From ovary to brain: Specific imaging features of ovarian teratomas associated with anti-N-methyl-d-aspartate receptor encephalitis

This article aims to explore the problem of anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis and also describes our own experience in treating anti-NMDAR encephalitis in patients with ovarian teratomas. This pathological condition is a rare complication of cancer. Practicing gynecologists are often unfamiliar with it, although its consequences can be life-threatening. Early diagnosis and causal treatment, particularly teratoma removal, are critical for the outcome and can prevent death or the development of neurological deficits in patients. Key words: anti-NMDAR, autoimmune encephalitis, ovarian cysts, complications, ovarian teratoma, encephalitis, encephalitis in women

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Are Anti-N-methyl-D-aspartate Receptor Encephalitis-Related Ovarian Teratomas Distinct? Possible Role of Immunopathological Pathway

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqw159.051 ◽

2016 ◽

Vol 146 (suppl_1) ◽

Author(s):

Smita Patel ◽

Erika Paulsen ◽

Paolo Gattuso ◽

Pincas Bitterman

Keyword(s):

Aspartate Receptor ◽

Ovarian Teratomas

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Imaging of Ovarian Teratomas in Children: A 9-Year Review

Canadian Association of Radiologists Journal ◽

10.1016/j.carj.2009.07.001 ◽

2010 ◽

Vol 61 (1) ◽

pp. 23-28 ◽

Cited By ~ 15

Author(s):

Mohammed O.S. Alotaibi ◽

Oscar M. Navarro

Keyword(s):

Ovarian Neoplasms ◽

Mature Teratoma ◽

Ovarian Teratoma ◽

Imaging Features ◽

Review Of The Literature ◽

Endodermal Sinus Tumour ◽

Cystic Component ◽

Significant Difference ◽

Mature Type ◽

Ovarian Teratomas

Objective Germ cell tumours are the most common ovarian neoplasms in childhood and, of these, teratomas, whether mature or immature, are the most frequently found. Mature teratoma is a benign tumour, whereas the immature type, although also benign, has a more aggressive course, with a propensity to recurrence. A review of the literature revealed that there are some imaging features that may help to differentiate between these 2 types of teratoma, although no systematic comparison has been made. The objective of this study was to review imaging features of ovarian teratomas in children and to assess differentiating imaging features between the mature and immature types of ovarian teratoma. Methods Retrospective analysis of all patients who presented to our institution during a 9-year period (September 1999 to August 2008) with ovarian teratoma as confirmed on histology. Results Forty-one patients with pathologically proven ovarian teratoma were found. The patient ages ranged from 4–18 years at presentation (mean [standard deviation] age, 12.4 ± 3.4 years; median age, 13 years). Thirty patients (73.2%) were found to have mature ovarian teratoma, and 11 (26.8%) had immature teratoma. A component of endodermal sinus tumour was found in one of the immature teratomas. On ultrasonography, the appearance of the immature teratomas was purely solid in 3 (27.3%), mixed solid and cystic in 6 (54.5%), and predominantly cystic in 2 (18%). The mature ovarian teratomas demonstrated a predominantly cystic appearance in 22 (73.3%) and a mixed solid and cystic appearance in 8 (26.6%); there were no cases with a pure solid appearance. The prevalence of the more cystic appearance of the mature type showed significant statistical difference when compared with its prevalence in the immature type ( P = .0008, χ2 test). Other imaging features, such as size, presence of fat, or calcifications, did not show a significant difference between the 2 types of teratoma. Conclusions The predominance of a cystic component and a pure solid component in ovarian teratoma are significant differentiating factors between the mature type and the more aggressive immature type of teratoma.

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The Association of Ovarian Teratoma and Anti-N-Methyl-D-Aspartate Receptor Encephalitis: An Updated Integrative Review

International Journal of Molecular Sciences ◽

10.3390/ijms222010911 ◽

2021 ◽

Vol 22 (20) ◽

pp. 10911

Author(s):

Cheng-Yang Wu ◽

Jiann-Der Wu ◽

Chien-Chin Chen

Keyword(s):

Cerebral Spinal Fluid ◽

Treatment Strategies ◽

Paraneoplastic Neurological Syndrome ◽

Cell Tumor ◽

Ovarian Teratoma ◽

Cell Populations ◽

Aspartate Receptor ◽

Nmdar Encephalitis ◽

Somatic Transformation ◽

Ovarian Teratomas

Ovarian teratomas are by far the most common ovarian germ cell tumor. Most teratomas are benign unless a somatic transformation occurs. The designation of teratoma refers to a neoplasm that differentiates toward somatic-type cell populations. Recent research shows a striking association between ovarian teratomas and anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis, a rare and understudied paraneoplastic neurological syndrome (PNS). Among teratomas, mature teratomas are thought to have a greater relevance with those neurological impairments. PNS is described as a neurologic deficit triggered by an underlying remote tumor, whereas anti-NMDAR encephalitis is characterized by a complex neuropsychiatric syndrome and the presence of autoantibodies in cerebral spinal fluid against the GluN1 subunit of the NMDAR. This review aims to summarize recent reports on the association between anti-NMDAR encephalitis and ovarian teratoma. In particular, the molecular pathway of pathogenesis and the updated mechanism and disease models would be discussed. We hope to provide an in-depth review of this issue and, therefore, to better understand its epidemiology, diagnostic approach, and treatment strategies.

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