110 The ultrasound and MRI findings in a young girl with an ovarian mass

Abstract

Objective: We report a case of a 12-year-old girl with foci of immature teratoma G2 who was treated with the ovary-sparing surgery. Study design: A 12-year-old premenarchal girl complained about mild lower abdominal pain of one-month duration three years after she underwent laparoscopy because of the dermoid cyst in the left ovary (with a volume of 350 ml). On ultrasound a large right ovarian tumor 165 ml in volume was seen, containing fatty and fluid contents, and multiple septations up to 3 mm. The normal ovarian tissue or ovarian crescent sign was present and reported. Pelvis MRI scan confirmed ultrasonography findings, but exclusively emphasized the absence of normal ovarian tissue of the right ovary. Laparoscopic right ovarian cystectomy and reconstruction without suturing was performed. The final pathological diagnosis was mature teratoma with foci of immature teratoma of the right ovary, grade 2. Results: The treatment of immature teratomas has gone through an evolution from aggressive treatment with surgery followed by multidrug chemotherapy to conservative surgical approaches with no adjuvant therapy. To preserve fertility as much as possible, ovarian cystectomy is undoubtedly better than excising the whole ovary as this practice would minimize loss of normal cortex tissue. Preservation of ovarian tissue depends on the presence of the normal ovarian tissue with follicles and can be visualized using ultrasonography or MRI. A positive ultrasonographic ovarian crescent sign should be taken into account when deciding the surgical approach, whether the ovary-sparing cystectomy should be attempted. There is little to no data on ovarian crescent sign seen and reported on MRI examinations of the ovary. Conclusion: A movement toward standardized imaging, specific criteria for the diagnosis and optimal therapeutic approach should be done to benefit children and adolescents' recovery and future fertility.