Abstract
Mature cystic teratomas (dermoid cysts) are themost common germ cell tumours with 10-25% incidence of adult and 50% of paediatric ovarian tumours. Theaetiology of dermoid cysts is still unclear, although currently theparthenogenic theory is most widely accepted. Thetumour is slow-growing and in themajority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. Themain complication of adermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Prolonged pressure during pregnancy, torsion with infarction, or adirect trauma are themain risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. Thediagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. We present areport of aclinical case of a35-years-old female, who was referred to thehospital due to abdominal pain spreading to her feet for three successive days. She had ahistory of anormal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed amultiloculated cystic mass measuring 16×10cm in thepelvis. In theabsence of urgency, planned surgical treatment was recommended. Thenext day thepatient was referred to thehospital again, with acomplaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. Theultrasound scan differed from theprevious one. This time, thetransvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was alarge amount of free fluid in theabdominal cavity. Thepatient was operated on-left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of thethromboembolism were administered. Thepatient was discharged from thehospital on theseventh postoperative day and was sent for outpatient observation. Ultrasound is theimaging modality of choice for adermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once arupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of thespontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.
Highlights
Mature cystic teratomas or dermoid cysts are the most common germ cell tumours with the incidence of 10–25% and 50% of paediatric ovarian tumours [1]
1) Mature cystic teratomas or dermoid cysts are the most common germ cell tumours that comprise about 30% of all benign ovarian tumours and are the most commonly diagnosed in females of the reproductive age
8) Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of a spontaneously ruptured ovarian cyst with thorough peritoneal lavage is required
Summary
Mature cystic teratomas or dermoid cysts are the most common germ cell tumours with the incidence of 10–25% and 50% of paediatric ovarian tumours [1]. Cyst torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis [5]. Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10–25% incidence of adult and 50% of paediatric ovarian tumours. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1–2%), infection (1%), and rupture (0.3–2%). Torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology
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