Diagnostic Significance of Cellular Neuroglial Tissue in Ovarian Immature Teratoma

다국어 초록 (Multilingual Abstract)

Background: Immature teratoma (IT) is a tumor containing immature neuroectodermal tissue, primarily in the form of neuroepithelial tubules. However, the diagnosis of tumors containing only cellular neuroglial tissue (CNT) without distinct neuroepithelial tubules is often difficult, since the histological characteristics of immature neuroectodermal tissues remain unclear. Here, we examined the significance of CNT and tried to define immature neuroectodermal tissues by comparing the histological features of neuroglial tissues between mature teratoma (MT) and IT. Methods: The histological features of neuroglial tissue, including the cellularity, border between the neuroglial and adjacent tissues, cellular composition, mitotic index, Ki-67 proliferation rate, presence or absence of tissue necrosis, vascularity, and endothelial hyperplasia, were compared between 91 MT and 35 IT cases. Results: CNTs with a cellularity grade of ≥ 2 were observed in 96% of IT cases and 4% of MT cases (p < .001); however, CNT with a cellularity grade of 3 in MT cases was confined to the histologically distinct granular layer of mature cerebellar tissue. Moreover, CNT in IT exhibited significantly higher rates of Ki-67 proliferation, mitoses, and necrosis than those in MT (p < .001). Furthermore, an infiltrative border of neuroglial tissue and glomeruloid endothelial hyperplasia were significantly more frequent in IT cases than in MT cases (p < .001). Conclusions: Our results suggest that if CNT with a cellularity grade of ≥ 2 is not a component of cerebellar tissue, such cases should be diagnosed as IT containing immature neuroectodermal tissue, particularly if they exhibit an infiltrative border, mitoses, necrosis, and increased Ki-67 proliferation.

참고문헌 (Reference)

1 Ballabh P, "and white matter in developing infants" 56 : 117-124, 2004

2 Sugiyama T, "The germinal matrices in the developing dentate gyrus are composed of neuronal progenitors at distinct differentiation stages" 242 : 1442-1453, 2013

3 Kleinman GM, "Primary neuroectodermal tumors of the ovary : a report of 25 cases" 17 : 764-778, 1993

4 Baker PM, "Ovarian teratomas with florid benign vascular proliferation: a distinctive finding associated with the neural component of teratomas that may be confused with a vascular neoplasm" 21 : 16-21, 2002

5 Smith HO, "Incidence and survival rates for female malignant germ cell tumors" 107 : 1075-1085, 2006

6 Gershenson DM, "Immature teratoma of the ovary" 68 : 624-629, 1986

7 Koulos JP, "Immature teratoma of the ovary" 34 : 46-49, 1989

8 Gallion H, "Immature teratoma of the ovary" 146 : 361-365, 1983

9 Kierszenbaum AL, "Histology and cell biology: an introduction to pathology" Mosby 199-225, 2002

10 Gaudin PB, "Florid vascular proliferation associated with neural and neuroendocrine neoplasms: a diagnostic clue and potential pitfall" 19 : 642-652, 1995

11 Boor PJ, "Fetal cerebellar tissue associated with a primitive neuro-epithelial tumor in an ovarian teratoma" 2 : 139-141, 1975

12 Sanes DH, "Development of the nervous system" Academic Press 57-85, 2006

13 Dummula K, "Development of integrins in the vasculature of germinal matrix, cerebral cortex, and white matter of fetuses and premature infants" 88 : 1193-1204, 2010

14 Talerman A, "Blaustein’s pathology of female genital tract" Springer 847-907, 2011