Ovarian Mature Teratoma Presenting as a Rectal Mass; Report of a Case

Abstract

We present a rare case of ovarian mature teratoma ruptured into the rectum. The case was a 39 year-old woman who presented with a symptom of rectal bleeding. Colonoscopy revealed a diverticulum-like structure in the rectum. The structure measuring approximately 1.5cm in diameter, was filled with a lot of hairs. Inside of that was covered with skin-like component. Biopsy specimen from the lesion revealed squamous cell with no malignancy. After barium enema and the abdominal computed tomography examination, she was diagnosed as an ovarian teratoma ruptured into the rectum. Laparoscopy-assisted anterior resection of the rectum and right salpingo-oophorectomy were undergone. Macroscopically, a lot of hairs were found in the cystic mass in the right ovary. In the cut surface of the surgical specimen, cystic tumor measuring 3.5 cm in diameter, located adjacent both to the rectal wall and the right ovary. In addition, the tumor tightly adhered to the rectal wall and made the fistula with the rectal mucosal surface. Histopathologically, inside of the tumor was covered with squamous epithelium, contained adipose tissue, cutaneous appendage, and mature ointment. In this case, it was suggested that a mature teratoma arising from the right ovary perforated to the rectum. This type of complication for benign ovarian teratoma is thought to be unusual and the possible mechanisms of rectal perforation by this teratoma will be discussed herein.