Case Report
Uterine cervical teratoma with divergent neuroepithelial differentiation and development of an oligodendroglioma: report of a case and review of the literature

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Abstract

Teratomas of the uterine cervix are rare. Immature and malignant uterine cervical teratomas are extremely rare. A uterine cervical teratoma with divergent neuroepithelial differentiation and/or development of a neurological tumor has never been reported. We describe a case of uterine cervical teratoma exhibiting ectodermal, endodermal, mesodermal, and various types of neuroepithelial differentiation and development of a small oligodendroglioma in a 38-year-old female. The presence of immature neuroepithelium defines this teratoma as immature, and the development of a low-grade malignant neoplasm from one of its components makes it malignant. The pertinent literature is reviewed.

Introduction

The extragonadal germ cell tumors represent 1%-2% of all the germ cell tumors. The most common extragonadal sites are the retroperitoneum and the mediastinum. The visceral teratomas are very rare [1]. To our knowledge, 15 cases of uterine cervical teratoma have been described so far in the English literature [1], [2], [3], [4], [5], [6], [7]. Of all the uterine cervical teratomas reported so far, 3 were immature [1], [4], [5], and 1 was malignant [6]. The immature component in 1 of the immature teratomas was rhabdomyoblastic tissue and Wilms tumor–like immature tissue [1]. The other immature cervical teratoma was reported to contain partly immature ectodermal, mesodermal, and endodermal components [5]. The nature of the immature component was not mentioned in the third case of immature teratoma [4]. The case of malignant teratoma contained invasive squamous cell carcinoma [6]. We present here a case of uterine cervical teratoma containing mature ectodermal, endodermal, and mesodermal components as well as many types of immature neuroepithelial elements with a small oligodendroglioma.

Section snippets

Report of a case

A 38-year-old white woman presented to her gynecologist in December 2003 with a history of severe menorrhagia and severe dysmenorrhea of approximately 6-month duration. She had remote history of termination of 2 first-trimester pregnancies. The mode of termination is unknown. On examination, she was found to have a few myoma-like nodules protruding from the cervical os along with severe bleeding. Under the impression of aborting leiomyomas, the nodules were excised and sent to the pathology

Materials and methods

The specimen was fixed in 10% buffered formalin, and the paraffin sections were stained with hematoxylin and eosin according to the standard protocols at the Putnam Hospital Center, Carmel, NY. Immunohistochemical staining with the labeled streptavidin-biotin peroxidase detection system was performed using the Ventana automated immunostainer (Ventana Medical Systems, Tucson, Ariz) at the Wilson Memorial Regional Medical Center, Johnson City, NY. The following antibodies were used: GFAP

Pathologic findings

Grossly, there were 2 irregular tan-pink and firm pieces of tissue measuring 3.1 × 2 × 1 and 4.5 × 3 × 2.5 cm. Cut surfaces were tan and cystic. The cysts measured 2 to 4 mm and contained mucoid material.

Microscopically, the ectocervical-endocervical junction was identified (Fig. 1). The subepithelial tissue contained normal endocervical glands and foci of teratoma. The teratomatous tissue contained mature ectodermal elements, that is, epidermis and skin adnexa (Fig. 2), mature endodermal and

Discussion

Teratomas are the most frequent germ cell tumors. The extragonadal germ cell tumors are neoplasia histologically identical to those of gonadal origin that develop mostly in the mediastinum, retroperitoneal region, pineal gland, and presacral area. Primary germ cell tumors have also been described in the parotid gland, breast, pericardium, esophagus, stomach, intestine, liver, lung, kidney, prostate, urinary blabber, uterine corpus, placenta, uterine cervix, vagina, and vulva. Extragonadal germ

Acknowledgments

The authors thank Dr Vinita Agarwal for her support and encouragement to publish this article. They also thank Dr William Taylor for his expert neuropathology opinion, Dr Sanjay Mukhopadhyay for his technical assistance, and Tracie Bird for her secretarial assistance.

References (11)

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