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Ovarian teratomas in women with anti-N-methyl-D-aspartate receptor encephalitis: Topography and composition of immune cell and neuroglial populations is compatible with an autoimmune mechanism of disease

American Journal of Surgical Pathology Jun 17, 2019

Nolan A, et al. - An autoimmune syndrome in young women, named anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is often accompanied by an ovarian teratoma (NMDAR-E teratoma). Considering a prevailing theory indicating the triggering of the generation of autoantibodies to NMDAR on neurons in the central nervous system by neuroglial tissue in the associated teratoma, researchers examined if colocalized neuroglial tissue and lymphoid aggregates with germinal centers and alterations in the composition and morphology of neuroglial tissues could provide evidence of antibody generation in NMDAR-E teratomas. Twelve NMDAR-E teratomas (11 ovarian, 1 mediastinal) were compared with 61 control teratomas containing neuroglial tissue from women without NMDAR-E. As per outcomes, they recommend giving clinical consideration for NMDAR-E when colocalized neuroglial tissue and lymphoid aggregates with germinal centers are present along with a general paucity of neurons, even in asymptomatic women, as the symptoms may occasionally develop after an otherwise incidental oophorectomy. They recommend performing tissue sampling directed to the Rokitansky nodule, when present, to distinguish neuroglial tissues and considering complete microscopic examination of the ovarian specimen in absence of gross pathologic features of teratoma.
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