A teething problem! Ovarian teratoma causing hip pain!

Clinical History

A 30-year-old female was referred to us by her general practitioner for an X-ray of her right hip in order to exclude the possibility of her having arthritis.

Imaging Findings

The patient was referred to us by her general practitioner for an X-ray of her right hip in order to exclude the possibility of her having arthritis, and she complained of having a gnawing pain! The X-ray film revealed the presence of a large right-sided teratoma of the ovary containing highly differentiated teeth.

Discussion

Teratomas are known to be ovarian neoplasms of a germ cell origin, and they are classified as mature (96%, also called dermoid cysts), immature, and monodermal teratomas. All teratomas are of the karyotype 46,XX and are derived from ectodermal differentiation of totipotential cells arising from an ovum after the first meiotic division. Teratomas are most commonly found during the reproductive years, with a peak incidence in the second and third decades. Similar to other ovarian neoplasms, teratomas are usually either asymptomatic or produce only vague gastrointestinal symptoms or pelvic pressure. Torsion can occur in up to 15% of the patients with dermoid cysts, because the high fat content of these masses allows them to float in the abdominal cavity. Once detected, the diagnosis of an ovarian teratoma rests primarily on radiologic findings of fat, calcium, or dental elements. Predictive factors of benign disease include age (ovarian teratomas in younger patients are more commonly benign), size (<15 cm usually benign), and CA 125 level (<35 U/mL usually benign). In 2% of the patients with a previously classified benign disease, malignant degeneration can occur, usually from squamous cell elements. The treatment for dermoid cysts is surgical excision, and prognosis is excellent.

Differential Diagnosis List

Final Diagnosis

Bilateral ovarian teratomas.

URL:	https://www.eurorad.org/case/2863
DOI:	10.1594/EURORAD/CASE.2863
ISSN:	1563-4086