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Breast Cancer/secondary tumors, most likely teratoma, nonmalignant:surgery


QUESTION: Dear Doctor, we are from Iceland. My daughter had a total hysterooophotoectomy in 2001 because of teratocarcinoma III and since then she has used contracecptive hormone pills (marvelon presently) for hormone replacement therapy. After the last operation in 2002, she has tumors in the liver, abdomen, and pelvis which were probably invisible during the last operation and were not removed. The tumors slowly grow up with the biggest being in the liver (5,5 cm on MRI 2014). I am worried if the hormone pills must be stopped but she said if she stop using them, she has hot waves, hair loss, etc and she doesn't want to get older without these pills. We asked if she can have these tumors removed but the oncologists in Iceland refused to perform the operation. What is to be done in order to prevent the tumors growth and the rick of malignisation?

ANSWER: If her tumor was a carcinoma her case is rather remarkable by her long time survival. Was it not a non malignant teratoma? If so I do understand that she wants hormone replacement therapy. To be able to give you more and better information I do need to see her pathologist's diagnosis of the surgical material from her operation. Otherwise I can not be sure of what we are dealing with! If you want and can it is also possible to write to me in Danish. Since I am Swedish I have no problems with Norwegian or Danish!

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---------- FOLLOW-UP ----------

QUESTION: Claes-Gustaf Nordquist, M.D.
Thank you so much for looking into my daughter's case and for your kind offer to look at the histology reports.
I think it is impossible that the teratoma was non-malignant, but perhaps a teratocarcinoma was a working diagnosis. I added the details to clarify the matter.
The large teratoma of the left ovary was surgically removed (altogether with the left ovary) in 2000. Histology report showed some changes, which were ignored in the Russian hospital. In 2 months, my daughter had ascities, and was hospitalized into the oncology department in the city's hospital. The fluid from her abdomen was taken to the laboratory and cancer was confirmed. After that she was operated: abdominal second ovary, and hysterectomy, and many grape-sized metastases from the pelvis and the omentum major. She had a stoma, from which the ascitic fluid continue to run out, and the doctors tried to use intravenous and intraabdominal chemotherapy, but the situation didn't improve and they signed her out to die.
We went to Iceland with the stoma and the pieces of the tissues after this second operation in Russia, which were analyzed in Iceland. Then she received massive 4 courses of intravenous chemotherapy, and when the tumors' growth stopped, she was operated. There were the very large metastases removed, one of them 6 kg around the liver.
After that, the Icelandic doctors prescribed her the contraceptives for the hormonal replacement therapy(first Jasmine, and now Marvelon). When I asked if it is correct to use the pills that are actually contraceptives, the doctors say she can choose these pills or not, but without ovaries she will have complications of an old lady. And they never recommended anything else but contraceptives.
Below are the 3 histology reports of the teratoma tissues brought from Russia and after the 2 operations that Olga had in Iceland.
I can send you the originals in Icelandic, but unfortunately I don't know either Danish or Swedish.
Actually, I have 2 questions for you:
1) shall the tumors be removed and where if in Sweden.
2) shall she continue with the contraceptive pills or she shall be consulted by the specialist in onco-endocrinology, and where if in Sweden?
My daughter can move to Sweden and be operated there, she has the disability benefits and Iceland will pay for her operation. Please, be so kind to give us a hint: in which Swedish hospital it is possible to remove the tumors before they turned malignant again, and also because they continue growing and she has pain in the liver area and in right back side. Most complications for this operation are expected because of the 6 cm large tumor in the liver.
Thank you in advance.

         Hystology reports
Report N1
03.07.2001 (after the operation in Russia)
Microscopic examination shows: In the material, it is mostly tumor tissue, teratoma of mixed mature and immature origin. At one place, there is normal ovarial tissue with a part of tubu and proximal parametrial tissue adjacent to tumor growth. In some places, there is only tumor tissue with mature component, cysts that either with squamous or mucinous epithelium. However, there are also extensive immature areas with similar tissue, although neuroectodermal tissue with tubes and primitivum neuroepithelial tissue around. In one place, there is bone tissue. At a single point there is a little area with dysgerminoma, but the area is too crushed to be precise. Also the glia elements present. There are no embryonal carcinoma, sack tumor, or choriocarcinoma found. There are two pieces from the lymph nodes without tumor growth. Omental tissue is not present. So, there is a teratoma of mixed mature and immature origin with more immature than mature component. It is difficult to define the tumor growth by comparing the material from the first to those of the second surgery, it might be a tumor grade 2 and might be tumor grade 3.

Report N2
18.10.2001 (after the 1st operation in Iceland)
The samples of 11 tumors that were removed from the abdomenal wall, from the right and left size of abdomen, from the guts, pelvis, diaphragm, near spleen, near rectum, near sigmoideum, aorta bifc, and from retroperitoneum analysed.
Microscopic examination shows:  In all samples there are the teramatous tumors, the most part of which is of mature teratoma origin. Most of the tumors have the small cysts with the walls build up of different epithelium, including skin, endo cervical epithelium and bronchial epithelium. In the stromal part of the tumors, there are connective tissue, fat tissue, cartilage, bone, and nerve tissue. In one sample, there are groups of degenerate cells which seem to be the remains of immature teratoma, but the alive malignant cells are not found.

Report N3
14.03.2002 (after the 2nd operation in Iceland)
The samples of 4 tumors that were removed from pelvis and abdominal peritoneum. Also apendectomy was performed.
Microscopic examination shows: all four tumors are of mature teratoma origin. Various different epithelial elements appear, including a stratified squamous, etc. epithelium, both of endo cervical and small intestine origin. Skin or its elements are not found. There is nerve tissue and also cartilage islands. Immature or malignant elements are not found. Appendix is with no pathological changes.

ANSWER: Thanks for your clarification! OK this is a malignant tumour BUT rather mature in its tissues so not very malignant. That is probably - together with her treatment - the reason for her long time survival in this situation. Yes without the hormonal medicine - even if it is a pill for avoiding pregnancies, but the hormones are the correct ones - she would run into the lack of hormones problems of an old woman like osteoporosis etc. so I have NO problems with that medication. However in view of her present situation I do understand your need of a second opinion. But it is not quite easy to arrange! You are on Iceland a small country with only around 320000 inhabitants. The number of experts there in this field is quite limited. While being a Nordic country, like Sweden, Denmark, Norway and Finland and a member of NATO, Iceland is not a member of EU. Had it been it would be rather easy to arrange a check up and even treatment in another EU country like Sweden. But in this situation it is not and also very expensive. If you still are Russian citizens and not Icelandic ones it may even be more difficult. There may be special agreements between Iceland and Norway (both are not EU members) or even with Denmark in spite of the fact that Denmark is a EU member, this for historical reasons since they have been in union up to 1944. But I do not know. This you have to find out by calling their embassies. If a department of gynecological oncology is prepared to help is therefore not just a medical question but also a political, social and economic one. Call these embassies and discuss the problem with her Icelandic doctors. I am sure they know of the concept of second opinion. Good luck!

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---------- FOLLOW-UP ----------

QUESTION: Thank you, doctor, but I would still like to ask you:
1)where in Sweden and Denmark these tumors can be removed with the best choice of survival after the operation?
2)where in Sweden and Denmark she can be consulted by the specialist in onco-endocrinology on hormone replacement after the operation because of malignant teratoma?
3)maybe, you know the specialists in the field of benign liver tumors surgery or specialists in teratoma working in Sweden and Denmark?
Thanks a lot for your help.

Thanks! Well she could be checked, evaluated & treated in any big university hospital in Sweden, Denmark, Norway and Finland provided ithat she is accepted for it as I described previously. In Denmark for example at the Rigshospitalet in Copenhagen, in Sweden for example at the Karolinska University Hospital in Stockholm, department of gynecological oncology (part of the department of oncology in the Radiumhemmet - = the Home of Radium).. You will need to get the help of her Icelandic doctors to refer her there. And you will need the assistance of the embassy to arrange this. and it will probably be expensive! When she is here the gynecological oncologists can also arrange the consultations with a gynecological endocrinologist. I am now 71 years old and I have been retired for quite a while. Most of those I have known there are now retired too - or dead. So it is hard to recommend anyone or arrange things from my side. So I have to tell you to use the official channels. The gynecological oncologists will also get any needed help from gynecological surgeons. Good luck!

You can also reach me at:
There is no limit to the number of questions there. Please note: NEW SITE!

Donations are also always welcome! No amount is too small, no amount is too big!
The language problem I have had with the payment site has been solved.  

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Claes-Gustaf Nordquist, M.D.


I`m a doctor of medicine and a specialist in radiation therapy and medical oncology. I have long experience in diagnostics and treatment of breast tumours.


I'm a Doctor of Medicine and specialist in Medical Oncology and Radiation Therapy educated & trained in Sweden. Now retired. Background in Radiation Therapy, Medical Oncology, Radiation Protection, Nuclear Medicine, Diagnostic Radiology, Gynecological Oncology, Clinical Pathology, Clinical Cytology,Hematology and Internal Medicine. M.D. from the faculty of medicine, Royal Karolinska Institute, Stockholm, Sweden. Have also been an exchange student at the Hebrew University, Hadassah Medical School, Jerusalem Israel. Former medical consultant, Swedish National Board of Radiation Protection. Former Police Surgeon and Medical Examiner, Stockholm Police Department. Former Chief Medical Officer, The Royal Guards, The Royal Horse Guards and the Royal Household Brigade, Royal Swedish Army Medical Corps.You can also reach me on: I have no restrictions on the number of questions there.

I also answer questions about Oncology (General Cancer), General History, Military History, Brain Tumors, Colon Cancer

I'm a medical doctor and specialist in medical oncology and radiation therapy.

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