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Войти в исследования Gynecologic oncology reports · 2026
Malignant transformation of mature ovarian teratoma into goblet cell adenocarcinoma: a case report.
Клинический случайСтатьяНазвание и аннотация: Перевод в очереди
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Aryasomayajula Chinmayi, Legaspi Nichole, Elzieny Mai, Wang Hanlin L, Salani Ritu, Sullivan Peggy S
Аннотация
BACKGROUND: Malignant transformation of ovarian mature cystic teratomas (MCTs) occurs in 0.17-2% of cases, with squamous cell carcinoma comprising over 80%. Transformation to goblet cell adenocarcinoma is exceedingly rare, and optimal management remains undefined.
CASE: A 39-year-old woman with a history of prior ovarian cystectomy for MCT presented with severe abdominal pain and bilateral adnexal masses. Tumor markers were elevated (CA-125 76 U/mL, CEA 175 ng/mL, CA 19-9139 U/mL). She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and surgical staging. Intraoperative findings included a 21 cm right and 15 cm left ovarian mass with hemoperitoneum. Final pathology demonstrated goblet cell adenocarcinoma arising from MCT with contralateral ovarian involvement. No tumor was identified in the appendix. Immunohistochemistry was positive for SATB2, CK20, and CDX2, and negative for CK7 and PAX8, consistent with intestinal-type differentiation, with focal synaptophysin positivity indicating neuroendocrine features. Postoperative imaging revealed suspicious retroperitoneal lymphadenopathy. Given that standard germ cell regimens target totipotent biology and platinum-taxane regimens address Mullerian-derived epithelial ovarian carcinoma - neither of which reflects the histology seen - a histology-directed approach favoring GI-based chemotherapy was adopted, treating by cell type rather than site of origin. She is currently on third line treatment given disease progression.
CONCLUSION: Goblet cell adenocarcinoma arising in ovarian MCT is a rare entity without standardized treatment guidelines. The intestinal-type immunophenotype supports extrapolation from appendiceal goblet cell adenocarcinoma treatment paradigms, favoring gastrointestinal over traditional gynecologic chemotherapy regimens. Further collaborative reporting is needed to define optimal management for this rare tumor.
CASE: A 39-year-old woman with a history of prior ovarian cystectomy for MCT presented with severe abdominal pain and bilateral adnexal masses. Tumor markers were elevated (CA-125 76 U/mL, CEA 175 ng/mL, CA 19-9139 U/mL). She underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, appendectomy, and surgical staging. Intraoperative findings included a 21 cm right and 15 cm left ovarian mass with hemoperitoneum. Final pathology demonstrated goblet cell adenocarcinoma arising from MCT with contralateral ovarian involvement. No tumor was identified in the appendix. Immunohistochemistry was positive for SATB2, CK20, and CDX2, and negative for CK7 and PAX8, consistent with intestinal-type differentiation, with focal synaptophysin positivity indicating neuroendocrine features. Postoperative imaging revealed suspicious retroperitoneal lymphadenopathy. Given that standard germ cell regimens target totipotent biology and platinum-taxane regimens address Mullerian-derived epithelial ovarian carcinoma - neither of which reflects the histology seen - a histology-directed approach favoring GI-based chemotherapy was adopted, treating by cell type rather than site of origin. She is currently on third line treatment given disease progression.
CONCLUSION: Goblet cell adenocarcinoma arising in ovarian MCT is a rare entity without standardized treatment guidelines. The intestinal-type immunophenotype supports extrapolation from appendiceal goblet cell adenocarcinoma treatment paradigms, favoring gastrointestinal over traditional gynecologic chemotherapy regimens. Further collaborative reporting is needed to define optimal management for this rare tumor.