Cleveland Clinic Abu Dhabi, UAE
Scientific Tracks Abstracts: Surgery Curr Res
Ovarian cysts, tumours and tumour-like conditions are common in routine gynaecology and histology practices. Majority of cases, including malignancies are without diagnostic challenges. The purpose of this presentation is to demonstrate 3 cases (2 cases of teratoma and 1 case of endometriosis) in which the diagnosis had a huge impact on patient treatment and further management because of the unusual associated clinical implications. Case 1 is of a young female who presented with rapidly progressing neurological deficit and was found to have NMDA encephalitis and ovarian teratoma was the underlying cause. Bilateral oophorectomy and plasmapharesis were the mainstay of treatment. Case 2 is of a perimenopausal woman who presented with worsening androgenic manifestations with significantly elevated serum testosterone levels and was found to have an ovarian mass. Hormone producing sex cord stromal tumour was suspected, but the ovarian tumour was a monodermal teratoma (mucinous carcinoid). Although this tumour itself was not hormone producing, it had induced florid luteinization of the native nontumour ovarian stroma leading to androgenic manifestations. Metastatic carcinoid to the ovary was excluded by appendectomy and octreotide scan, both of which showed no evidence of any tumour. Androgenic features reversed within a short time post oophorectomy. Case 3 is of a young female who underwent unilateral ovarian cystectomy and pelvic peritoneal biopsies for endometriosis. Histology confirmed endometriosis in the ovarian cyst as well as in the peritoneal biopsies, and in addition the ovarian cyst also showed in situ clear cell carcinoma. The risk of transformation to clear cell carcinoma in the ovary and at extra-ovarian sites of endometriosis thus posed a challenge in surveillance and further management.
Priti Joshi MBBS, MD, FRCPath is a Consultant Anatomic Pathologist and Cytopathologist at Cleveland Clinic in Abu Dhabi. She is Clinical Associate Professor of Pathology at Cleveland Clinic Lerner College of Medicine and a Fellow of The Royal College of Pathologists, UK. Her areas of interest are Gynaecological, Urological and Gastrointestinal Pathology and has over 17 years’ experience in the field.