cm cystic mass with hyperechoic lines produced by the presence of hair, within the left ovary [Figure 1]. The tumor markers were as follows: carcinoembryonic antigen, 2.133 ng/mL (reference range [3]. The second-most common organ for these tumors is the lungs. Ovarian carcinoid tumors are rare and may be primary or metastatic. Primary ovarian carcinoids make up approximately 0.3% of all carcinoid tumors [2].

Microscopically, primary ovarian carcinoids are classified into four types: insular, trabecular, mucinous, and mixed. Among the four types, insular carcinoid tumor is the most common type, and trabecular carcinoid tumor is the second-most common carcinoid tumor (about one-third as common as insular tumors), and it occurs in women between 30 and 70 years of age [4]. However, trabecular carcinoid tumor is not typically associated with carcinoid syndrome and has good prognosis with no tumor-related deaths have been reported [4].

The majority of women with primary ovarian carcinoid tumors are peri- or postmenopausal with symptoms of an enlarging mass, or a mass found incidentally. Relatively rarely, they may also present with abdominal pain, constipation, hirsutism and a pelvic mass [4]. In our case, abdominal pain and urinary frequency were the presenting symptoms due to the large pelvic mass.

The preoperative diagnosis of MCT of the ovary is relatively easy due to the radiologic detection of bony tissues including teeth, bones, and cartilage. However, preoperative diagnosis of malignant transformation is very difficult. In most cases, a definitive diagnosis of TMT is confirmed by postoperative pathological findings, and IHC analysis [5],[6]. In our case, a small carcinoid tumor was identified in a huge ovarian tumor. It is important to perform a complete section of the tumor. The tumor cells were arranged in a trabecular structure. The IHC study revealed a neuroendocrine origin. The tumor was strongly positive for chromogranin A and negative for synaptophysin and had a low Ki-67 labeling index (<1%). Non-specific tumor markers are used to detect or screen for concomitant malignant transformation of MCTs, especially carcinoid tumors, but CA-125 and CA-19-9 may be elevated in some cases [6].

Aside from surgery, the optimal treatment has not yet been established. Unilateral oophorectomy may be the best approach for nulliparous and young patients with early-stage IA disease for fertility-sparing. Hence, for our patient, a 40-year-old nulliparous premenopausal woman, conservative treatment was performed then.

Declaration of patient consent

The authors certify that the patient has obtained an appropriate patient consent form. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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