Ovarian neuroblastoma due to malignant transformation of mature cystic teratoma: A clinicopathologic and immunohistologic analysis

We present the eighth case of a neuroblastoma to present clinically as a primary ovarian cancer, and the third to be confirmed as a malignant transformation of a mature cystic teratoma of the ovary. Histological sections of the ovarian mass obtained from this 23-year-old patient showed two distinct elements. More than half of the tumor was occupied by a mature cystic teratoma that contained stratified keratinizing squamous epithelium, bronchial epithelium combined with sub-mucosal smooth muscle, and neuroectodermal tissue. The second element, neuroblastoma, transitionally arose from the neuroectodermal tissue, which suggested it appeared as the malignant transformation of mature cystic teratoma component.Tumor cells obtained from a bone marrow metastasis at end stage disease and from the ascitic fluid demonstrated the cytological characteristics of a neuroblastoma. Immunohistochemical staining of intermediate filament and neuro-secretory component, neuron specific enolase, creatinine kinase BB, laminin and fibronectin all showed marked positivity. The patient died 6 months after the initial presentation, despite tumor reduction surgery followed by combined chemotherapy with cisplatin and etoposide.