SEM contribution to the morphoiogicai study of dental structures in ovarian cystic teratoma
p. Audiat, M. Decombas and J. C. Kaqueler D^parfement d'Anatomie Pathologique, Faculty de Chirurgie Dentaire, University Paris V, Paris, France
Audiat P, Decombas M, Kaqueler JC: SEM contribution to the morphological study of dental structures in ovarian cystic teratoma. J Oral Pathol Med 1990; 19: 435-8. This study in scanning eleetron microscopy (SEM) was earried out to observe the possible pathologic aspect of five teeth grossly arranged in nomial sequenee and of their surrounding tissues, found inside an ovarian cystic teratoma. Though the general rnorphology of the teeth was nearly normal, several anomalies affected the different mineralized dental tissues such as enamel hypoplasia, irregular growth of cetnenturn, altered predetitin layer, and irnmature osteofibrous bony outgrowths.
The ovarian cystic teratoma also-called dermoid cyst is a parthenogenetic tumor arising posttrteiotically frotn a single germ eell, after the first meiotic division. This generally benign tutnor is characterized by the coexistence of several tissues at different histogenie stages. Hair and teeth are the mature structures mainly encountered. Teratomas have been studied by different research methods: clinical and radiologic works have demonstrated their occurrence at all ages of life (I) and underlined the presence of mature dental organs inside the tumor as being a pathognomonic sign in radiologic diagnosis (2). Histologic and embryologic studies have been carried out on the differentiation and organization of teratomas (3, 4). It has also been suggested that the odontogenesis process inside the tumor could be used as an organogenetic study model (5, 6), Numerous genetic experiments have given partial informations about the origin of this parthenogenetic tumor seldom found in humans. The study of LiNDER el al. (7) has proven that the beginning of parthenogenesis takes place after the first meiotie division. The iieterozygosity or homozygosity of the tumor is dependent on the distance of one given gene loeus site from the eentromere (8) and this infonnation has allowed some authors to consider the teratomas as a genetic model (9),
A series of investigations have been carried out on dental structures, such as the observations of DAVID & GAtLLARD (10) and DE FERRARIS et al. (II) on the
embryogenesis of teeth in a few intratumoral dental germs. CLAISSE & HERITIER (12) and DICK & HONORE (13) estimated
radiologically and histologically the germs' number and studied their morphology. Only AWAZAWA'S study (14) was performed using SEM in 1971. This author examined replicas of abraded and etched surfaces of teeth from three teratomas. The purpose of this work was to observe in SEM the possible pathological aspect of teeth and of this surrounding tissues found inside an ovarian cystic teratotna. Material and methods Case history
A 42-year old woman having carried three full-term pregnancies cotnplained of permanent abdominal pain. Radiographic and echographic exatninations clearly showed the presence of a left ovarian cystic teratoma with recogtiizable teeth (Fig. 1). After surgical removal, the tumor appeared as a mass overlaid with a smooth and rather thin external wall. The opening of the tumor revealed the existence of a creamy-like liquid containing many hair and another fibrous bag containing the dental structures. The histologic results showed that the cystic
Key words: ovarian cystic teratoma; scanning electron microscopy; teeth. P. Audiat, Dfepartement d'Anatomie Pathologique, Faculty de Chirurgie Dentaire. University Paris V, 1, Rue Maurice Arnoux 92120 Montrouge, France. Accepted for publication July 23, 1990.
wall was lined by a highly keratinized rnalpighian epithelium associated with several well-differeneiated pilo-sebaceous appendants. Many fatty cell lobules were also observed. Besides the dental structures previously tnentioned, no other reeognizable tissues were found. The tumor in its whole was benign and the other ovary showed no signifieant abnormalities. The fibrous mass eontaining the teeth was macroscopically photographed and then radiographed using ultrasensitive Kodak type M Industrial Film (Fig. 2), Each tooth and its surrounding tissues was isolated by disseetion, and then photographed a seeond time. Speeimens were longitudinally fractured, one half kept unaltered and the other one treated by hypochlorite. All fractured parts were fixed in Karnovsky solution for 24 h, rinsed in cacodylate buffer, dehydrated in gradient alcohol baths, critical point-dried and gold coated for SEM observations. Results
Macroscopically, the bag containing the dental struetures was eomposed of various outgrowths overlaid by a yellowish highly resistant fibrous tissue. The radiographs confirmed the presenee of five well-formed teeth and a fragment of bone possessing three apophysis, one of them similar to a miniature eondyle. The crowns of the teeth were grossly
436
AuDiAT et al.
Fig. 1. Radiographic aspccl of lhc tcratoma in situ. Teeth, superimposed to sacral vertebrae, are clearly visible (arrow). Fig. 2. Radiograph of the five teeth and the bony fragment before dissection. Fig. 3. Simplified diagram of a human skull with the teratoma dental structures in their supposed situation. Ftg. 4. Two enamel defects partially filled with amorphous material and surrounded by hypomineralized prisms X 200. Fig. 5. Lateral view of the canine showing a longitudinal cementum rib (black arrow) running along its radicular axis and more or less marked incremental lines (white arrow), x 20. Fig. 6. Arch-shaped formation of osleoid tissue at the tooth bony blade junction x 200
opposed and this in an occlusion-like relationship, suggesting the preexistence of two unilateral dental blades. By superimposing the forementioned to a
simplified diagram of a human face profile, the bony fragment could be placed in a site posterior to the two dental groups. Therefore one could consider
the following teeth sequences: canine, premoiar and molar, on one side, and tnolar and molar gertn, on the other side (Fig. 3),
Detttal structures in ovarian cvstic teratotna 437
Fig. 7. Aspect of dcntin (D) and predcntin (PD). The prcdcntin front is irregular suggesting abnormal mineralization though Ihe odontoblast layer is unaltered (O). x 1000. Fig. S. Detail of the bony cortical facing the tooth 5 (germ). Several nutritious channels perforate the bone in various directions (arrow), x 70. Figs. 9 & 10. Two examples of the very active osteogenesis found in some regions of the bony fragment: Fig. 9. Pediculated nodule, x 200. Fig. 10. Elevated bony sheet forming a collar around a channel opening, x 300.
with a twist at its extremity and an undeveloped root apex. The cementoSpecitnen 1: cartine - The untreated half- enamel junction was well-defined and canine was entirely covered by an tinor- did not show any significant anomalies. ganized fibrous envelope, except for the Cementum was normally dappled all cuspid tip which appeared almost free over the root surface but showed e.xcesof organic material. At the borderline sively marked incrcrnental lines. Morebetween the enamel and the fibrous cov- over a protruding ridge was observable er, an epithelial sheet composed of a few along the longitudinal radicular axis cell layers joined by slightly stretched and ended up in the enamel body (Fig. desmosomes was visible. The under- 5). The root fortnation was incomplete neath perikymatia raised in successive increasing the reduced aspect of the waves this very thin epithelitmi. On the tooth lower part. emerging top of the canine several ovalSpecitnett 2: pretnolar - The root divishaped enamel defects were visibly dis- sion took place at half-length and the posed in a line. At a higher magnifica- two apices were bent in the same direction the walls of these defects presented tion. A thin bony blade stood perpena honeycomb pattern similar to enamel dictilar to the premolar cervical region hypoplasia and their bottom was par- and another bone formation filled the tially filled with apparently amorphous intcrradicular space. At low magnificamaterial (Fig. 4). tion the hypochlorite treated half-preThe hypochlorite treated half canine molar with the bony fragtnent showed possessed a slightly fiatlcned crown a bicuspid crown formed of two pearSEM observations of dental structures
shaped masses (Fig. 6). The enamel surface presented many defects quite similar to those already described in the precedent tooth. The bony blade had two different looking sides: the front surface was pierced by tnany holes giving a cribriform aspect while the back vvas smoother and denser in which a few channels probably giving way to vessels and nerves. At its junction with the root, osteoid and cetnentoid tissues were tnixed together as in the ankylosis process (Fig. 7). The other half was studied without any previous treatment of its fractured stirface. No atiomaly was visible in the dentin and the dentinal tubules ended at the dentin-enamel junction by branching in the same way as in nomial oral teeth. The prcdentin layer, however appeared irregular, either almost nonexistent or thickened including islands of mature dentin. The unaltered odon-
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AUDIAT et al.
toblasts were aligned and their processes were visible inside the lumen of the fractured tubules (Fig, 8), Specimen 3: lower molar - This molar had a significant decrease of its coronoradicular ratio. The hypotrophic crown presented sharp cusps and its blunt aspect was emphasized by a constricted cervical region and a bulbous root. The first signs of a root division were visible in its lower part. In spite of those macroscopic malformations, the ultrastructure of each halves was completely normal, Speeimen 4: maxillary molar - This molar was smaller than normal, but its proportions remained harmonious. The enamel layer was very thin on the whole crown, and sometimes completely absent at the tips of the cusps, and the adjacent dentin was then observable. Moreover, the enamel surface showed large areas of hypomineralized prisms within the typical honeycomb pattern, Speeitnen 5: molar germ - The crown formation was complete as was the mineralization of the crown, while the root was barely outlined. The only noticeable point was that the enamel was about three times thicker than that of the adjacent tooth 4, though this latter presented a more advanced degree of odontogenesis. The hypochlodte treatment allowed the visualization of calcospherites usually found in the globular predentin, Speeimen 6: bone - The large bony fragment located between the molar 3 and the germ 5 showed two types of surfaces at low magnification. The zone facing the dental structures was similar to a dense trabeculated cortical bone tissue perforated by nutritious channels of various sizes (Fig, 9), The posterior side was more heterogeneous with mixed regions of compact and cribriform bone. Next to the apophysis a high osteogenic activity was manifested by pediculated nodules at various stages of mineralization and by thin irregular
bony sheets like collars around the openings of the vascular and nerve channels (Figs, 10 and 11),
Discussion
References 1, PETERSON W F , PREVOST EC, EDMUNDS FT, HUNDLEY JM, MORRIS F K , Benign
cystic teratomas of the ovary, A clinicostatistical study of 1007 cases with a review of the literature. Ant J Obstet Gytteeot 1955; 70: 368-82, 2, ZAKIN D , Radiologic diagnosis of dermoid cysts of the ovary, Obst Gyneeot Surv 1976; 31: 165-84, 3, STEVENS LC, The biology of teratomas including evidence indicating their origin from primordial germ cells, Ann Bioi 1962; 1: 585-610,
The ovarian cystic teratoma described in this work contained several teeth grossly in an occlusion-like relationship and a bony fragment situated at the junction of the two outline dental 4, GAILLARD JA, Differenciation and orblades. This kind of observation has ganization in teratomas. In: Neoptasta recently been reported by DICK (13) and cetl dtfferetmation. Basel: Karger, 1974; 319-49, and quite often in the more ancient lit5, DAVID P H , GAILLARD JA, L'odontogcnerature, confirming the hypothesis of ese, modele organogenetique au sein des the favorising role of the tumor enviteratomcs, C R Aead Set (Paris) 1975; ronment in the morphodifferentiation 280: 2697-700, of teeth and on a general point of 6, DAVID P H , GAILLARD JA, L'odontogenview upon ectodermic formations. ese modele organogenetiqtie au sein des However, our SEM findings revealed teratomes, L'claboration coronaire, C R many anomalies affecting unequally AcadSci (Paris) 1977; 284: 1223-6, 7, LiNDER D, KAISER M A C CAW B , HECHT different dental tissues but always F, Parthenogenic origin of benign ovarishowing an immaturity. Thus, the an teratomas. A' Ettgt J Med 1975; 292: enamel hypoplasia could result from 63-6, the mineralization defects during the 9, PARKS S G , Origin of teratomas, N Ettgt crown elaboration or on the contrary J Med \915; 292: 1 0 3 ^ , from a dissolutive phenomenon due to 9, DE GROUCHY J, Human parthenogenethe cystic environment. The irregular sis: A fascinating single event, Biomedtettte 1980; 32: 51-3. incremental rings of the cementum 10, DAVID P H , GAILLARD JA, La formation and the altered predentin layer could des germes dans les teratomes, Ann Anat be the consequence of tumoral growth Pathol (Parts) 1978; 23: 287-308, disorders. These pathologic observa11, D E FERRARIS C , FONSECA M , GENDDLtions were nevertheless quite common MAN H, FERRARIS HE. Etude morphologand were not characteristic of a tuique des structures dentaires et peridenmoral system. The numerous outtaires incluses dans les teratomes ovagrowths found in the bony fragment riens, Acta Stotnatol Betg 1979- 76331-41, could be the only sign of a tumoral 12, CLAISSE D, HERITIER M , Etude des dents activity, especially by their complex et d'os "maxillaire" inclus dans des dyosteofibrous nature and their immasembryomes kystiques de l'ovaire. Rev ture aspect. Though our observations Odottto.'itomatot 1974; 115: 169-77. were made on only one case of terato13, DICK HM, HONORE L, Dental structures ma and should not be generalized, the in benign ovarian cystic teratomas (DerSEM gave such interesting spatial and moid cysts), Orat Surg Orat Med Orat morphologic information complemenPathol 1985; 60: 299-307, tary to the histologic findings that this 14, AWAZAWA Y, Electron microscopic aspects of teeth taken from the ovarian technic should be applied to any new dermoid cysts, J Nitton Untv Seh Denl case of dermoid cysts to come. 1971; 13: 13-6,
p. Audiat, M. Decombas and J. C. Kaqueler D^parfement d'Anatomie Pathologique, Faculty de Chirurgie Dentaire, University Paris V, Paris, France
Audiat P, Decombas M, Kaqueler JC: SEM contribution to the morphological study of dental structures in ovarian cystic teratoma. J Oral Pathol Med 1990; 19: 435-8. This study in scanning eleetron microscopy (SEM) was earried out to observe the possible pathologic aspect of five teeth grossly arranged in nomial sequenee and of their surrounding tissues, found inside an ovarian cystic teratoma. Though the general rnorphology of the teeth was nearly normal, several anomalies affected the different mineralized dental tissues such as enamel hypoplasia, irregular growth of cetnenturn, altered predetitin layer, and irnmature osteofibrous bony outgrowths.
The ovarian cystic teratoma also-called dermoid cyst is a parthenogenetic tumor arising posttrteiotically frotn a single germ eell, after the first meiotic division. This generally benign tutnor is characterized by the coexistence of several tissues at different histogenie stages. Hair and teeth are the mature structures mainly encountered. Teratomas have been studied by different research methods: clinical and radiologic works have demonstrated their occurrence at all ages of life (I) and underlined the presence of mature dental organs inside the tumor as being a pathognomonic sign in radiologic diagnosis (2). Histologic and embryologic studies have been carried out on the differentiation and organization of teratomas (3, 4). It has also been suggested that the odontogenesis process inside the tumor could be used as an organogenetic study model (5, 6), Numerous genetic experiments have given partial informations about the origin of this parthenogenetic tumor seldom found in humans. The study of LiNDER el al. (7) has proven that the beginning of parthenogenesis takes place after the first meiotie division. The iieterozygosity or homozygosity of the tumor is dependent on the distance of one given gene loeus site from the eentromere (8) and this infonnation has allowed some authors to consider the teratomas as a genetic model (9),
A series of investigations have been carried out on dental structures, such as the observations of DAVID & GAtLLARD (10) and DE FERRARIS et al. (II) on the
embryogenesis of teeth in a few intratumoral dental germs. CLAISSE & HERITIER (12) and DICK & HONORE (13) estimated
radiologically and histologically the germs' number and studied their morphology. Only AWAZAWA'S study (14) was performed using SEM in 1971. This author examined replicas of abraded and etched surfaces of teeth from three teratomas. The purpose of this work was to observe in SEM the possible pathological aspect of teeth and of this surrounding tissues found inside an ovarian cystic teratotna. Material and methods Case history
A 42-year old woman having carried three full-term pregnancies cotnplained of permanent abdominal pain. Radiographic and echographic exatninations clearly showed the presence of a left ovarian cystic teratoma with recogtiizable teeth (Fig. 1). After surgical removal, the tumor appeared as a mass overlaid with a smooth and rather thin external wall. The opening of the tumor revealed the existence of a creamy-like liquid containing many hair and another fibrous bag containing the dental structures. The histologic results showed that the cystic
Key words: ovarian cystic teratoma; scanning electron microscopy; teeth. P. Audiat, Dfepartement d'Anatomie Pathologique, Faculty de Chirurgie Dentaire. University Paris V, 1, Rue Maurice Arnoux 92120 Montrouge, France. Accepted for publication July 23, 1990.
wall was lined by a highly keratinized rnalpighian epithelium associated with several well-differeneiated pilo-sebaceous appendants. Many fatty cell lobules were also observed. Besides the dental structures previously tnentioned, no other reeognizable tissues were found. The tumor in its whole was benign and the other ovary showed no signifieant abnormalities. The fibrous mass eontaining the teeth was macroscopically photographed and then radiographed using ultrasensitive Kodak type M Industrial Film (Fig. 2), Each tooth and its surrounding tissues was isolated by disseetion, and then photographed a seeond time. Speeimens were longitudinally fractured, one half kept unaltered and the other one treated by hypochlorite. All fractured parts were fixed in Karnovsky solution for 24 h, rinsed in cacodylate buffer, dehydrated in gradient alcohol baths, critical point-dried and gold coated for SEM observations. Results
Macroscopically, the bag containing the dental struetures was eomposed of various outgrowths overlaid by a yellowish highly resistant fibrous tissue. The radiographs confirmed the presenee of five well-formed teeth and a fragment of bone possessing three apophysis, one of them similar to a miniature eondyle. The crowns of the teeth were grossly
436
AuDiAT et al.
Fig. 1. Radiographic aspccl of lhc tcratoma in situ. Teeth, superimposed to sacral vertebrae, are clearly visible (arrow). Fig. 2. Radiograph of the five teeth and the bony fragment before dissection. Fig. 3. Simplified diagram of a human skull with the teratoma dental structures in their supposed situation. Ftg. 4. Two enamel defects partially filled with amorphous material and surrounded by hypomineralized prisms X 200. Fig. 5. Lateral view of the canine showing a longitudinal cementum rib (black arrow) running along its radicular axis and more or less marked incremental lines (white arrow), x 20. Fig. 6. Arch-shaped formation of osleoid tissue at the tooth bony blade junction x 200
opposed and this in an occlusion-like relationship, suggesting the preexistence of two unilateral dental blades. By superimposing the forementioned to a
simplified diagram of a human face profile, the bony fragment could be placed in a site posterior to the two dental groups. Therefore one could consider
the following teeth sequences: canine, premoiar and molar, on one side, and tnolar and molar gertn, on the other side (Fig. 3),
Detttal structures in ovarian cvstic teratotna 437
Fig. 7. Aspect of dcntin (D) and predcntin (PD). The prcdcntin front is irregular suggesting abnormal mineralization though Ihe odontoblast layer is unaltered (O). x 1000. Fig. S. Detail of the bony cortical facing the tooth 5 (germ). Several nutritious channels perforate the bone in various directions (arrow), x 70. Figs. 9 & 10. Two examples of the very active osteogenesis found in some regions of the bony fragment: Fig. 9. Pediculated nodule, x 200. Fig. 10. Elevated bony sheet forming a collar around a channel opening, x 300.
with a twist at its extremity and an undeveloped root apex. The cementoSpecitnen 1: cartine - The untreated half- enamel junction was well-defined and canine was entirely covered by an tinor- did not show any significant anomalies. ganized fibrous envelope, except for the Cementum was normally dappled all cuspid tip which appeared almost free over the root surface but showed e.xcesof organic material. At the borderline sively marked incrcrnental lines. Morebetween the enamel and the fibrous cov- over a protruding ridge was observable er, an epithelial sheet composed of a few along the longitudinal radicular axis cell layers joined by slightly stretched and ended up in the enamel body (Fig. desmosomes was visible. The under- 5). The root fortnation was incomplete neath perikymatia raised in successive increasing the reduced aspect of the waves this very thin epithelitmi. On the tooth lower part. emerging top of the canine several ovalSpecitnett 2: pretnolar - The root divishaped enamel defects were visibly dis- sion took place at half-length and the posed in a line. At a higher magnifica- two apices were bent in the same direction the walls of these defects presented tion. A thin bony blade stood perpena honeycomb pattern similar to enamel dictilar to the premolar cervical region hypoplasia and their bottom was par- and another bone formation filled the tially filled with apparently amorphous intcrradicular space. At low magnificamaterial (Fig. 4). tion the hypochlorite treated half-preThe hypochlorite treated half canine molar with the bony fragtnent showed possessed a slightly fiatlcned crown a bicuspid crown formed of two pearSEM observations of dental structures
shaped masses (Fig. 6). The enamel surface presented many defects quite similar to those already described in the precedent tooth. The bony blade had two different looking sides: the front surface was pierced by tnany holes giving a cribriform aspect while the back vvas smoother and denser in which a few channels probably giving way to vessels and nerves. At its junction with the root, osteoid and cetnentoid tissues were tnixed together as in the ankylosis process (Fig. 7). The other half was studied without any previous treatment of its fractured stirface. No atiomaly was visible in the dentin and the dentinal tubules ended at the dentin-enamel junction by branching in the same way as in nomial oral teeth. The prcdentin layer, however appeared irregular, either almost nonexistent or thickened including islands of mature dentin. The unaltered odon-
438
AUDIAT et al.
toblasts were aligned and their processes were visible inside the lumen of the fractured tubules (Fig, 8), Specimen 3: lower molar - This molar had a significant decrease of its coronoradicular ratio. The hypotrophic crown presented sharp cusps and its blunt aspect was emphasized by a constricted cervical region and a bulbous root. The first signs of a root division were visible in its lower part. In spite of those macroscopic malformations, the ultrastructure of each halves was completely normal, Speeimen 4: maxillary molar - This molar was smaller than normal, but its proportions remained harmonious. The enamel layer was very thin on the whole crown, and sometimes completely absent at the tips of the cusps, and the adjacent dentin was then observable. Moreover, the enamel surface showed large areas of hypomineralized prisms within the typical honeycomb pattern, Speeitnen 5: molar germ - The crown formation was complete as was the mineralization of the crown, while the root was barely outlined. The only noticeable point was that the enamel was about three times thicker than that of the adjacent tooth 4, though this latter presented a more advanced degree of odontogenesis. The hypochlodte treatment allowed the visualization of calcospherites usually found in the globular predentin, Speeimen 6: bone - The large bony fragment located between the molar 3 and the germ 5 showed two types of surfaces at low magnification. The zone facing the dental structures was similar to a dense trabeculated cortical bone tissue perforated by nutritious channels of various sizes (Fig, 9), The posterior side was more heterogeneous with mixed regions of compact and cribriform bone. Next to the apophysis a high osteogenic activity was manifested by pediculated nodules at various stages of mineralization and by thin irregular
bony sheets like collars around the openings of the vascular and nerve channels (Figs, 10 and 11),
Discussion
References 1, PETERSON W F , PREVOST EC, EDMUNDS FT, HUNDLEY JM, MORRIS F K , Benign
cystic teratomas of the ovary, A clinicostatistical study of 1007 cases with a review of the literature. Ant J Obstet Gytteeot 1955; 70: 368-82, 2, ZAKIN D , Radiologic diagnosis of dermoid cysts of the ovary, Obst Gyneeot Surv 1976; 31: 165-84, 3, STEVENS LC, The biology of teratomas including evidence indicating their origin from primordial germ cells, Ann Bioi 1962; 1: 585-610,
The ovarian cystic teratoma described in this work contained several teeth grossly in an occlusion-like relationship and a bony fragment situated at the junction of the two outline dental 4, GAILLARD JA, Differenciation and orblades. This kind of observation has ganization in teratomas. In: Neoptasta recently been reported by DICK (13) and cetl dtfferetmation. Basel: Karger, 1974; 319-49, and quite often in the more ancient lit5, DAVID P H , GAILLARD JA, L'odontogcnerature, confirming the hypothesis of ese, modele organogenetique au sein des the favorising role of the tumor enviteratomcs, C R Aead Set (Paris) 1975; ronment in the morphodifferentiation 280: 2697-700, of teeth and on a general point of 6, DAVID P H , GAILLARD JA, L'odontogenview upon ectodermic formations. ese modele organogenetiqtie au sein des However, our SEM findings revealed teratomes, L'claboration coronaire, C R many anomalies affecting unequally AcadSci (Paris) 1977; 284: 1223-6, 7, LiNDER D, KAISER M A C CAW B , HECHT different dental tissues but always F, Parthenogenic origin of benign ovarishowing an immaturity. Thus, the an teratomas. A' Ettgt J Med 1975; 292: enamel hypoplasia could result from 63-6, the mineralization defects during the 9, PARKS S G , Origin of teratomas, N Ettgt crown elaboration or on the contrary J Med \915; 292: 1 0 3 ^ , from a dissolutive phenomenon due to 9, DE GROUCHY J, Human parthenogenethe cystic environment. The irregular sis: A fascinating single event, Biomedtettte 1980; 32: 51-3. incremental rings of the cementum 10, DAVID P H , GAILLARD JA, La formation and the altered predentin layer could des germes dans les teratomes, Ann Anat be the consequence of tumoral growth Pathol (Parts) 1978; 23: 287-308, disorders. These pathologic observa11, D E FERRARIS C , FONSECA M , GENDDLtions were nevertheless quite common MAN H, FERRARIS HE. Etude morphologand were not characteristic of a tuique des structures dentaires et peridenmoral system. The numerous outtaires incluses dans les teratomes ovagrowths found in the bony fragment riens, Acta Stotnatol Betg 1979- 76331-41, could be the only sign of a tumoral 12, CLAISSE D, HERITIER M , Etude des dents activity, especially by their complex et d'os "maxillaire" inclus dans des dyosteofibrous nature and their immasembryomes kystiques de l'ovaire. Rev ture aspect. Though our observations Odottto.'itomatot 1974; 115: 169-77. were made on only one case of terato13, DICK HM, HONORE L, Dental structures ma and should not be generalized, the in benign ovarian cystic teratomas (DerSEM gave such interesting spatial and moid cysts), Orat Surg Orat Med Orat morphologic information complemenPathol 1985; 60: 299-307, tary to the histologic findings that this 14, AWAZAWA Y, Electron microscopic aspects of teeth taken from the ovarian technic should be applied to any new dermoid cysts, J Nitton Untv Seh Denl case of dermoid cysts to come. 1971; 13: 13-6,
