Frequency and clinicopathological features of somatic neoplasms arising in ovarian mature teratomas: a single-center experience.
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OBJECTIVE: Somatic neoplasms arising in mature teratomas (SN-MT) are rare clinical entities that pose significant diagnostic and therapeutic challenges. This study aims to determine the frequency of SN-MT and evaluate the clinicopathological characteristics that distinguish these cases from uncomplicated mature teratomas (MT). METHODS: We retrospectively reviewed 500 cases of presumed ovarian mature teratomas evaluated at a single center between 2006 and 2021. After strict exclusion criteria, 385 patients were included. All histopathological slides underwent systematic pathological re-evaluation by expert pathologists. Clinical, radiological, and laboratory data were compared between the MT and SN-MT groups. RESULTS: The overall incidence of somatic neoplasms (benign and malignant) was 3.1% (n = 12), with a malignant transformation rate of 2.07% (n = 8). The histological spectrum was highly heterogeneous and comprised both benign and malignant entities. Benign tumors identified in MTs included paraganglioma, choroid plexus papilloma, and adnexal tumor, whereas malignant tumors included squamous cell carcinoma (SCC), glioblastoma, anaplastic astrocytoma, adult-type granulosa cell tumor, and mixed carcinoma. The SN-MT group exhibited significantly larger mean tumor diameters compared to the MT group (9.45 ± 4.22 cm vs. 6.67 ± 3.32 cm, p < 0.05). On gross examination, mixed solid-cystic architecture was a powerful predictor of neoplasia (83.3% in SN-MT vs. 22.3% in MT, p < 0.0001). Preoperative serum tumor markers (CA 125, CA 19-9, and CEA) showed no significant discriminatory value. False-negative findings on intraoperative frozen section analysis may be attributable to the focal distribution of these lesions. CONCLUSION: SN-MT is a rare but histologically diverse condition. Large tumor size and the presence of solid components on macroscopic examination should raise suspicion of somatic transformation. Given the limitations of frozen section analysis and serum markers, rigorous macroscopic sampling and expert pathological examination remain the gold standard for diagnosis. While early-stage disease carries a favorable prognosis, the heterogeneity of subtypes necessitates individualized management.