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Choudhary et al.
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LETTER TO EDITORS
68
OPEN ACCESS
Collision tumors of ovary: A rare phenomenon
Shaista Choudhary, Shankar Adisesha
To the Editors,
Collision tumors represent a coexistence of two
adjacent but histologically distinct tumors without
admixture in the same tissue or organ. Though such
tumors have been reported often in various organs, their
occurrence in ovary is rare.
We report here a rare case of collision tumor of ovary
comprising serous cystadenoma and mature cystic
teratoma. A 55­year­old woman was presented with
palpable mass in the lower abdomen associated with
pelvic pain and dysfunctional uterine bleeding. Patient
underwent right salphingo oophorectomy following
ultrasound diagnosis of ovarian tumor. Grossly the
tumor measured 6 cm in diameter. Cut surface revealed
a trilocular cyst with two locules containing clear fluid.
Inner wall of one of the locules exhibited few tiny
polypoidal excrescences (Figure 1). The other locule had
a gelatinous appearance.
Microscopy revealed a combination of morphologic
features. Sections from two locules showed the cyst wall
lined by unilayer of low cuboidal epithelium which at
places exhibited presence of cilia. A few papillary
processes lined by ciliated/cuboidal epithelium were
also noted. Sections from locule with gelatinous
appearance revealed cyst wall lined by well
differentiated stratified squamous epithelium (Figure 2),
Figure 1: Microphotograph showing a trilocular ovarian cyst
with papillary excrescences. H&E stain, 40x.
Shaista Choudhary1 , Shankar Adisesha 2
Affiliations: 1 MD, Pathology, Associate Professor,
Pathology, B R Ambedkar Medical College, Bangalore,
Karnataka, India; 2MD, Pathology, Head of Department,
Pathology, Annapurna Medical
College, Salem,
Tamilnadu, India
Corresponding Author: Shaista Choudhary, House No60,1 0thA cross, West of Chord Road, 2nd stage,
Bangalore, Karnataka, Pin: 560086, India; Ph: 91 09901 474389; Email: [email protected]
Received: 02 March 201 2
Accepted: 06 May 201 2
Published: 01 October 201 2
Figure 2: Microphotograph showing serous cystadenoma and
teratomatous component. H&E stain 10x.
IJCRI – International Journal of Case Reports and Images, Vol. 3 No. 1 0, October 201 2. ISSN – [0976-31 98]
IJCRI 201 2;3(1 0):68–70.
Choudhary et al.
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beneath which was seen adipose tissue, sebaceous
glands, sweat glands, hair follicles, ganglion cells
(Figure 3) and a focus of colloid filled area. Based on the
microscopy, a diagnosis of collision tumor of ovary was
made.
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examined, so as not to miss any component which might
have a bearing on prognosis of the patient. Such cases
need to be documented for academic as well as
prognostic purpose.
*********
Choudhary S, Adisesha S. Collision tumors of ovary: A
rare phenomenon. International Journal of Case
Reports and Images 2012;3(10):68–70.
*********
doi:10.5348/ijcri­2012­10­206­LE­19
*********
Author Contributions
Figure 3: Microphotograph showing a gland lined by cuboidal
epithelium with adjacent ganglion cells H&E stain 40x.
We present this case because collision tumors in
ovary are a rare entity and combination of serous
cystadenoma with teratoma is rarer [1]. Though collision
tumors have been reported earlier, combined serous
cystadenoma with mature cystic teratoma is rarely
reported. With the available literature, there is just one
similar case reported in a non child bearing young
woman [2]. There are instances of collision tumors
consisting of teratoma with serous cystadenocarcinoma,
mucinous cystadenocarcinoma and/or granulosa cell
tumor [3]. In a study conducted at Seoul national
University college of medicine, the authors reviewed
seven pathologically proven cases of collision tumors of
ovary associated with teratoma. Ovarian teratomas were
co­existent with mucinous cystadenoma (4 cases),
borderline mucinous tumor (1 case), mucinous
cystadenocarcinoma (1 case) and dysgerminoma (1 case)
[4]. There is a single case report of collision tumor
composed of a colonic adenocarcinoma arising in a
sigmoid diverticulosis coexisting with recurrent ovarian
granulosa cell tumor [5]. Though mature cystic teratoma
of ovary contains derivatives of all three embryonic
germ cell layers, it rarely presents with ovarian epithelial
or sex cord stromal tumors. Rare cases of ovarian cystic
teratoma in association with surface epithelial tumors
have been reported in literature and occurrence of
serous cystadenomas with mature cystic teratoma is
even rarer [3]. Collision tumors have been described in
various organs including oesophagus, stomach, liver,
bone, kidney, brain and lung. Such tumors involving
ovary are rare.
In conclusion, we would like to emphasize upon the
fact that multiloculated cysts have to be extensively
Shaista Choudhary – Conception and design, acquisition
of data, Drafting the article, Final approval of the
version to be published
Shankar Adisesha – Analysis and interpretation of data,
Critical revision of the article, Final approval of the
version to be published
Guarantor
The corresponding
submission.
author
is
the
guarantor
of
Conflict of Interest
Authors declare no conflict of interest.
Copyright
© Shaista Choudhary et al. 2012; This article is
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