A 19-year-old woman undergoes right salpingo-oophorectomy for a 10 cm right ovarian mass. Pathology reports an immature teratoma Grade 2. Which additional histological feature, if present, would upstage her prognosis to more aggressive behavior and mandate adjuvant chemotherapy?
- A Presence of mature cartilage islands within the teratoma
- B Elevated mitotic index >15 per 10 high-power fields in the immature neuroepithelium
- C Peritoneal implants showing immature neural tissue (gliomatosis peritonei) of embryonal type ✓
- D Co-existing ipsilateral serous cystadenoma component in the same ovary
Explanation
Immature teratoma grading (Grade 1–3) is based on quantity of immature neuroepithelium per low-power field. The critical prognostic factor that changes management to mandatory BEP chemotherapy is the presence of peritoneal implants containing embryonal-type (immature) neural tissue — gliomatosis peritonei with immature elements indicates malignant implants and upgrades clinical stage. If peritoneal implants contain only mature glial tissue (mature gliomatosis peritonei), prognosis remains excellent. Mature cartilage (A) is expected in teratomas and not adverse. Mitotic index (B) is important for sarcoma grading, not standard immature teratoma grading. Co-existing cystadenoma (D) is incidental and does not affect prognosis.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.