A Primipara of Ovarian Immature Teratoma with its Peritoneal Dessemination and of Postoperative Transitional Elevation of a-Fetoprotein

Abstract

Over fist-sized Douglaus' tumor was found in a 27 year-old primipara complained of edema of the legs and abdominal pain at her 25 gestation weeks. At her 35 gestation weeks, she revealing general edema arid ascites entered into the Kouri Hospital of Kansai Medical University for the laparotomy. After the removal of 6,000m1 of hemorrhagic ascites, childhead-sized tumor without the peritoneal adhesion could be seen in the left ovary. In addition, many finger-sized nodular and hemorrhagic tumors were observed around the uterine cervical cannal, on the posterior wall of the uterus, and on the peritoneum of Douglaus pouch. No any tumors could be detected macroscopically on the right ovary, upper abdominal cavity, liver and digestive tracts. A female baby weighing 2,520g was delivered by cesarotomy, and she is growing up normally now. Bilateral tubo-ovariectomy, hysterectomy and extirpation of almost all tumors in the Douglaus pouch were performed. At the end of operation anti-cancer drugs were administered intraperitoneally. An oval, somewhat ragged ovarian tumor, sized 15 x 12 x 10cm and weighed ca 500g, had the uneven fibrous capsule, some parts of which were perforated by the hemorrhagic tumor tissues. On the cut surface,2/3 of the tumor was solid elements, in which bone, cartilage, brain, multivesicular tissue, and foci of hemorrhagic necrosis could be detected. and the other was multiple serous cysts. Macroscopic appearance of the metastatic tumors looked to be the solid primary tumor. Histologically, both abundancy of mature elements of 3 germ layers (Ectoderm; epidermis and its belongs, tooth and nervous tissue including chorioid plexus, Mesoderm; cartilage, bone, muscle and the other mesenchymal cells, Endoderm; bronchus, intestine and tubular epithels) and focally located few immature elements (nervous tissue including retinoblast and tubular structure including a glomeruloid body?)could be detected in 14 blocks of the primary tumor. On 15 blocks of the metastatic foci, the histologic appearances were mainly teratoma mixed with immature nervous elements. All metastatic foci were located in the peritoneal walls, and none of them infiltrated into the intraperitoneal organs. After the operation, her general condition was no good. She was suffered from severe anemia and died of respiratory insufficiency 8 months after the operation. In the postoperative course,5 times removals of abundunt, non-hemorrhagic ascites and a transitional elevation of α-fetoprotein in serum (3 days after the operation; 300ng/ml,2-3 months after the operation; 1060-2310ng/rnl, and thereafter; subnormal)were marked. Squamous epithelial cells could be detected in the ascites cytologically, and columnar epithels could be also found in the pleural fluids besides of the suspect for pulmonary metastasis on X-ray examination.
Many points, e. g. histological classification of ovarian teratoma and her pathological diagnosis, ovarian immature teratoma and prognosis, metastasis of teratoma (ovarian teratoma with the elements of 3 germ layers in the metastatic foci), gliomatosis per itoni and tumor maturation, changes of serum 0a-fetoprotein in the neoplastic disease, and neoplasms in the pregnant women, were discussed, although her autopsy could not be done.