Disseminated relapse of ovarian mature cystic teratoma with squamous cell carcinoma transformation following intraoperative spillage: a case report
Antonio Maccio, Manuela Neri, Valerio Vallerino, Gabriele Sole, Elisabetta Pusceddu, Paolo Albino FerrariIntroduction:
Malignant transformation of ovarian mature cystic teratoma is rare, usually presenting as squamous cell carcinoma (SCC). Rupture or spillage may complicate management, although a causal relationship with recurrence cannot be inferred from individual cases.
Presentation of case:
A 59-year-old woman developed disseminated relapse after excision of an ovarian dermoid cyst with SCC transformation, complicated by intraoperative rupture and pelvic spillage. She presented with an abdominal-wall mass and multifocal pelvic/peritoneal disease, consistent with at least FIGO stage IIIC-equivalent recurrence. She underwent diagnostic laparoscopy, then a complete open cytoreduction, including abdominal-wall resection/reconstruction, omentectomy, multivisceral bowel resections, type C2 radical hysterectomy, rectal resection, and pelvic/para-aortic lymphadenectomy. Histology confirmed a poorly differentiated SCC in a dermoid cyst, with negative margins and 87 negative lymph nodes. Adjuvant carboplatin-paclitaxel was administered without any CTCAE grade ≥1 toxicity. At 4 years, she remains disease-free.
Discussion:
Reports describe implantation/carcinomatosis after rupture/spillage. Complete cytoreduction, adherence to no-spillage principles, and early expert referral are essential.
Conclusion:
Strict no-spillage principles and early referral to high-expertise centers are essential when malignancy is suspected.