Ovarian teratoma

Clinical History

A 24 years old female with a free history evaluated for lower abdominal pain. On clinical examination of the abdomen there wasn’t any abdominal tenderness or pain. A pelvic mass was palpated.

Imaging Findings

A 24 years old female with a free history evaluated for lower abdominal pain. On clinical examination of the abdomen there wasn’t any abdominal tenderness or pain. The mass was painless, soft and easily moveable. Blood test results were normal. The patient underwent computed tomography examination. CT scan demonstrated α large predominantly fatty mass (Fig1a) with well defined and sharp margins and a round nodules within it. (Fig1b) A laparatomy were performed and reveal an ovarian mass. When bisected a Rokitansky nodules was depicted, which had yellowish appearance of adipose tissue and sebaceous components. The bulk of the cyst cavity was filled with hair. The patient spent 10 days in the ward and was discharged following instructions for the follow up.

Discussion

Teratomas are tumors compromising more that a single cell type derived from more that one germ cell. The word itself it derived from teraton, meaning monster. Ovarian teratomas include mature cystic teratoma (dermoid cyst), immature teratomas, and monoclonal teratomas (eg struma ovarii, carcinoid tumors, and neural tumours). Teratomas range from benign, well differentiated (mature) cystic lesions to those that are solid and malignant (immature). Most common type is the cystic teratoma (dermoid cyst), which usually affects a younger age group and is asymptomatic. The most common gonadal location, of teratomas, is the ovary, although they also occur less frequently in the testes. Cystic teratoma occasionally occurs in sequestered midline embryonic cell rests and can be mediastinal (7%), retroperitoneal (4%), cervical (3%) and intracranial (3%).The tumours are bilateral in about 10% of cases. Abdominal pain or other non-specific symptoms occur in a minority of cases. Mature cystic teratoma grows slowly and requires removal with simple cystectomy. Complications of the ovarian teratoma include torsion, rupture, infection, haemolytic anaemia and malignant degeneration. Ovarian cystic teratoma should be differentiated from other benign and malignant ovarian neoplasms, endometriomas, tuboovarian abscesses, pedunculated uterine cysts, fibroids, hydrosalpinxes, ectopic pregnancies, pelvic kidneys and peritoneal cysts. Elevated alpha fetoprotein and beta chorionic gonatotropin be indicative of malignancy. Dermoids have been described using all imaging modalities, but the specificity for diagnosis of fat and calcification makes the diagnosis. CT is a modality of choice, detects fat in 93% of cases, teeth or other calcifications in 56% and tufts of hair in 65%. A Rokitansky protruberance, or «dermoid nipple» was seen in 81%. A Fat fluid level was found in 12% of ovarian dermoids and is considered diagnostics. The treatment of mature teratoma is largely surgical.  

Differential Diagnosis List

Final Diagnosis

Ovarian teratoma

URL:	https://www.eurorad.org/case/5013
DOI:	10.1594/EURORAD/CASE.5013
ISSN:	1563-4086