43 year old lady with complaints of Menorrhagia for the past

Pathology

43 year old lady with complaints of Menorrhagia for the past 7 years, on investigation left ovarian cyst was found.. Hysterectomy done , Ovarian cyst measuring 10 x 8 x 4 cm. On cut section cystic area showed cheesy material .. Images attached , Diagnosis ??

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Dr. Kandukuri Mahesh Kumar

Pathology

Hello all, Benign cystic teratoma with predominant neural component ( Pilocytic Astrocytoma) Benign teratomas, also known as dermoid cysts, account for over 90% of ovarian germ cell tumors. Tumors composed nearly exclusively of neuroectodermal tissue have been separated from other teratomas and are treated as a distinct group of neoplasms . These monophasic teratomas, collectively called neuroectodermal tumors of the ovary, are quite rare, with roughly 60 cases reported in the literature. Neuroectodermal tumors of the ovary comprise ependymoma, astrocytoma, glioblastoma multiforme, medulloblastoma, medulloepithelioma, ependymoblastoma, neuroblastoma and primitive neuroectodermal tumor. Most women diagnosed with neuroectodermal tumors of the ovary are in their third or fourth decade of life, with the less differentiated anaplastic and primitive tumors occurring in younger patients. Patients often present with abdominal and pelvic pain accompanied by abdominal fullness or swelling. The average size of neuroectodermal tumors of the ovary is 10-14 cm.Grossly, most neuroectodermal ovarian tumors are solid but may be partially cystic. The solid areas of the tumor are composed of grayish white tissue with possible foci of necrosis or hemorrhage. The external surface is generally smooth and glistening. The histopathology of astrocytoma, WHO grade I, within a dermoid cyst reveals features of mature cystic teratoma, including a cyst wall lined with epidermis containing dermal appendages. The wall may also contain glial tissue or mature lipomatous, cartilaginous or bony tissue. Within the cyst, there is an area of loose connective tissue containing stellate or elongated astrocytes in microcystic regions. Rosenthal fibers, which appear as bright pink ropey or sausage-shaped fibers, are seen throughout . The tumor is immunoreactive for glial fibrillary acidc protein . Mitoses are rare in a grade I lesion. Microscopically, astrocytoma, WHO grade I, in a dermoid cyst is identical to its counterpart arising in the central nervous system. If more primitive areas are seen, the differential diagnosis would include an immature teratoma, although this entity would demonstrate greater diversity of neuroepithelial differentiation as well as a more extensive and varied admixture of endodermal, mesodermal and other ectodermal tissues. This distinction is important as immature teratomas have malignant potential. Clinical stage seems to be the most important prognostic parameter of survival, and patients with clinical stages I and II have fewer recurrences and overall longer survival. Stage I and II patients may receive surgery as the only therapy, while stage III and IV patients may receive additional chemotherapy and/or radiation . Thank you