抗N-methyl-D-asparate（NMDA）受容体抗体脳炎を合併する卵巣奇形腫に対する腹腔鏡下手術－術中迅速病理診断の意義について－

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Objective: Anti-N-methyl-D-asparate (NMDA)-receptor encephalitis associated with ovarian teratoma was first reported in 2007. Here we report two cases of anti-NMDA-receptor encephalitis associated with immature ovarian teratomas, which were diagnosed and successfully treated with laparoscopy. Design: Case report. Setting: Academic medical center. Patients: Two women, aged 31 and 22 years old, were admitted to our hospital with acute encephalitis. Results: Clinical course was unusual to encephalitis, so we performed abdominal CT to evaluate other differential diagnosis. Diagnostic imaging revealed ovarian teratoma in both patients. For the first case, we selected laparoscopic bilateral ovarian cystectomy as primary surgery. Following pathological diagnosis indicating immature teratoma in the left ovary, we performed laparoscopic left salpingo-oophorectomy. For the second case, rapid intraoperative diagnosis revealed immature teratoma, for which we performed laparoscopic right salpingo-oophorectomy. In both cases, neurological symptoms completely resolved after surgery. Conclusion: Early diagnosis and surgical treatment are important for quick recovery of anti-NMDA-receptor encephalitis associated with ovarian teratoma. Because of the high prevalence of immature teratoma in such cases, laparoscopic surgery with intraoperative rapid diagnosis is recommended.