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Ovarian teratoma associated with anti-N-methyl D-aspartate receptor encephalitis: a report of 5 cases documenting prominent intratumoral lymphoid infiltrates.
Int J Gynecol Pathol. 2012 Sep; 31(5):429-37.IJ

Abstract

Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a recently described severe neurological disorder predominantly affecting young women, which presents with psychosis, memory deficits, seizures, and encephalopathy, often requiring prolonged hospitalization. The condition is frequently associated with an underlying neoplasm, most often an ovarian teratoma, and in such cases appears to be a para-neoplastic, immune-mediated encephalopathy. The histologic features of the teratomas associated with anti-NMDAR encephalitis have seldom been described in detail. Therefore, in this report, we have compared ovarian teratomas (4 mature and 1 immature) from 5 patients with anti-NMDAR encephalitis with 22 sporadic control teratomas (14 mature and 8 immature) that included neuroglial elements. The encephalitis-associated tumors ranged from 0.7 to 9.5 cm diameter, and 1 case was bilateral; the second teratoma was discovered 13 mo after the first when symptoms recurred. In comparison with control teratomas, the anti-NMDAR-associated tumors showed a more marked intratumoral lymphoid infiltrate that colocalized to the mature neuroglial elements. Reactive germinal centers (3 cases) and diffuse lymphoplasmacytic infiltrates within the neuroglial matrix (4 cases), and degenerative neuronal changes (2 cases), were seen only in the anti-NMDAR-positive cases. Pathologists encountering ovarian teratomas with these distinctive reactive lymphoid elements should consider the possibility of anti-NMDAR encephalitis, particularly because the neurological symptoms may develop after tumor resection. Careful histopathologic examination may be required to identify small, radiologically occult teratomas, and to demonstrate the presence of subtle neoplastic neuroglial components in teratomas associated with anti-NMDAR encephalitis.

Authors+Show Affiliations

Department of Histopathology, King Edward Memorial Hospital, Perth, Western Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

22833082

Citation

Dabner, Marcus, et al. "Ovarian Teratoma Associated With anti-N-methyl D-aspartate Receptor Encephalitis: a Report of 5 Cases Documenting Prominent Intratumoral Lymphoid Infiltrates." International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists, vol. 31, no. 5, 2012, pp. 429-37.
Dabner M, McCluggage WG, Bundell C, et al. Ovarian teratoma associated with anti-N-methyl D-aspartate receptor encephalitis: a report of 5 cases documenting prominent intratumoral lymphoid infiltrates. Int J Gynecol Pathol. 2012;31(5):429-37.
Dabner, M., McCluggage, W. G., Bundell, C., Carr, A., Leung, Y., Sharma, R., & Stewart, C. J. (2012). Ovarian teratoma associated with anti-N-methyl D-aspartate receptor encephalitis: a report of 5 cases documenting prominent intratumoral lymphoid infiltrates. International Journal of Gynecological Pathology : Official Journal of the International Society of Gynecological Pathologists, 31(5), 429-37.
Dabner M, et al. Ovarian Teratoma Associated With anti-N-methyl D-aspartate Receptor Encephalitis: a Report of 5 Cases Documenting Prominent Intratumoral Lymphoid Infiltrates. Int J Gynecol Pathol. 2012;31(5):429-37. PubMed PMID: 22833082.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Ovarian teratoma associated with anti-N-methyl D-aspartate receptor encephalitis: a report of 5 cases documenting prominent intratumoral lymphoid infiltrates. AU - Dabner,Marcus, AU - McCluggage,W Glenn, AU - Bundell,Chris, AU - Carr,Aisling, AU - Leung,Yee, AU - Sharma,Raghwa, AU - Stewart,Colin J R, PY - 2012/7/27/entrez PY - 2012/7/27/pubmed PY - 2012/12/18/medline SP - 429 EP - 37 JF - International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists JO - Int J Gynecol Pathol VL - 31 IS - 5 N2 - Anti-N-methyl D-aspartate receptor (NMDAR) encephalitis is a recently described severe neurological disorder predominantly affecting young women, which presents with psychosis, memory deficits, seizures, and encephalopathy, often requiring prolonged hospitalization. The condition is frequently associated with an underlying neoplasm, most often an ovarian teratoma, and in such cases appears to be a para-neoplastic, immune-mediated encephalopathy. The histologic features of the teratomas associated with anti-NMDAR encephalitis have seldom been described in detail. Therefore, in this report, we have compared ovarian teratomas (4 mature and 1 immature) from 5 patients with anti-NMDAR encephalitis with 22 sporadic control teratomas (14 mature and 8 immature) that included neuroglial elements. The encephalitis-associated tumors ranged from 0.7 to 9.5 cm diameter, and 1 case was bilateral; the second teratoma was discovered 13 mo after the first when symptoms recurred. In comparison with control teratomas, the anti-NMDAR-associated tumors showed a more marked intratumoral lymphoid infiltrate that colocalized to the mature neuroglial elements. Reactive germinal centers (3 cases) and diffuse lymphoplasmacytic infiltrates within the neuroglial matrix (4 cases), and degenerative neuronal changes (2 cases), were seen only in the anti-NMDAR-positive cases. Pathologists encountering ovarian teratomas with these distinctive reactive lymphoid elements should consider the possibility of anti-NMDAR encephalitis, particularly because the neurological symptoms may develop after tumor resection. Careful histopathologic examination may be required to identify small, radiologically occult teratomas, and to demonstrate the presence of subtle neoplastic neuroglial components in teratomas associated with anti-NMDAR encephalitis. SN - 1538-7151 UR - https://www.unboundmedicine.com/medline/citation/22833082/Ovarian_teratoma_associated_with_anti_N_methyl_D_aspartate_receptor_encephalitis:_a_report_of_5_cases_documenting_prominent_intratumoral_lymphoid_infiltrates_ L2 - https://doi.org/10.1097/PGP.0b013e31824a1de2 DB - PRIME DP - Unbound Medicine ER -