Mixed Carcinoid-Mucinous Adenocarcinoma Arising in Mature Teratoma of Mesentery

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Malignant transformation of mature cystic teratoma is uncommon , and occurs in approximately 2%–4% of cases. 1 The most common tumor is squamous cell carcinoma, followed by mucinous carcinoma, carcinoid tumor, thyroid carcinoma, etc.; however, any of the tissues in mature teratoma may undergo malignant transformation. 1 Goblet cell carcinoid (mucinous carcinoid) is a distinctive neoplasm with features of both carcinoid tumor and adenocarci-noma. Most cases described in the literature have occurred in the appendix and rarely, in the ovary. Although mature cystic teratomas occur in many extragonadal areas including the mes-entery 2 and greater omentum, occurrence of goblet cell carci-noid arising in extragonadal teratoma has been rarely described, with only a single case in mediastinum being reported in the English literature. 3 Moreover, a combination of mucinous ade-nocarcinoma, goblet cell carcinoid, carcinoid tumor, and mature teratoma in an extragenital organ has not been reported. Herein, we present a rare case of combined mucinous adeno-carcinoma and goblet cell and typical carcinoid tumor arising in mature cystic teratoma of the mesentery in a 48-year-old woman. A 48-year-old woman presented with a palpable abdominal mass in the periumbilical area with a vague abdominal pain of one month duration. Past medical history was unremarkable. She had no symptoms of carcinoid syndrome. On physical examination , the abdomen was markedly distended due to a solid movable mass. Abdominal and pelvic computed tomography scans revealed a huge heterogeneously enhanced mass in the abdominal cavity, which was associated with multiple smaller nodules throughout the entire abdominal and pelvic cavities and the right lobe of the liver. Bilateral ovaries were diffusely enlarged to form a semisolid mass. Laboratory findings demonstrated increased serum levels of carcinoembryonic antigen (264 ng/mL; normal<6 ng/mL) and carbohydrate antigen 125 (294 U/mL, normal<35 U/ml). Alpha-fetoprotein, beta-subunit of human chorionic gonadotropin and carcinohydrate antigen-19-9 were within normal range. Exploratory laparotomy revealed a huge mass in the mesen-tery of the small intestine (Fig. 1A), measuring 20×18×11 cm, with coexisting multiple outbulging hepatic masses, bilateral ovarian masses, and diffusely seeding nodules on the peritoneal surface and omentum. On cut section, the mesenteric mass had solid and cystic portions. The cystic portion, occupying approximately 60% of the tumor, was filled …