Benign Germ Cell Tumors Research Articles

A case report of intrapulmonary mature teratoma with aspergilloma

Introduction: Teratomas are benign germ cell tumors composed of components from the ectoderm, mesoderm, and endoderm. While germ cell tumors account for 10-20% of anterior mediastinal masses, intrapulmonary teratomas (IPTs) are extremely rare. They typically occur in the third decade of life and may present as metastasis from gonadal tumors. This study reports a rare case of a mature IPT in the right middle lobe of the lung, initially misdiagnosed as pulmonary tuberculosis and aspergilloma. Case Presentation: A 17-year-old female presented with a 4-year history of cough with sputum and two episodes of hemoptysis. Despite negative tuberculosis tests, she was treated with anti-tubercular drugs and multiple antibiotics. Imaging revealed a 5.5-cm cavitary mass in the right middle lobe containing an aspergilloma. Surgical resection was performed, and the pathology confirmed a mature teratoma with aspergilloma colonization. The patient recovered well postoperatively and showed no signs of recurrence. Discussion: Teratomas are germ cell tumors rarely found in the lungs, with fewer than 100 cases reported globally. Diagnosis is challenging due to overlapping symptoms with other conditions such as tuberculosis. In this case, the presence of an aspergilloma further complicated the diagnosis. Complete surgical resection led to the patient's recovery. Conclusion: Mature IPTs with aspergilloma are extremely rare, and should be considered in the differential diagnosis of cavitary lung lesions. Early diagnosis and surgical resection are crucial for successful treatment.

A curious case of benign ovarian teratoma with multiple malignant tranformations: A histopathologists quagmire

Mature cystic teratomas of ovary are common benign germ cell tumors that constitute about 20% of all the ovarian tumors. These tumors however have a rare potential for malignant transformation 0.17-2% and therefore there is a requirement for intraoperative diagnosis to establish an appropriate line of treatment. Incidence of mature cystic teratoma undergoing multiple types of malignant transformation in the same patient is extremely rare and only a small number of such cases have been published in literature. Histopathology and immunohistochemistry are the gold standard for diagnosis and remains the mainstay for defining the treatment course and prognosis.

An unusual location of newborn huge dermoid cyst: a case report and literature review

BackgroundDermoid cysts are benign germ cell tumors with ectodermal and mesodermal components. It is a slow-growing lesion that commonly arises in the midline of the head and neck. The last location represented 7%, and the periorbital region was the most frequently arising area. True lateral neck dermoid cysts are rare. We present an unusual location of a dermoid cyst in a newborn.Case presentationWe report an unusual location of a 10-day newborn giant dermoid cyst with multiple implantation sites, namely the shoulder, scapula, cervical, temporal, and occipital scalp. Successful surgical resection was achieved, and the patient was discharged after the removal of the stitches.ConclusionDermoid cysts are unusual neoplasms with rare diagnoses at birth, but often in childhood. Concomitant implantation locations on the shoulder, neck, temporal, and occipital scalps are rare.

Transumbilical Single-Port Laparoscopic Cystectomy of Giant Ovarian Teratoma

Mature ovarian teratomas are benign germ cell tumors of the ovary, accounting for about 10 % -20 % of ovarian tumors and 95 % of ovarian teratomas. Mature ovarian teratomas are common in young women. They are usually unilateral, slow growing, cystic, mobile, smooth, with little or no ascites. Ovarian cystectomy for benign neoplasms instead of oophorectomy is mandatory for ovarian function preservation. We report a case of a large pelvic teratoma in a 19-year-old adolescent female, approximately 20.7cm×10.5cm in size. The patient's main clinical presentation was mild lower abdominal pain, After transumbilical single-port laparoscopic ovarian cystectomy, the final histopathological report was bilateral ovarian mature teratoma. This case report suggests that transumbilical single-port laparoscopic-assisted in vitro giant ovarian tumor ablation is a safe and feasible surgical approach for patients with benign large adrenal tumors. it effectively combines the advantages of open surgery and laparoscopic resection of large ovarian tumors, which not only protects ovarian function, but also avoids cyst fluid overflow and has significant postoperative cosmetic effects. Nevertheless, this study also had some limitations. First, this was a case report and not a multi-center randomized controlled trial. Second, it included a single patient and the short follow-up data precluded us from deriving any conclusions about the long-term efficacy and safety of this method.

Surgical Treatment of the Cranial Basis Teratoma in a Newborn and Palatal Reconstruction With Tongue Flap a 17-Years Follow-Up: A Case Report

Epignathus or Tessier fissure 0-14 is a rare teratoma composed of the three embryonic germ layers. Clinically, it appears as a mass covered with skin and mucosa, originating from pluripotential stem cells. According to the latest classification by the World Health Organization teratoma represents the main benign Germ cell tumors of the sinus region and presents similar histological aspects with its counterparts in the gonads and other extragonadal sites. The purpose of this study is to present a case of epignathus originating from the base of the skull in a Caucasian female patient with a cleft palate after the incisive foramen, not affecting the nasal floor. During physical examination, via intraoral route, in the region below the base of the skull, an extensive solid mass, covered by mucosa and with the presence of hair. Computed tomography confirmed the lesion, in the region corresponding to the base of the patient’s skull. The first surgical approach of resection occurred at the 40th day of the patient’s life, under general anesthesia and subsequent primary closure of the palatal defect. The second surgery was performed 10 months later, when tissue expanders were used on the palate to increase the mucosal surface. At the age of 5, the patient underwent surgery with a tongue flap, from the lingual dorsum, with an anterior pedicle. The patient was kept under sedation and relaxation for a period of 10 days for flap autonomy. After this period, the section of the flap and the reconstruction of the tongue dorsum were performed. The patient had a good evolution and was maintained under outpatient treatment. Pediatricians and pediatric dentists should be aware of the importance of prenatal exams and soon after birth, to identify possible deformities in neonatal patients, which favors the diagnosis. The 17-year postoperative follow-up of complete surgical removal of the teratoma and reconstruction of the cleft palate, combining the use of a tissue expander on the palate and a flap on the dorsum of the tongue, proved to be a viable resource for improving the patient’s quality of life.

A neuroendocrine tumor within an anterior mediastinal mature teratoma: a case report

BackgroundMature teratomas are benign germ cell tumors. On rare occasions, they have been associated with somatic malignancies and are termed rare germ cell tumors with a somatic-type malignancy (GCTSM). Mature teratomas commonly comprise adenocarcinomas; only seven previous cases of mature teratomas with neuroendocrine tumors have been reported to date. Here, we report a patient with a neuroendocrine tumor whithin a mature teratoma.Case presentationA 26-year-old man visited our department complaining of chest tightness. Contrast-enhanced computed tomography (CT) scans showed a strongly enhanced lesion within a 10-cm encapsulated cystic lesion in the anterior mediastinum. Positron emission tomography (PET) scans showed no areas of significant 18F-fluorodeoxyglucose (18F-FDG) accumulation. He underwent complete tumor resection via the transsternal approach. Histopathological examination of the specimen indicated a neuroendocrine tumor contained within a mature teratoma.ConclusionsIn this case, a neuroendocrine tumor was contained within a mature teratoma. Our patient had no specific symptoms and his serum markers were within the normal range. Although PET is beneficial for diagnosing other GCTSM, it is not useful in detecting a neuroendocrine tumor. Therefore, the preoperative diagnosis of neuroendocrine tumors contained within mature teratomas remains challenging. However, GCTSM should be suspected in patients exhibiting CT findings of a mediastinal tumor, measuring ≥ 6 cm, in addition to characteristic GCTSM findings. Moreover, surgery should be performed carefully in such cases.

Squamous-Cell Carcinoma in Mature Cystic Teratoma of the Ovary - A Case Report

Mature cystic teratoma is the most common benign germ cell tumor of the ovary. More than 80% of MCTs develop during the reproductive year. About 1% of the dermoid cysts undergo malignant transformation, most commonly squamous cell carcinoma in post-menopausal age group. We report a rare case of Squamous cell carcinoma transformation in mature cystic teratoma which was diagnosed and confirmed by histopathology and immunohistochemistry.

Intramedullary spinal teratoma: An interesting case report and review of the literature

Mature spinal intramedullary teratomas are benign germ cell tumors that are associated with an excellent long-term outcome following early treatment with radical surgical resection. However, the preoperative diagnosis is often difficult and delayed due to their rare occurrence in the spinal cord, especially when the typical clinical and imaging features are not present. We report a case of intramedullary teratoma in a young adult female who presented with unusual clinical and preoperative radiographic findings. The final diagnosis was made on histopathological examination postoperatively. Variations in clinical presentations, imaging, optimal treatment strategies and histopathological characteristics of this rare tumor are discussed here with a review of the literature.

Unusual occurrence of tuberculosis in mature cystic teratoma

Mature cystic teratoma is a common benign germ cell tumor of ovary. Unusual presentation can be seen in mature cystic teratoma like struma ovarii, carcinoid tumor, and malignant transformation. Detection of tuberculosis in mature cystic teratoma is uncommon. Here, a 57-years-female who presented with abdominal mass and pain abdomen who had tuberculosis in mature cystic teratoma

INFECTED MEDIASTINAL MATURE TERATOMA

TOPIC: Disorders of the Mediastinum TYPE: Medical Student/Resident Case Reports INTRODUCTION: Mature teratoma, a benign germ-cell tumor, commonly presents in the ovaries. Extragonadal manifestation is uncommon and rarely occurs with superimposed infection. We present a unique case of extragonadal teratoma found in the mediastinum complicated by infection. CASE PRESENTATION: A 24-year-old male with a history of asthma presented with a 3-day history of dyspnea and right rib pain radiating into the center of his chest. He reported a 30-pound weight loss in the preceding 3 months. He denied tobacco, alcohol, or recreational drug use. He previously worked as a coal miner but is now working in coastal drilling. He was afebrile and normotensive but had an oxygen saturation of 93% on room air. On examination, he had right upper lobe rhonchi with absent breath sounds in the right basilar region. Chest imaging showed complete collapse of the right middle and lower lobes, large loculated right pleural effusion within the anterior right lung base, and heterogeneity with rim enhancing fluid collection, which was suggestive of empyema. The patient had leukocytosis of 16.6k with neutrophil predominance of 14.18k. The patient was started on empiric intravenous antibiotics with vancomycin, ceftriaxone, and metronidazole. He underwent video-assisted thoracoscopic surgery with cystic mass resection from the pericardial surface and anterior surface of right lower lobe, 1600 milliliters of purulent fluid drainage, and decortication of right middle and lower lobes. Frozen section showed squamous and glandular cells. Pathology showed keratinized skin with granulation tissue, acute and chronic inflammation, and giant cell reaction consistent with infected mature teratoma. Pleural fluid's gram stain revealed 2+ PMNs and no growth in aerobic, anerobic, fungus, or AFB cultures. The patient was de-escalated to amoxicillin-clavulanate for a 14-day course and clinically improved. DISCUSSION: This case demonstrates a rare presentation of extragonadal mature teratoma in the mediastinum. Mediastinal teratomas occur from 20 to 40 years old with clinical symptoms of cough, chest pain, trichoptysis, and fever. Possible complications are infection, rupture, malignant transformation, and paraneoplastic anti-N-methyl-D-aspartate receptor (anti-NMDA receptor) associated limbic encephalitis. Infected mature teratomas are uncommon. Reported infectious organisms include Salmonella enterica, Escherichia coli, Mycoplasma pneumonia, Staphylococcus aureus, Staphylococcus agalactiae, and Haemophilus influenza. Proposed pathogenesis is due to the release of proteolytic enzymes from pancreatic and/or intestinal mucosal tissues in the tumor leading to inflammation and eventual infection. CONCLUSIONS: Teratoma rarely presents with superimposed infection, which may be complicated by rupture. Definitive management is surgical excision of teratoma and antibiotic targeting the organism. REFERENCE #1: Lee WL, Yen MS, Tseng JY, Yu KW, Wang PH. Mature teratoma with secondary infection: case report. Changgeng Yi Xue Za Zhi. 1999 Jun;22(2):339-43. PMID: 10493045. REFERENCE #2: Li C, Lin F, Liu C, Hai Y, Liu L. Intrapulmonary teratoma misdiagnosed as aspergilloma. Thorac Cancer. 2018;9(2):328-329. doi:10.1111/1759-7714.12566 REFERENCE #3: Tian Z, Liu H, Li S, et al. Surgical treatment of benign mediastinal teratoma: summary of experience of 108 cases. J Cardiothorac Surg. 2020;15(1):36. Published 2020 Feb 17. doi:10.1186/s13019-020-1075- DISCLOSURES: No relevant relationships by Ashley Anselene, source=Web Response No relevant relationships by Asma Balobaid, source=Web Response No relevant relationships by Shu Xian Lee, source=Web Response No relevant relationships by Rebecca Reece, source=Web Response

“Sack of marble” appearance in mature cystic teratoma: an unusual finding

Mature cystic teratoma (Dermoid) of ovary is a benign germ cell tumor consisting predominantly of ectodermal derivatives. In rare occasion sebaceous material may get aggregated to form marble like appearance because of continuous mobility of Dermoid and its content. Such a case in a menopausal woman has been presented in this report.

УЗ-признаки герминогенных опухолей яичников у беременных перед хирургическим лечением или химиотерапией

The problem of ovarian tumor differential diagnosis is solved using comprehensive ultrasound examination at different levels of efficiency. However, ultrasound imaging is an operator-dependent technique due to subjective interpretation of results. The study was aimed to assess the ultrasound signs of benign and malignant ovarian germ cell tumors (OGCTs) in pregnant women in order to determine the feasibility of surgical treatment and chemotherapy. The study was carried out using the logistic regression models. A group of 199 pregnant women with benign and malignant OGCTs were enrolled. Of them, 183 patients had benign, and nine patients had malignant tumors. In order to assess menstrual function and fertility, seven pregnant women were enrolled, who had previously received treatment for malignant OGCTs. Pre-operative assessment results were compared with morphological assessment data. Organ-preserving surgical treatment was performed (unilateral adnexectomy); if necessary, the patients received cisplatin-based chemotherapy. Perinatal outcomes were assessed. The median observation time between the malignant OGCT detection and the end of the study was 66 months (12–240 months). It was found that comprehensive ultrasound examination and logistic regression models (sensitivity 100%, specificity 92.3%, overall accuracy 92.8%) enabled differential diagnosis of benign and malignant OGCTs. The number of unnecessary surgical procedures in patients with benign OGCTs was been limited, the pregnancy and childbirth outcomes were improved. Nine pregnant women received organ-preserving surgical treatment for malignant OGCTs, and three patients received chemotherapy after surgery, which allowed the patients to realize their reproductive potential.

Evaluation of an Algorithm for Testis-Sparing Surgery in Boys with Testicular Tumors: A Retrospective Cohort Study

Aim: This study reports surgical treatment and its outcome for boys with a testicular tumor, in order to analyze the considerations of testis-sparing surgery (TSS) and investigate whether, in retrospect, treatment was according to a recently developed algorithm. Methods: We retrospectively reviewed boys with testicular tumors who underwent surgical treatment between January 2000 and June 2020 at the Wilhelmina’s Children’s Hospital and the Princess Máxima Center for Pediatric Oncology, The Netherlands. Medical records were searched for clinical characteristics and outcome. Results: We identified 31 boys (median age = 5.5 years) with a testicular tumor, 26 germ cell tumors (GCTs), four sex cord-stromal tumors, and one gonadoblastoma. Seventeen boys (median age = 1.5 years) had malignant and 14 (median age = 3.6 years) had benign tumors. Four boys with benign GCTs were treated with TSS, 25 with radical inguinal orchiectomy (RIO), and 2 with scrotal orchiectomy. No recurrence or testicular atrophy was reported. All boys with benign testicular tumors were treated as suggested by the algorithm, except for one boy treated with RIO. Conclusion: Retrospective analysis of surgical treatment of prepubertal boys with benign testicular tumors showed that TSS appears to be safe, and should be considered based on clinicoradiological data, in line with our algorithm.

Computed Tomography Features of Adnexal Torsion: A Meta-Analysis

We performed a meta-analysis of studies examining the computed tomography (CT) features of adnexal torsion (AT). We searched PubMed, Embase, Web of Science, and the Cochrane Library for studies involving the proportion of CT features in patients with AT and that used surgery as the reference test. Study quality was assessed using the Newcastle-Ottawa scale and the Agency for Healthcare Research and Quality tool. Twelve articles involving 483 patients were included. The pooled proportion of right-sided adnexal lesion was 54% (95% confidence interval [CI]: 49%-56%). The pooled proportions of the ovarian lesion histopathological types were: benign germ cell tumors, 33% (95% CI: 28%-37%); benign cystic lesions, 26% (95% CI: 21%-30%); benign epithelial neoplasms, 24% (95% CI: 20%-29%); sex cord-stromal tumors, 4% (95% CI: 2%-6%); borderline neoplasms, 3% (95% CI: 1%-6%); and hemorrhagic cysts, 2% (95% CI: 0%-3%). The pooled proportions of CT features were: Adnexal enlargement, 99% (95% CI: 98%-99%); adnexal with mass, 98% (95% CI: 97%-100%); twisted pedicle, 81% (95% CI: 78%-83%); mass with thickened wall, 77% (95% CI: 73%-81%); tubal thickening, 73% (95% CI: 68%-77%); abnormal location of adnexa, 69% (95% CI: 63%-75%), pelvic ascites, 43% (95% CI: 38%-49%); pelvic fat infiltration, 41% (95% CI: 34%-48%); uterine deviation, 37% (95% CI: 31%-42%); and lack of enhancement, 20% (95% CI: 14%-25%). Adnexal enlargement, adnexal mass, and twisted pedicle may be the most important CT features for diagnosing AT.

Testis Sparing Surgery in Pediatric Testicular Tumors.

Simple SummaryTestis sparing surgery (TSS) is a safe treatment option in selected cases of testicular tumors in adults, focusing on technical feasibility, oncologic safety, preserving of testicular function, and long-term outcome. This surgical technique is also increasingly being considered in children, as benign tumors are more common in this population. With this systematic review, we aim to evaluate outcome of TSS and to investigate under which circumstances TSS can be considered safe in boys with testicular tumors. Based on the current practice described in this systematic review, combined with the outcome of TSS, we would like to suggest an algorithm to guide clinicians in determining the appropriate surgical treatment in prepubertal patients less than 12 years of age with a testicular tumor. TSS may lead to improved testicular function and quality of life in boys with testicular tumors. Objective: The purpose of this review is to evaluate the outcomes of testis sparing surgery (TSS) and to investigate under which circumstances TSS can be considered a safe treatment option in pediatric patients with testicular tumors. Methods: A database search was performed in Cochrane, Pubmed, and Embase for studies that focused on TSS as treatment for testicular tumors in the pediatric population, excluding reviews and single case reports. Results: Twenty studies, describing the surgical treatment of 777 patients with testicular tumors, were included in the analysis. The majority of pediatric patients with benign germ cell tumors (GCTs) (mean age: 3.7 years) and sex cord-stromal tumors (SCSTs) (mean age: 6.6 years) were treated with TSS, 61.9% and 61.2%, respectively. No cases of testicular atrophy occurred. Four of the benign GCTs, i.e., three teratomas and one epidermoid cyst, recurred. No cases of recurrence were reported in patients with SCSTs. Of the 243 malignant GCTs (mean age: 4.2 years), only one patient had TSS (0.4%). Conclusion: TSS is a safe treatment option for prepubertal patients less than 12 years of age with benign GCTs and low grade SCSTs.

Preoperative Differentiation of Benign and Malignant Non-epithelial Ovarian Tumors: Clinical Features and Tumor Markers.

To evaluate the role of clinical features and preoperative measurement of cancer antigen 125 (CA125), human epididymis protein (HE4), and carcinoembryonic antigen (CEA) serum levels in women with benign and malignant non-epithelial ovarian tumors. One hundred and nineteen consecutive women with germ cell, sex cord-stromal, and ovarian leiomyomas were included in this study. The preoperative levels of biomarkers were measured, and then surgery and histopathological analysis were performed. Information about the treatment and disease recurrence were obtained from the medical files of patients. Our sample included 71 women with germ cell tumors (64 benign and 7 malignant), 46 with sex cord-stromal tumors (32 benign and 14 malignant), and 2 with ovarian leiomyomas. Among benign germ cell tumors, 63 were mature teratomas, and, among malignant, four were immature teratomas. The most common tumors in the sex cord-stromal group were fibromas (benign) and granulosa cell tumor (malignant). The biomarker serum levels were not different among benign and malignant non-epithelial ovarian tumors. Fertility-sparing surgeries were performed in 5 (71.4%) women with malignant germ cell tumor. Eleven (78.6%) patients with malignant sex cord-stromal tumors were treated with fertility-sparing surgeries. Five women (71.4%) with germ cell tumors and only 1 (7.1%) with sex cord-stromal tumor were treated with chemotherapy. One woman with germ cell tumor recurred and died of the disease and one woman with sex cord-stromal tumor recurred. Non-epithelial ovarian tumors were benign in the majority of cases, and the malignant cases were diagnosed at initial stages with good prognosis. The measurements of CA125, HE4, and CEA serum levels were not useful in the preoperative diagnosis of these tumors.

Sonographic Diagnosis of a Mature Cystic Teratoma Resulting in Acute Torsion

Mature cystic teratomas are benign germ cell tumors and, depending on the size, may be at risk for torsion. These ovarian masses can cause the ovarian vasculature to twist upon itself and inhibit blood flow, resulting in partial to complete torsion. If detection and treatment are not prompt, a salpingo-oophorectomy may be needed impeding future fertility. This case describes a young woman with acute left adnexal pain where sonography aided in the diagnosis of ovarian torsion caused by a large mature cystic teratoma. Transabdominal sonography was used, aided by extended field-of-view technology for characterization of the mass. The sonographic attributes of mature cystic teratomas vary, but careful evaluations can lead to an accurate diagnosis to aid in surgical procedures. The patient underwent an exploratory laparotomy, which resulted in a left ovary oophorectomy and excision of the mass.

Mature teratoma with aspergilloma

Mediastinal mature teratomas are benign germ cell tumors which rarely involve the lung, but when they involve the lung they can cavitate. Aspergilloma developing in a mature teratoma is extremely rare, and according to our English literature search, there is only one previously reported case. We report a 21-year-old female who presented with cough and foul-smelling sputum. investigations revealed an intrathoracic mass, which intraoperatively and upon subsequent histological exam was found to be a mature mediastinal teratoma involving the lung and associated with an aspergilloma. Reporting our case will add to the understanding of this rare presentation of mediastinal mature teratomas. Keywords: mature teratoma; aspergilloma; surgical treatment

Malignant Transformation of a Mature Ovarian Teratoma: A Case Report and Review of the Literature

A mature ovarian teratoma is a common benign germ cell tumor of the ovary in women that rarely causes a malignant transformation. However, a malignant transformation can occur in the ectodermal, mesodermal, and endodermal tissues of the tumor. A squamous cell carcinoma is the most common and an adenocarcinoma is the second most common malignant tumor derived from a cystic teratoma. Due to the rarity of malignant transformations in mature teratomas and the lack of clinical data, the clinical pathological features, malignant transformation mechanism, therapeutic methods, and prognosis-relevant factors are unclear. Currently, there is no specific diagnostic method, and it is a difficult lesion to diagnose before performing surgery. In order to improve clinicians’ understanding of a malignant-transformed mature teratoma and identification of malignant-transformed teratomas at early stages, we have reported a case of a mature teratoma with the malignant transformation of a sebaceous gland carcinoma in the Yiwu Central Hospital in Zhejiang, China on May 31, 2018. A review of the literature is also presented to summarize the clinical symptoms, pathogenesis, diagnosis, and treatment of malignant-transformed mature teratomas. Keywords: mature teratoma, malignant transformation, sebaceous gland carcinoma

Squamous Cell Carcinoma Arising in Ovarian Teratoma: A Diagnostic Conundrum.

Sir, Germ cell tumors (GCT) comprise 20–30 % of the ovarian tumors [1]. Mature cystic teratoma (MCT) is the most common benign GCT comprising 10–20 % of all tumors in women of reproductive age group. The cancers in the ovary are most commonly of epithelial origin with serous cystadenocarcinoma and mucinous cystadenocarcinoma comprising the majority of these lesions. Malignant germ cell tumors are less common and malignant transformation of MCT is rare. Most common malignancy to occur in the setting of MCT is SCC, though other malignancies including sarcomas, melanomas and carcinoid have been highlighted in case reports [2]. The other differentials of SCC in the ovary to the considered are of de novo origin, metastases and transformation in endometriotic foci. De novo origin of SCC in an ovary is extremely rare [3]. We recently reviewed two cases of SCC in the background ofMCT. Both these middle aged females presented with a few months history of vague lower abdominal pain and distension. Evaluation revealed unilateral ovarian masses. CA-125 levels were normal. Pre-operative diagnosis of malignant epithelial ovarian neoplasm was considered in both cases and staging laparotomy was performed. Histopathology, however, revealed a diagnosis of MCT with malignant transformation based on the findings of solid cystic tumor showing areas of calcification, fat and hair [Fig. 1]. The clinical features, imaging findings and per-operative findings are no different from other ovarian malignancies and the diagnosis is established by histopathology. The importance of diagnosing this entity preoperatively lies in the prognosis that has been found to be uniformly poor even after several forms of adjuvant treatment. These tumors usually present in the post-menopausal women with the age range of 45–65 years, though cases of these tumors in young women have been documented in literature [4]. Patients present with non-specific complaints of vague abdominal pain, nausea, vomiting, constipation, vaginal bleeding, abdominal enlargement and weight loss. Examination findings including the abdominal and per-vaginal examination are non-specific and reveal a pelvic or abdomino-pelvic mass. Imaging in these cases is not specific and confirms the presence of a complex pelvic mass and provides an insight into the disease extent and the presence of metastases that is critical before the surgical exploration is undertaken. However, certain clinical, imaging and biochemical markers for suspecting these cases have been suggested by various researchers. These include older age at presentation, large size (>10 cm at presentation) and proportion of solid component [5]. The most important differential diagnosis to be considered is the metastasis, particularly from cervical carcinoma, by both clinical examination and at histopathology [6]. S. Sharma (*) :N. Gupta :A. Rajwanshi Department of Cytology and Gynaecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India e-mail: drsaniya.sharma@gmail.com