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Year : 2017  |  Volume : 60  |  Issue : 4  |  Page : 606-607
Gliomatosis peritonei in mature cystic teratoma


Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India

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Date of Web Publication12-Jan-2018
 

How to cite this article:
Singla G, Zaheer S, Singla S, Kolte S, Mandal AK. Gliomatosis peritonei in mature cystic teratoma. Indian J Pathol Microbiol 2017;60:606-7

How to cite this URL:
Singla G, Zaheer S, Singla S, Kolte S, Mandal AK. Gliomatosis peritonei in mature cystic teratoma. Indian J Pathol Microbiol [serial online] 2017 [cited 2019 Sep 15];60:606-7. Available from: http://www.ijpmonline.org/text.asp?2017/60/4/606/222971




Gliomatosis peritonei is a rare condition characterized by the presence of mature glial tissue in the peritoneum. It is often associated with immature ovarian teratoma and rarely associated with mature teratomas. There are reports of its association with pregnancy and ventriculoperitoneal shunts performed for hydrocephalus.[1],[2] Here, we present a case of mature cystic teratoma with omental implants of mature glial tissue.

A 10-year-old girl was admitted to outpatient gynecology department of our tertiary care hospital with history of abdominal distension for 25 days and abdominal pain for 1 day. There were no other complaints. Ultrasound revealed 17 cm × 8 cm heterogeneously hyperechoic lesion noted in the abdominopelvic region on the right side with multiple cystic areas of variable size. CT scan revealed a 16.9 cm × 7.6 cm × 9.6 cm sized heterogeneously enhancing predominantly solid mass with cystic areas seen in the lower abdomen and pelvic cavity [Figure 1]a. Peritoneal deposits were also observed on the subdiaphragmatic surface [Figure 1]b. The mass showed multiple foci of calcification as well as areas showing fat attenuation. Right salpingo-oophorectomy along with partial omentectomy was done. An enlarged ovary measuring 20 cm × 12 cm × 8 cm was received. Externally, it was bosselated and capsular breach was seen [Figure 2]. On cut, it was solid, cystic with cysts measuring in size from 0.1 to 0.4 cm in diameter. These cysts were filled with mucoid material. On cut, few gritty areas were also present. Also received was omentum measuring 10 cm × 6 cm × 0.6 cm. Focal gray white areas were also seen.
Figure 1: (a) Heterogeneously enhancing predominantly solid mass with cystic areas seen in the pelvic cavity. (b) Peritoneal deposits present on the subdiaphragmatic surface

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Figure 2: Ovary with bosselated surface and capsular breach along with omentum

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Histopathological examination revealed features of mature cystic teratoma comprising of skin along with skin adnexa, columnar epithelium, fat, bone, cartilage, and mature brain tissue [Figure 3]a. Despite extensive sectioning, no immature elements were seen. Sections from omentum showed multiple nodules of mature brain tissue [Figure 3]b.
Figure 3: (a) Ovarian tissue shows keratin, stratified squamous epithelium, hair follicle, columnar epithelium, fat, and cartilage. (b) Showing nodules of mature glial tissue in the omentum

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The association of gliomatosis peritonei with the immature teratoma is rather classical; however, it is quite rare with mature ovarian teratomas. The origin of glial implants in gliomatosis peritonei, and the factors responsible for the development of gliomatosis peritonei in association with selected teratomas has been the subject of much debate. One theory regarding the origin of glial tissue suggests that it is genetically related to the associated teratoma, being either extruded from the primary neoplasm through capsular defects or disseminated through angiolymphatic channels.[3] An alternate theory suggests that glial foci are genetically unrelated to the associated teratoma and arise from normal cells in response to favorable environmental conditions. The most likely candidate normal cells are pluripotent Müllerian stem cells on the peritoneal surface or in the subcoelomic mesenchyme.[3]

Why some intraperitoneal stem cells (or tissues) differentiate along a glial pathway, whereas others do not requires some speculation. It has been suggested that a stem cells microenvironment can induce a specific differentiation pathway or pathways, and it is possible that some teratomas with an abundant glial component secrete factors that induce glial differentiation in the peritoneum.[4]

To date, approximately 100 cases (both mature and immature teratomas) have been described in the literature.[5] Out of which six cases have been reported from India. The first case from India was reported by Joshi et al. in 1981. Gliomatosis peritonei when associated with immature teratomas render a good diagnosis if the implants consist entirely of mature glial tissue.[1] For confirmation of mature glial tissue, GFAP stain can be used. A strong expression of GFAP often suggests that tumor cells are mature and differentiated.[1]

A benign clinical course is expected, however, malignant transformation of mature gliomatosis peritonei has been reported in literature.[6] Hence, a long-term follow up even in the case of mature glial implants is highly recommended.

However, extensive sampling of all peritoneal implants is important. If no other teratomatous elements or malignant glial tissue is found in the implants, the mature glial implants can be ignored, and the method of therapy should be judged only by the stage and grade of the primary ovarian teratoma.[2] However, if immature glial tissue or other teratomatous components or both are present in the peritoneum or omentum, the treatment should be the same as for metastatic ovarian teratoma.[2]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Heda SA, Patrikar AD, Bothale KA, Mahore SD. A rare case of immature ovarian teratoma with gliomatosis peritonei. J Basic Clin Reprod Sci 2014;3:126-9.  Back to cited text no. 1
  [Full text]  
2.
Das CJ, Sharma R, Thulkar S, Mukhopadhyay S, Deka D, Mannan R, et al. Mature ovarian teratoma with gliomatosis peritonei – A case report. Indian J Cancer 2005;42:165-7.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
Ferguson AW, Katabuchi H, Ronnett BM, Cho KR. Glial implants in gliomatosis peritonei arise from normal tissue, not from the associated teratoma. Am J Pathol 2001;159:51-5.  Back to cited text no. 3
    
4.
Vogel G. Cell biology. Stem cells: New excitement, persistent questions. Science 2000;290:1672-4.  Back to cited text no. 4
    
5.
Kim NR, Lim S, Jeong J, Cho HY. Peritoneal and nodal gliomatosis with endometriosis, accompanied with ovarian immature teratoma: A case study and literature review. Korean J Pathol 2013;47:587-91.  Back to cited text no. 5
    
6.
Dadmanesh F, Miller DM, Swenerton KD, Clement PB. Gliomatosis peritonei with malignant transformation. Mod Pathol 1997;10:597-601.  Back to cited text no. 6
    

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Correspondence Address:
Gaurav Singla
Department of Pathology, Safdarjung Hospital and Vardhman Mahavir Medical College, New Delhi - 110 029
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_342_16

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  [Figure 1], [Figure 2], [Figure 3]



 

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