Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

Users Online : 19149

AbstractCase ReportDiscussionConclusionReferencesDOI and Others
Article in PDF How to Cite Citation Manager Readers' Comments (0) Audio Visual Article Statistics Link to PUBMED Print this Article Send to a Friend
Advertisers Access Statistics Resources

Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Case report
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : ED04 - ED06 Full Version

Pilocytic Astrocytoma Arising in Ovarian Mature Cystic Teratoma: An Unusual Neuroectodermal Malignant Transformation Occurring in Pregnant Female


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60785.17312
Kalaivani Amitkumar, Abbirami Rajarajan, R Bhuvanamhadevi, Sowmya Dayalan, Muthu Sudalaimuthu

1. Professor, Department of Pathology, SRM Medical College Hospital and Research Centre, Faculty of Medicine, SRM, Chengalpattu, Tamil Nadu, India. 2. Postgraduate Student, Department of Pathology, SRM Medical College Hospital and Research Centre; Faculty of Medicine, SRM Institute of Science, Chengalpattu, Tamil Nadu, India. 3. Professor, Department of Pathology, SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India. 4. Assistant Professor, Department of Pathology, SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India. 5. Professor, Department of Pathology, SRM Medical College Hospital and Research Centre, Chengalpattu, Tamil Nadu, India.

Correspondence Address :
Kalaivani Amitkumar,
S1, Thanyaregency, 11/61 Ganesh Nagar Main Road, Selaiyur, East Tambaram, Kancheepuram, Tamil Nadu, India.
E-mail: drkalaivani1980@gmail.com

Abstract

Mature cystic teratomas are usually benign, however malignant transformation occurs rarely. It is identified in only 0.17-2% of cases. Malignant cells can arise from cell of any type, but most common malignant transformation found to be squamous cell carcinoma (80% cases) followed by adenocarcinoma. While neural tissue is identified in nearly 80% cases of mature cystic teratomas, neuroectodermal tissue with malignant transformation is the most exceptional event. There is minimal data available on primary neuroectodermal tumours of ovary, majority are astrocytoma of different grades, only few cases were reported in the literature so far. Authors report a extremely rare and unique case of pilocytic astrocytoma arising from a mature cystic teratoma in a pregnant female. A 33-year-old pregnant female in her first trimester came for regular antenatal visit, Ultrasound (USG) abdomen and pelvis single live intrauterine gestation corresponding to 10 weeks and incidental complex right ovarian cyst likely to be mature cystic teratoma. Patient underwent right ovarian cystectomy five months after normal vaginal delivery and provisional diagnosis was given as complex right ovarian dermoid cyst. Final detailed histopathological examination revealed a tumour with glial tissue within the cyst, reported as pilocytic astrocytoma {World Health Organization (WHO) grade 1} arising in mature cystic teratoma. To the best of authors’ knowledge this is the third case showing pilocytic astrocytoma component in ovarian teratoma and the first case of this entity occurring in a pregnant female. Authors present an unusual case where radiology gave preliminary diagnosis however, extensive histopathological examination, histochemistry and immunohistochemistry helped in definite diagnosis.

Keywords

Dermoid cyst, Glioma, Mature teratoma, Rosenthal fibers

Case Report

A 33-year-old pregnant female in her first trimester of second pregnancy, came to Obstetric Outpatient Department for regular antenatal check-up without any significant complaints. Ultrasound (USG) abdomen and pelvis revealed single live intrauterine gestation corresponding to 10 weeks and complex right adnexal cyst of size 6.5×5.8×6.0 cm (Table/Fig 1)a,b.

She was advised Nuchal Translucency (NT) scan and follow-up at 11 to 13 weeks, however she revisited the Institute OPD for cystectomy only five months after normal vaginal delivery which was conducted outside. She was P2L2 with regular previous menstrual cycles, married four years back and last child birth was five months. No other associated co-morbidities present. On abdominal palpation, separate, non tender, mobile right-sided cystic mass was found, compatible with ovarian cyst, was sent to radiology department for further evaluation. Baseline investigations such as complete blood count, routine urine examination were done and found to be within normal limits. Serum tumour markers were analysed, Cancer Antigen (CA)125 was 12.6 U/mL, Alfa fetoprotein was 3.10 ng/mL, and beta human Chorionic Gonadotropin (hCG) was not detectable. USG abdomen and pelvis showed a complex right adnexal cyst of size 7.8×6.7×7.2 cm with fluid fat level and calcific focus. Magnetic Resonance Imaging (MRI) revealed large cyst with heterogenous fluid and fat signalingcomplex ovarian cyst of size 7.9×7.9×6.2 cm and the impression was given as likey to be mature cystic teratoma (Table/Fig 2).

Patient underwent exploratory laparotomy and right ovarian cystectomy demonstrating 8x8 cm large cyst replacing the right ovary along with bilateral tubectomy. Intraoperatively, right and left fallopian tubes, uterus and left ovary were unremarkable. Right ovarian cyst and bilateral tubectomy specimens were submitted for histopathology. Provisional diagnosis of dermoid cyst was made based on MRI impression and intraoperative findings. On gross examination, already cut opened cyst measured 9X6X2 cm completely replacing ovary, along with seperately lying bilateral tubes. On extending the cut, cyst drained clear fluid. Cut surface showed multiloculated cyst with visible hair follicles admixed with fat and pultaceous material, maximum cyst wall thickness was 1 cm with few solid areas (Table/Fig 1)c. Few cystic areas were filled with thick mucoid material. Specimen was sampled adequately.

Histologically cyst wall with mature derivatives of all three germ cell layers namely ectoderm, endoderm and mesoderm were identified. Stratified squamous epithelium with underlying good number of sebaceous glands, mature cartilage, foci of respiratory and transitional epithelium were identified. Areas of sharply demarcated glial tissue with biphasic morphology noted, predominantly composed of loose microcystic areawith eosinophilic granular bodies and compact areas with plenty of bright-red sausage or corkscrew-shaped Rosenthal fibres and astrocytes with elongated nuclei were noted. Degenerative change in the form of psammomatous as well as patchy type calcification appreciated at places (Table/Fig 3)a,b,c,d. There was no evidence of necrosis, endothelial proliferation or increase in mitotic activity. Final impression was released as mature cystic teratoma with pilocytic astrocytoma component- World Health Organization (WHO) grade 1 (1).

Periodic acid schiff histochemical stain highlighted eosinophilic granular bodies and Masson trichrome stain demonstrated bright Rosenthal fibers (Table/Fig 4)a,b. Immunohistochemical stain Glial Fibrillary Acidic Protein (GFAP) also performed to confirm glial origin and to highlight the Rosenthal fibres, came out to be strong and diffuse positivity. Ki-67 stain showed low proliferation index of 1 to 2% compatible with low grade (grade 1) tumour (Table/Fig 4)c,d. The postoperative period was uneventful. On follow-up visits till 11 months of postoperative period, patient was asymptomatic without any complaints. Written consent for publication was obtained from the patient.

Discussion

Benign (mature) cystic teratomas are one of the most common ovarian neoplasms occurring in women of reproductive age group, accounts for 20% of all ovarian neoplasm and 95% of all ovarian germ cell tumours (2). Peak incidence is 20-29 years. Mature teratomas/dermoid cyst, a germ cell tumour contains well differentiated tissue of all three layers of germ cells, including ectoderm, endoderm, and mesoderm (3),(4). Mature cystic teratomas are usually benign, but malignant transformation identified in 0.17-2% of cases (5). Malignant cells can arise from cell of any type, but most common malignant transformation is squamous cell carcinoma (80% cases) followed by adenocarcinoma (6).

While neural tissue is identified in nearly 80% cases of mature cystic teratomas (7), neuroectodermal tissue with malignant transformation is very rare, however neuroectodermal tumours including glioblastomas, oligodendrogliomas, ependymomas, and astrocytomas were reported previously (8). In the detailed literature search, only 44 cases of gliomas including the present case have been described, out of these cases 37 cases were found within a mature cystic teratoma and seven developed from immature type. Four cases diagnosed as fibrillary astrocytomas WHO grade ranging from I–II, 16 cases were ependymomas and 13 cases found to be grade IV glioma (9). Oigodendroglial, ependymal tissues, ganglia of sympathetic type, and Schwann cells may be identified in mature cystic teratomas. Pilocytic astrocytoma of central nervous system is the most common childhood tumour occurring in cerebellum, classified as grade-I tumour by World Health Organisation. This should be differentiated from other types such as infiltrating or diffuse type of astrocytoma since these types tend to infiltrate adjacent tissues. To the best of our knowledge this is the third case showing Pilocytic astrocytoma component, first case reported as pure pilocytic astrocytoma (10) and the second case reported as collision glial neoplasms composed of pilocytic and ependymal components (9).

Due to routine antenatal USG examination, incidental diagnosis of adnexal masses are on rise. Though there is spontaneous resolution of few masses, some cases end up in complications like torsion, interference in normal labour or rupture resulting in surgical emergency, which adversely affects maternofetal outcome (11). Late detection may increase the risk of malignant transformation, however the risk of occurrence of malignancy in pregnancy ranges from 1 in 10000 to 1 in 50000 (12). The most common ovarian tumour occurring in pregnancy was mature teratoma followed by serous cyst, bilateral borderline serous carcinoma was identified in one patient (13). The present case is the first unique case of pilocytic astrocytoma originating from a mature cystic teratoma occurring in a pregnant female. The treatment modes and prognosis are notwell prevalent for these tumours due to rarity.

While the literature knowledge is limited about the behaviour of low-grade astrocytoma arising in a mature cystic teratoma, the patients described in the previous studies were cured with surgical resection itself (8). As far as gynaecological tract’s astrocytomas are considered, authors believe that patients with low grade glial tumours undergoing complete surgical resection will have good prognosis. Szczepa Ska M et al., studied about ovarian lesions occurring in pregnant females 35% of cases were surgicly intervened to excise the tumour and 65% of the cases were managed by non surgical conservative modality (13). Gliomas of all types arising within mature or immature teratomas of the ovary tend to present as ectopic site lesions such as in peritoneal cavity and sometimes in the lymph nodes (14). This theory appears not suitable for this case.

The identified risk factors involving malignant transformation of mature cystic teratoma are larger size tumour, older age, postmenopausal status and elevated CA-125 levels (15). The exact mechanism is not understood, however it was suggested that presence of mature cystic teratomas without excision for longer period may be related to malignant transformation. Teratomas presenting in postmenopausal and older women may present for several years before excision. This long-term presence can be related with overexposure to carcinogens or causing increased mutations over a period of years (16). Interestingly, in the present case report the patient presented with larger size tumour which is the only known risk factor of malignant transformation.

Conclusion

This case report presented extremely rare entity of pilocytic astrocytoma originating from ovarian mature cystic teratoma occurring in a pregnant female. Where radiology gave preliminary diagnosis however, extensive histopathological examination and immunohistochemistry helped in definite diagnosis, emphasising the need of appropriate sampling to identify rare components with proper grading and subtyping. This case report will be contributing to the minimal information obtainable for primary pilocytic astrocytoma of female genial tract showing malignant ectodermal transformation in the background of mature cystic teratoma. Many more case studies and follow-up details are surely needed for helping physicians to plan for better treatment and to understand the prognosis of these rare entities.

References

1.
WHO Classification of Tumours Editorial Board. World Health Organization Classification of Tumours of the Central Nervous System. 5th ed.Lyon: International Agency for Research on Cancer; 2022.
2.
Sahin H, Abdullazade S, Sanci M. Mature cystic teratoma of the ovary: A cutting edge overview on imaging features. Insights Imaging. 2017;8(2):227-41. [crossref] [PubMed]
3.
Comerci JT, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: A clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynaecol. 1994;84(1):22-28.
4.
Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. Malignant transformation of mature cystic teratoma of the ovary: Experience at a single institution. Eur J Obstet Gynaecol Reprod Biol. 2008;141(2):173-78. [crossref] [PubMed]
5.
Ulker V, Numanoglu C, Akbayir O, Akyol A, Tuncel A, Akca A, et al. Malignant transformation arising from mature cystic teratoma of the ovary: A report of six cases: Teratoma with malignant transformation. J Obstet Gynaecol Res. 2012;38(5):849-53. [crossref] [PubMed]
6.
Thaker S. Squamous cell carcinoma developing in mature cystic teratoma of the ovary: a rare case. J ObstetGynaecol India. 2012;62(Suppl 1):63-64. [crossref] [PubMed]
7.
Yoder N, Marks A, Hui P, Litkouhi B, Cron J. Low-grade astrocytoma within a mature cystic teratoma in an adolescent patient. J Pediatr Adolesc Gynaecol. 2018;31(3):325-27. [crossref] [PubMed]
8.
Badran YR, Obeidat FN, Freij MA. Low-grade astrocytoma arising in a mature ovarian teratoma in an adolescent. Clin Ovarian Other Gynaecol Canc. 2013;6(1– 2):62-64. [crossref]
9.
Meliti A, Hafiz B, Al-Maghrabi H, Gari A. Collision glial neoplasms arising in an ovarian mature cystic teratoma: A rare event. Case Rep Pathol. 2020;2020:7568671. [crossref] [PubMed]
10.
Skopelitou A, Mitselou A, Michail M, Mitselos V. Stefanou. Pilocytic astrocytoma arising in a dermoid cyst of the ovary: A case presentation. Virchows Arch. 2002;440:105-06. [crossref] [PubMed]
11.
Moradan S. Ovarian immature teratoma during pregnancy: A case report. J Med Liban. 2014;62(4):245-47. [crossref] [PubMed]
12.
Giuntoli RL, Vang RS, Bristow RE. Evaluation and management of adnexal masses during pregnancy. Clin Obstet Gynaecol. 2006;49(3):492-505. [crossref] [PubMed]
13.
Szczepa Ska M, Rajewski M, Skrzypczak J. The management of ovarian tumours in pregnancy and perinatal outcome. Ginekol Pol. 2011;82(4):265-67.
14.
Den Boon J, Van Dijk CM, Helfferich M, Peterse HL. Glioblastoma multiform in a dermoid cyst of the ovary. A case report. Eur J Gynaecol Oncol. 1999;10:187-88.
15.
Park CH, Jung MH, Ji YI. Risk factors for malignant transformation of mature cystic teratoma. ObstetGynaecol Sci. 2015;58(6):475-80. [crossref] [PubMed]
16.
Rim SY, Kim SM, Choi HS. Malignant transformation of ovarian mature cystic teratoma. Int J Gynaecol Cancer. 2006;16(1):140-44. [crossref] [PubMed]

DOI and Others

DOI: 10.7860/JCDR/2023/60785.17312

Date of Submission: Oct 14, 2022
Date of Peer Review: Nov 17, 2022
Date of Acceptance: Dec 01, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. No

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Oct 14, 2022
• Manual Googling: Nov 23, 2022
• iThenticate Software: Nov 28, 2022 (2%)

ETYMOLOGY: Author Origin

JCDR is now Monthly and more widely Indexed .
  • Emerging Sources Citation Index (Web of Science, thomsonreuters)
  • Index Copernicus ICV 2017: 134.54
  • Academic Search Complete Database
  • Directory of Open Access Journals (DOAJ)
  • Embase
  • EBSCOhost
  • Google Scholar
  • HINARI Access to Research in Health Programme
  • Indian Science Abstracts (ISA)
  • Journal seek Database
  • Google
  • Popline (reproductive health literature)
  • www.omnimedicalsearch.com