Introduction
Gliomatosis peritonei is characterised by implantation of mature glial tissue within the peritoneal cavity. It is a rare condition almost exclusively associated with immature ovarian teratoma. We report a case of gliomatosis peritonei associated with recurrent bilateral mature teratomas diagnosed in pregnancy.
Clinical Description
A 28 year old G1P0, who had a history of laparotomy for a 2kg mature teratoma, was incidentally noted to have a 9x4cm complex right adnexal mass and enlarged left ovary on dating ultrasound at 7/40. The right multiloculated cystic mass with solid areas enlarged rapidly over four weeks to a size of 17x5x12cm. The left ovarian cyst remained stable at 3.9x3x3.9cm in size. At 16/40, she underwent a laparoscopy which was converted to laparotomy due to dense bowel adhesions. At laparotomy there was a 4cm left ovarian cyst and a 17cm complex right ovarian cyst with no ovarian tissue. Small white deposits on the bowel serosa and omentum was noted. A right salpingo-oophorectomy, left ovarian cystectomy and omental biopsy was performed. Histopathology demonstrated bilateral mature teratomas and gliomatosis peritonei.
Her pregnancy continued without complications until 33/40 when she developed cholestasis of pregnancy. She underwent an induction of labour with prostaglandins at 37+2/40 and progressed to a spontaneous vaginal delivery of a 2865g female with Apgars 9, 9.
Discussion
Mature teratomas are the most common ovarian germ cell tumour occurring in young women. They are often slow-growing and recurrence is low (4.2%). However in women with large tumours diagnosed at a young age, such as in our case, the recurrence rate is significantly higher, at 21.4% (Harada et al.). This is a unique case in that the recurrence was bilateral, was diagnosed in pregnancy and was associated with gliomatosis peritonei, a rare complication of teratomas with most cases reported occurring with immature teratomas. The rapid growth of the tumour seen in the first trimester is also unusual and could be related to the increased levels of estrogen and progesterone in pregnancy.