Meeting Abstract: Ovarian Teratoma masquerading as Idiopathic
Juvenile Arthritis in a 5 year old girl. Presented at the American
Society of Pediatric Hematology/Oncology (ASPHO) Annual Meeting. Fort
Worth, TX. May 10 - 13, 2023. Poster# 225. 2023 ASPHO Conference
Paper and Poster Index. Pediatric Blood Cancer, 70: e30390.
S101 https://doi.org/10.1002/pbc.30390
Juvenile idiopathic arthritis (JIA) is an auto-inflammatory disorder
that is the most common type of arthritis in children under the age of
16. Thirty percent of patients with JIA have seronegative polyarticular
disease. In adults, there are few reports of seronegative polyarthritis
associated with ovarian teratomas and sacrococcygeal teratomas; however,
to date, there are none reported in the pediatric
population.2,3,4
A 4-year-old Caucasian female presented with 6 month-history of upper
and lower extremity joint pain and swelling associated with myalgias.
Family history of psoriatic arthritis, rheumatoid arthritis, and lupus
was reported. On examination, she had hypermobility in multiple joints
associated with swelling particularly in bilateral knees, right wrist,
and left elbow. Complete blood counts, comprehensive chemistry, lactate
dehydrogenase, and uric acid were normal. Initial erythrocyte
sedimentation rate was elevated at 15 mm/h. Antinuclear antibody and
human leukocyte antigen B27 markers were negative. The patient was
diagnosed with oligoarticular JIA and started on scheduled non-steroidal
anti-inflammatory drug (NSAID) therapy. Due to persistent bilateral knee
pain for 8 months despite NSAIDs, magnetic resonance imaging (MRI) of
bilateral knees was ordered to look for radiological inflammation or
erosive joint disease prior to starting disease modifying anti-rheumatic
drugs. As part of routine MRI screening, the mother reported that the
child may have swallowed a metallic object, prompting a chest X-ray,
which showed a lobular mass with unusual calcifications in the
epigastric area. Further investigation prompted computed tomography (CT)
and MRI of the abdomen, which showed an epigastric well-circumcised mass
(8.8 x 8.3 x 5.5 cm) with soft tissue, fat, and calcified components
including numerous tooth-like structures most consistent with teratoma.
The MRI of bilateral knees was negative for active inflammation. Tumor
markers alpha-fetoprotein and total beta-human chorionic gonadotropin
were negative. Tumor resection and histopathology confirmed benign
mature retroperitoneal teratoma without immature or malignant
components. After tumor removal, the patient’s joint pain resolved.
The spontaneous resolution of an inflammatory seronegative arthritis
after the excision of the tumoral mass suggests a cause-and-effect
relationship between paraneoplastic manifestations and a benign
teratoma. It is unclear if the early manifestations of JIA resulted from
a genetic predisposition to autoimmune disorders as suggested by the
family history.
Teratomas are often found incidentally and most are asymptomatic. There
is no known association of JIA with benign teratoma; however, there are
abdominal tumors associated with other autoimmune conditions such as
juvenile dermatomyositis.1 This case highlights the
importance of thorough clinical evaluation in patients with seronegative
arthritis and consideration for teratoma.
Figure 1 Figure 2