Sabato 27 ottobre 2012 - Pacini Editore

386
Materials and methods. We present a case of benign mature cystic
teratoma of the right fallopian tube associated with an intrauterine
leiomioma found incidentally in a 32 year old term pregnant
woman subjected to caesarean section. The patient was nulliparous,
asymptomatic and she had a history of infertility for four and half
years. She had been no previous treated for subfertility and she had
no before surgical operations. The patient was pregnant spontaneously.
It was found a intrauterine leiomyoma and no other maternal
internal genital alteration during a routine ultrasound fetal. At the
end of intrauterine pregnancy it was performed cesarean section
during which the gynecologist executed uterine myomectomy
and right salpingectomy because right fallopian tube looked to be
extremely dilated at the ampolla, the apparence which was suggestive
of a hydrosalpinx or a fallopian neoplasm. The controlateral
fallopian tube and the right ovary were normal.
Results. At gross examination, uterine leiomyoma was the size
3,5x3x2,5 cm and microscopically it was apoplectic cellular leiomyoma.
Right fallopian tube revealed a 6x5x3 cm intraluminal
cystic tumor located at the ampolla. It contained a yellowish,
cheesy, sebaceous material and black hair. Cross section revealed
a thin wall lined by an opaque yellowish, gray-white wrinkled
apparent epidermis. Whitin the wall was not calcification. The
distal and proximal portions of tubal lumen appared normal
with decidual changes of the mucosal tunic. On microscopic examination,
the right fallopian tube showed benign mature cystic
teratoma with focal solid area. The cystic wall was lined mainly
with skin composed of keratinized well-differentiated squamous
epithelium, hair follicles or shafts, underlying stratified squamous
cells, sebaceous and sweat glands. The solid area contained a plug
of mature fatty tissue in absence of glial and cartilaginous tissues.
A foreign body-type granulomatous reaction is seen in association
with hair or epithelial contents of the cyst.
Discussion. The benign teratoma of the fallopian tube is composed
of recognizable tissues of ectodermal, mesodermal and
endodermal origin in any combination. The term dermoid cyst
was conied over 160 years old. Tubal dermoid cyst is a mature
teratoma that is composed predominantly of a cyst lined entirely
or partly by well-differentiated keratin-producing squamous epithelium,
which emerges from the tubal wall, not continuous with
the tubal epithelium. Primary teratoma of the fallopian tube is extremely
uncommon. At the present time, only about 58 cases have
been reported in the literature. The ages of these patients ranged
from 21-60 years, with most of them occurring in the fourth
decade. The diagnosis is almost never made pre-operatively as
most of these patients are asymptomatic. The common symptom
are colicky abdominal pain, dysmenorrhoea, leucorrhoea, menstrual
irregularity and postmenopausal bleeding. It is noted that
these patients are mainly nulliparous or have parity less than two.
Unusual presentations of some teratoma of the fallopian tube
include its co-existence with a tube pregnancy or intrauterine
term pregnancy, a free floating pelvic mass and rupture into the
rectum. Their sizes vary widely ranging from 0,4-20 cm. The
majority are cystic, others are solid. The location is commonly in
the ampulla or the isthmus.
Conclusions. Benign teratomas are the most common of all ovarian
neoplasms and represent a diverse group of tumors that may
develop at other sites. They develop from a totipotential stem cell.
The histogenesis is still unclear. One theory suggested the genesis
from parthenogenetic fertilization of the germ cell in situ because
teratomas are found along the know pathways of migration of the
germ cell during foetal development. Another theory suggested the
process of blastomeric isolation in which some cells of the blastula
which was sequatrated and later developed into teratomas because
they still retained their pluripotent character. The diversity of teratoma
behavior probably reflects the different biological potentials
of various stem cells, including germ cells and pluripotent embryonic
cells. Benign teratoma of the fallopian tube associated with
intramural leyomioma is extremely rare. If the tumor is not large
CONGRESSO aNNualE di aNatOmia patOlOGiCa SiapEC – iap • fiRENzE, 25-27 OttOBRE 2012
enough, preoperative diagnosis is difficult. Prognosis is favorable
following complete surgical excision. About 5-10% of dermoids
undergo malignant transformation of any one the component elements
(most commonly squamous cell carcinoma).
references
1 Schuveiller MJ, et al. Unusual Intratubal Location of Dermoid Cyst.
Journal of Diagnostic Medical Sonography1990;6;229-231.
2 Lai SF Lim-Tan SK. Benign Teratoma of the fallopian tube: a case
report. Singapore Med J 1993;34:274-5.
3 Hoda SA, Huvo AG. Struma salpingis associated with struma ovarii.
Am J Surg Pathol 1993;17:1187-9.
4 Hseih CS, Cheng GF, Liu YG, et al. Benign cystic teratoma of unilateral
fallopian tube associated with intrauterine pregnancy: a case
report. Zhonghua Yi Xue Za Zhi (Taipei) 1998;61:239-42.
5 Yoshioka T, Tanaka T. Mature solid teratoma of the fallopian tube:
case report. Eur J.Ostet. Gynecol Reprod Biol 2000;89:205-6.
6 Fattaneh A, Tavassoli PD. Pathology and genetics of tumours of the
breast and female genital organs. WHO/OMS 2003, p. 211.
7 Menki A, Bouraoui S, Oueslati B, et al. Mature cystic teratoma of the
fallopian tube. A case report. Tunis Med 2005;83:48-50.
8 Johnson C, Hansen KA. Mature cystic teratoma of the fallopian tube.
Fertility and sterility 2006;86:995-6.
9 Haslik L, Mara M, Kuzel D, et al. Present occurence of benign teratoma
of ovary and fallopian tube in a patient with adenexal torsion.
Ceska Gynekol 2006;71:342-4.
10 Ingec M, Kadanali S, Erdogan F. Huge teratoma of the fallopian tube:
a case report. J Reprod Med 2007;52:247-9.
11 Chao TJ, Chao J, Kuan Lj, et al. Mature solid teratoma of the fallopian
tube associated with uterine leiomyomas. J Chin Med Assoc
2008;71:425-7.
12 Satoe Fujiwara, Yoshiki Yamashita. et al. Mature cystic teratoma of
the fallopian tube. Fertility and sterility 2010;94:2708-9.
Pure Yolk Sac Tumor of adult testis: a case report
R. Nenna1 , G. Albino2 , C.D. Inchingolo1 1 U.O.C. di Anatomia Patologica, Ospedale “ L.Bonomo “, Andria, ASL
BT; 2 U.O.C. di Urologia, Ospedale “L. Bonomo”, Andria, ASL BT
Background. Yolk Sac Tumour is a testicular non-seminomatous
germ cell tumour (NSGCT) characterized by numerous patterns
that recapitulate the yolk sac, allantois and extraembrionic mesenchyme.
In the testis YST is seen in two distinct age groups, infants and
young children and postpubertal males. In young children it is
almost always seen in pure form. In adults, the pure form is very
rare because it usually occurs as a component of mixed germ cell
tumours.
Materials and methods. A 38-year old man presented the urologist
complaining acute left scrotal pain for suspected recurrent
testicular torsion. The pain disappeared with manual testicular
derotation.
Scrotal ultrasound showed disruption of the parenchymal texture
and hypervascularization perharps inflammatory reactive nature
for focal necrosis by repeated incomplete testis torsion.
The patient was operated for testicular fixation. With the intent
to reduce testicular tension, the albuginea tunic was incised at the
upper pole of left testis and was aspirated serous hemorrhagic
fluid submitted for cytological examination. Surprisingly, the
citologic diagnosis was “Germ Cell Malignant Tumour”.
Therefore, left radical orchiectomy and left emiscrotum skin resection
were performed.
Preoperative blood level of Alfa-fetoprotein was 2749 ng/ml,
while one month after surgery was < 4 ng/ml. The staging TC was
negative for lymph nodes and distant metastases (N0, M0). The
patient performed four cycles of chemotherapy. No recurrences
are found after five months of follow-up.
Results. On gross examination, testis was enlarged (size 7x6x4
cm) for presence within it of large, solid, soft and pale grayyellow
mass (size 4,3x4 cm) with haemorrhage and necrosis.
The testicular hilum was diffusely haemorrhagic. The tumor has