Immature teratomas are rare malignant
tumors of the ovary. They are made of immature components of germ cell origin. The incidence of immature teratomas is highest in young adults aged 18 to 39. The prognosis heavily depends on the International Federation of Gynecology and Obstetrics (FIGO) staging system and is influenced by factors such as cell type,
tumor grade, capsular
rupture, and metastatic risk factors. Initial treatment is complete surgical resection. When indicated,
platinum-based
adjuvant chemotherapy with
bleomycin,
etoposide, and
cisplatin (BEP) is the treatment of choice. Next-generation sequencing of the
tumor can influence treatment in the recurrent setting. Temozolomide is an
alkylating agent used to target high-grade gliomas. Bevacizumab is a targeted
therapy that interferes with the process of angiogenesis by inhibiting
vascular endothelial growth factor (
VEGF). We report a 36-year-old female who presented with
a 17.6cm x 10.5cm x 24.2cm intraabdominal mass and
ascites. Upon
tumor resection, she was found to have a stage IIIa, grade 2
immature teratoma of the left ovary, with glial tissue being the metastatic cell type.
Disease progression continued despite treatment with BEP. She was then treated experimentally with six months of
bevacizumab and
temozolomide, given its rarity and targeted
therapy for glial tissue. Despite
monoclonal antibody therapy, the
tumor progressed again and was treated with
docetaxel and
gemcitabine. A repeat CT of the chest, abdomen, and pelvis demonstrated scattered peritoneal implants that were increasing in size. Chromosome analysis was performed and revealed somatic mutations of MLH1, MSH2, MSH6, and PD-L1. The patient has requested a break from
chemotherapy but will be treated with direct
immunotherapy when she restarts. This case's importance lies in its rarity because fewer than 10 cases of
immature teratomas with metastatic glial tissue are noted in the world's literature. Furthermore, this is the first reported case of this cell type being treated with
immunotherapy in the world literature.