Bilateral Mature Cystic Teratomas Research Articles

Uncommon Pathological Presentations of Mature Cystic Teratoma: A Case Series

Mature cystic teratomas are benign tumours of the ovary but rarely certain unusual gross and microscopic findings might complicate their diagnosis or may have an impact on their clinical outcome. Here, we are presenting a case series of five unusual pathological presentations of mature cystic teratomas of ovary. Out of five cases, three cases were of collision tumours, in which combination of mature cystic teratoma is seen with mucinous cystadenoma in two cases, and with serous cystadenoma in one case. True collision tumours are defined as histologically distinct neoplasms in the same tissue or organ without any histologic admixture or intermediate cell population zone between two components. These tumours are located in various organs but ovarian location is rare. Mature cystic teratoma is the most common component of collision combinations in the ovary. All classes of ovarian tumours, benign, borderline and malignant may collide and therefore, clinical outcomesin collision tumours depend on individual tumour characteristics. Fourth case was of a mature cystic teratoma associated with a distinct hemangiomatous component. Mature cystic teratoma associated with prominent hemangiomatous component is a very rare finding with only few case reports in the literature and it should be differentiated from true ovarian hemangioma, lymphangioma and angiosarcoma. Fifth case was of bilateral mature cystic teratomas associated with a well-defined lipomatous lesion in right sided mature cystic teratoma mimicking lipoma. Lipomatous ovarian lesions are very rare and mature cystic teratoma with prominent adipocytic proliferation is also an exceedingly uncommon finding and it should be differentiated from true ovarian lipoma and other atypical lipomatous proliferations. Most of these tumours remain clinically and radiologically unrecognized, therefore their histological recognition is essential for adequate patient management.

Bilateral mature cystic teratoma of ovary: A rare case presentation

Mature cystic teratomas are ovarian neoplasms derived from two to three germ cell layers i.e. ectoderm, mesoderm and endoderm. Ovarian teratomas are usually benign tumours of the reproductive age group. They usually have right-sided predisposition. However, only 10-20% of these neoplasms may have bilateral presentation. Here, we present a rare case of bilateral mature cystic teratoma of ovaries in a 32 years old multigravida female who presented with pain lower abdomen from one month. Ultrasonography showed bilateral solid-cystic adnexal lesions along with calcifications in the left adnexal mass. Serum level of CA-125 was within normal range. Laparoscopic bilateral oophorectomy was done along with bilateral tubal ligation. The histopathological examination confirmed the diagnosis of bilateral mature cystic teratoma of the ovaries. Keywords: Benign, Cyst, Dermoid, Ovary, Teratoma.

Ovarian Mature Cystic Teratoma Combined with Mucinous Boderline Tumor-A Case Report with Literature Review

<p>Mature ovarian cystic teratoma with co-existing mucinous borderline tumor is an extremely rare finding in literature. Here, we report a case of bilateral mature cystic teratoma of the ovary with mucinous borderline tumors and intraepithelial carcinoma in a very young, 26-year-old female. The case was diagnosed histologically through immunohistochemical support. The biological behavior of mature ovarian cystic teratoma with mucinous borderline tumor is between those of benign and malignant tumors, having low malignant potential. Since the patient had given birth to a child, a radical operation was performed and no <br />tumor recurrence was observed after one year follow-up.</p>

Bilateral Ovarian Mature Cystic Teratoma- A Rare Case Presentation

The incidence of bilateral mature cystic teratoma of the ovary is only 10%. Ovarian mature cystic teratomas are common, benign, pelvic tumours and can be easily detected by ultrasonography. Recurrent ovarian teratomas are very rare, and cases of bilateral teratomas are even rarer. So, it is advisable to routinely check the ovary contralaterally during the surgical procedure along with careful pelvic sonographic examination of both the ovaries. Inadvertent extensive surgery should be avoided in this benign condition that might further compromise the fertility of young patients. We report a rare case of bilateral mature cystic teratoma of the ovary in a 28-year-old female, who presented to the gynaecologic outpatient department with complaints of intermittent dull aching, diffuse lower abdominal pain and dysmenorrhea for three months. Transvaginal ultrasonography revealed bilateral complex ovarian masses that raised suspicion of dermoid cysts with hypoechoic endometrial collections. Her Cancer Antigen 125 (CA-125) was normal. A bilateral ovarian cystectomy was performed and histopathology confirmed the diagnosis. This case highlights a rare occurrence of bilateral ovarian mature cystic teratoma, where cystectomy was performed to preserve the fertility in a young female.

SAT-289 An Unusual Virilizing Ovarian Tumor in Adolescence

Background: The etiology of hyperandrogenism in adolescent females includes polycystic ovarian syndrome, non-classical congenital adrenal hyperplasia (CAH), Cushing’s syndrome, androgen-secreting tumors (adrenal or ovarian) or exogenous use. Ovarian tumors producing androgens comprise <5% of all ovarian neoplasms and usually originate from sex cord stromal cells. There are sporadic case reports of mature cystic teratomas (MCTs), a type of germ cell tumor, causing hyperandrogenism in women but only two reported cases of virilizing MCTs in adolescent girls (1, 2). We present a third case of this nature. Case presentation: A 17-year old girl with no past medical history presented with worsening abdominal distension and discomfort. She was also noted to have excessive thick facial hair which she stated had been present throughout adolescence. She reported recent irregularity in her menstrual periods. She had no history genital abnormalities at birth or premature adrenarche, thelarche or menarche. She denied using anabolic steroids or other medications. Family history was negative for CAH or sudden infant death. On examination, there was significant abdominal distension, terminal hair over the chin, upper lip, side-burns and abdomen, as well as severe clitoromegaly with prominent glans measuring 3cm x 1.5cm, but no evidence of acanthosis nigricans. Chemistry showed testosterone of 178.3 ng/dL (3.75 - 49.57 ng/dL), DHEA-S of 550.4 mcg/dL (150.0 - 590.0 mcg/dL) and 17-hydroxyprogesterone of 224.7 ng/dL (26 - 325 ng/dL). Her abdomino-pelvic ultrasound and CT scan showed a 35.5 cm cystic mass with focal fatty components and dystrophic calcifications suggestive of MCT. Adrenal glands were normal. The patient underwent an exploratory laparotomy with left salpingo-oopherectomy and right cystectomy. Preliminary pathology results showed bilateral MCTs. Two weeks post-operatively, testosterone level decreased to 32.5 ng/dL. Conclusion: Given the normalization of testosterone after surgery, the bilateral MCTs are the suspected source of the patient’s androgen excess. MCTs are the most common ovarian neoplasm in adolescent females, but they are an exceedingly rare cause of hyperandrogenemia. They can be slow-growing and local manifestations may not present until years later. However, testosterone-secreting MCTs may be brought to a physician’s attention due to signs of virilization. A multidisciplinary approach with primary care physicians, endocrinologists, gynecologists and pathologists is needed to make an accurate diagnosis in a timely manner.

Live birth following laparoscopic fertility-sparing surgery for papillary thyroid carcinoma arising from mature ovarian cystic teratoma: A case report.

Papillary thyroid carcinoma arising from ovarian mature cystic teratoma is clinically rare. We herein present a case of live birth following two laparoscopic surgeries for papillary thyroid carcinoma arising in a mature ovarian cystic teratoma. A 30-year-old female patient, gravida 1 para 1, was treated by laparoscopic bilateral ovarian cystectomy for suspicion of bilateral mature cystic teratoma. The diagnosis of papillary thyroid carcinoma arising from right ovarian mature cystic teratoma was established based on postoperative pathological examination of the tumor. Such rare neoplasms may be difficult to diagnose preoperatively based on radiological examinations alone. The patient underwent laparoscopic fertility-preserving unilateral (right) salpingo-oophorectomy. Following an extensive discussion with the patient and her family, appropriate informed consent was obtained for the treatment option and the patient and her family chose to preserve her fertility. She could have a baby following the treatment and no evidence of disease for 6 years. Gynecologists should be aware of the possibility of such rare cases, and the available surgical interventions should be fully discussed with patients who wish to preserve their fertility. Laparoscopic fertility-sparing surgery may be a feasible option when encountering such a rare condition.

Laparoscopic Detorsion of Twisted Ovary in a Nulliparous Woman with a Recurrent, Bilateral Mature Cystic Teratoma

Abstract Background: Ovarian mature cystic teratomas are common, benign, pelvic tumors easily detected by ultrasonography. These tumors are bilateral in 8% to 15%, and recurrent teratomas are uncommon and underdiagnosed. A benign dermoid cyst is the most common ovarian mass to develop torsion. Although uncommon, adnexal torsions are an important cause of gynecological emergencies. It was previously thought that untwisting the adnexa could result in an embolus from thrombosed veins but this has proved untrue. Currently, it is considered that laparoscopic conservative management by untwisting the ovary allows recovery of almost all cases, even when the ovaries seem nonviable. Case: This article presents a case of an ovarian torsion in a 23-year-old nulliparous woman referred to our emergency room because of acute right iliac fossa pain. Ultrasound showed a complex right adnexal mass 60 × 60 mm. Three years earlier she had undergone, in an urgent context, a left adnexectomy and a right cystectomy for bilater...

Bilateral Mature Cystic Teratoma Masquerading as an Ectopic Pregnancy: A Case Report and Review of the Literature

Abstract Background: The presentation of an adnexal mass with a raised beta–human chorionic gonadotropin (β-hCG level) does not necessarily indicate a diagnosis of ectopic pregnancy. This article highlights an unusual case of benign cystic teratomas with β-hCG production, mimicking the presentation of an ectopic pregnancy. Case: A 28-year-old woman who had a 10-week period of amenorrhea presented with an acute abdomen and an increased β-hCG level. An ultrasound scan revealed features suggestive of an ectopic pregnancy. Results: The patient underwent right salpingo-oophorectomy (for torsion of an ovarian cyst) and a left cystectomy (for an ovarian cyst). There was no evidence of an ectopic pregnancy found during the surgery. Histopathology examination reported that she had bilateral mature cystic teratomas. Conclusions: Careful assessment and consideration of ovarian accidents or neoplasms is crucial, especially in the presence of an ovarian mass with an increased β-hCG level. (J GYNECOL SURG 20XX:000)

Theres a Hair in my Egg: Exploring the Possibility of Fertility after Dramatic Bilateral Mature Cystic Teratoma Cystectomy

Mature cystic teratomas (MCTs) are the most common benign germ cell neoplasm in reproductive aged females that contributes to 40-50% of all benign ovarian neoplasms overall. MTCs often grow in multiples within an ovary, and 15% of cases grow within both ovaries, and can become severely large causing mass effects within the pelvis, as well as essentially replacing the functional ovarian parenchyma. Because the majority of women with mature cystic teratomas are of childbearing age, cystectomy is preferred over oophorectomy for the preservation of fertility. Techniques during cystectomy have been shown to play a role in ovarian reserve, and spillage of cystic contents has been linked to adhesion formation. However, as per Mecke et al. it is unlikely that those who experienced spilling of cystic contents to acquire serious complications. Thus, patients who undergo cystectomy due to MTCs can go on to have successful pregnancies. Our case follows a 22 year old G0 female referred to the gynecologic-oncology clinic for bilateral pelvic masses discovered via transvaginal ultrasound, with subsequent removal, and confirmation from pathology of several MCTs.

Age-stratified analysis of tumor markers and tumor characteristics in adolescents and young women with mature cystic teratoma

BackgroundSerum tumor markers are widely used for the preoperative evaluation of an adnexal mass. Elevations of cancer antigen (CA) 125 and CA 19-9 have been reported in patients with mature cystic teratoma (MCT). The aim of the study is to investigate the relation of serum tumor markers with tumor characteristics in young women with MCT. MethodsWe conducted a retrospective review of 157 patients under the age of 35 who underwent laparoscopic surgery for ovarian MCT. Patients were divided into two age groups: Group I (n = 80): adolescents/young adults (aged 13–25 years) and Group II (n = 77): women aged 26–35 years. Data were analyzed for serum tumor markers, tumor size, and bilaterality. ResultsThe rates of elevated CA 125 and CA 19-9 were 10.7% and 31.5%, respectively, for Group I, and 13.9% and 26.5%, respectively, for Group II. The bilaterality rate was higher in Group II compared to Group I (19.5% vs. 8.8%, respectively, p = 0.04). Serum CA 125 and CA 19-9 elevations were not related to tumor size in Group I. In Group II, elevated levels of CA 125 were also unrelated to tumor size. However, significant elevation in CA 19-9 levels was observed when tumor size was larger than 4 cm in this age group (p = 0.004). Elevated CA 125 and CA 19-9 levels were not significantly associated with the presence of bilateral MCT in either group. ConclusionThe results of our study indicate that elevations of CA 19-9 are associated with larger tumor size in women aged 26–35 years, but not in adolescents/young adults. However, elevated serum CA 125 levels are not related to tumor size in either age group.

Bilateral Mature Cystic Teratomas of the Ovary with Endometrial Cancer: A Rare Case Presentation

Abstract Background: Bilateral mature cystic teratomas are seen in only 10% of cases. Furthermore, the occurrence of endometrial cancer in this setting is extremely rare. Case: A 62-year-old woman presented with postmenopausal bleeding. On transvaginal ultrasound, bilateral complex ovarian masses, that raised suspicion of dermoid cysts with hypoechoic endometrial collection, were detected. Endometrial sampling showed inflammatory changes, and her Papanicolaou smear was normal. Her CA-125 was normal. During exploratory laparotomy, bilateral dermoid cysts of 7 × 7 cm were detected along with thickened endometrium. Results: Final histopathologic diagnosis confirmed benign mature cystic teratomas coexisting with moderately differentiated endometrial cancer, with less than half thickness of myometrial invasion. Conclusions: Bilateral mature cystic teratomas and endometrial cancer is an incidental finding. In all cases of postmenopausal bleeding with bilateral dermoid cysts, a strong suspicion of endometrial ca...

Evidence of metachronous development of ovarian teratomas: a case report of bilateral mature cystic teratomas of the ovaries and systematic literature review

BackgroundMature cystic teratomas are usually found in the ovaries. They are bilateral in 10 to 15% of cases and multiple cystic teratomas may be present in one ovary. The aim of this study is to clarify if development of mature cystic teratomas of the ovaries in a single host is metachronous or due to autoimplant or recurrence.Case presentationWe report a woman with bilateral mature cystic teratomas of the ovaries. DNA profiles of these teratomas were investigated via short tandem repeat (STR) analysis and methylation statuses were determined via methylation sensitive multiplex ligation-dependent probe amplification methods. The results showed that the cystic teratomas originated from different stages of oogonia or primary oocyte before germinal vesicle stage failure of meiosis I in female gametogenesis.Potentially relevant literature was searched in PubMed database. Cases of bilateral or multiple mature cystic teratomas of the ovaries were analyzed. To date, there has been no reported case of multiple mature cystic teratomas in which clarification of the origin was achieved using molecular genetic methods.ConclusionsThe results of this case study provide evidence of metachronous development of mature cystic teratomas of the ovaries and may serve as a reference in the management of patients following laparoscopic cystectomy.

Role of Elevated Cancer Antigen 19-9 in Women With Mature Cystic Teratoma

The objective of this study was to determine how often an elevated cancer antigen (CA) 19-9 (≥ 37 U/mL) was present during the preoperative evaluation of women with a mature cystic teratoma (MCT). This was a retrospective, consecutive case series (N = 139) of histologically proven MCT treated at Montefiore Medical Center from 1997 to 2008. Data were analyzed for patient and tumor characteristics, tumor markers (CA 19-9, CA 125, and carcinoembryonic antigen [CEA]), preoperative imaging, and procedure. CA 19-9 was elevated in 37.4% of patients. Elevated CA 19-9 was not significantly associated with age, race, CA 125 (≥35 U/mL), CEA (≥5 ng/mL), MCT size, or the presence of bilateral MCTs. Of the patients, 59% were ≥40 years old. Age <40 years was associated with cystectomy rather than oophorectomy (P < .001), regardless of CA 19-9 (P = .09). Elevated preoperative CA 19-9 in patients with MCT was associated with increased preoperative computed tomography (P = .04).

Immature teratoma after three laparoscopic resections for mature cystic teratomas.

We report a case in which an immature teratoma developed following three previous resections for mature cystic teratomas. The patient was a 26-year-old nulliparous woman with a regular menstrual cycle. Twelve years earlier, she had consulted a pediatrician for complaints of lower abdominal pain. Bilateral cystic teratomas were suspected and she underwent a left salpingo-oophorectomy and a right cystectomy laparoscopically, and bilateral mature cystic teratomas were diagnosed histologically. She underwent a right cystectomy twice afterwards and mature cystic teratomas were diagnosed. Three years after the third surgery, a regular checkup performed annually for ovarian cyst recurrence revealed a 9.3 cm ovarian cyst by ultrasonography without marker elevation or complaint of symptoms. Magnetic resonance imaging (MRI) showed a 10 cm multilocular cyst, including a part with heterogeneous medium and high-signal intensity on T2-weighted images, which revealed enhancement on dynamic contrast-enhanced MRI unlike the previous images. Ovarian tumors, including immature teratomas and malignancy, were considered. She had a strong wish to undergo laparoscopic surgery. She was diagnosed with an immature teratoma, grade 1 of the right ovary. Although the frequency of recurrence of immature teratomas after resection of mature cystic teratomas is very low, regular checkups are necessary because there may be no associated symptoms.

Bilateral ovarian teratoma presenting with a clinical picture of acute abdomen

We describe the case of a 30-year-old patient with bilateral mature cystic teratoma (MCT) of the ovaries. The patient had been complaining of mild abdominal pain for several months that had suddenly become severe. Early diagnosis at the emergency room was acute appendicitis, but definitive diagnosis was bilateral ovarian teratoma. We therefore recommend considering ovarian teratomas in the differential diagnosis of acute abdomen in young women in an emergency care setting.

Bilateral ovarian teratoma presenting with a clinical picture of acute abdomen

We describe the case of a 30-year-old patient with bilateral mature cystic teratoma (MCT) of the ovaries. The patient had been complaining of mild abdominal pain for several months that had suddenly become severe. Early diagnosis at the emergency room was acute appendicitis, but definitive diagnosis was bilateral ovarian teratoma. We therefore recommend considering ovarian teratomas in the differential diagnosis of acute abdomen in young women in an emergency care setting.

Minilaparotomy a Good Option in Specific Cases: A Case Report of Bilateral Ovarian Germ Cell Tumor

Mature cystic teratomas (MCTs) of the ovary represent 44% of ovarian neoplasmas. The surgical approach is important in young women especially for the cosmetic results. Nowadays most of the ovarian surgeries can be performed laparoscopically. An alternative between laparoscopy and laparotomy is the minilaparotomy (ML) which can be an interesting option, thanks to the small incision. We report a 39-year-old woman who was referred to our hospital with acute abdominal pain. In her past history the patient had an uncomplicated delivery. During pregnancy a 6 cm bilateral MCT was diagnosed and expectant management was followed. A left-sided ovarial torsion was postulated, and laparoscopic detorsion was performed. To avoid a rupture of the left MCT, the operation was interrupted. To remove the cyst, a ML was done two weeks later. A left-sided salpingo-oophorectomy was performed due to a large cyst including the entire ovary. On the other side, the right dermoid cyst was entirely removed. The advantage of a ML is not only shorter operating time with less learning curve compared to laparoscopy but also the possibility to extract the adnexal mass from the abdominal cavity with lower risk of rupture and in addition the possibility to preserve more ovarian tissue.

Struma ovarii in breast cancer

We described a case of benign struma ovarii associated to bilateral mature cystic ovarian teratoma in an asymptomatic post-menopausal woman with breast cancer. The patient synchronously underwent surgical treatment of breast and ovarian tumors.

OP17.03: Variation in the morphological appearance of ovarian mature cystic teratomas: Implications for diagnosis and management

Objectives: Mature cystic teratomas (MCT) or Dermoid cysts of the ovary account for approximately 25% of all ovarian tumours. The wide range of tissue types found in these tumours give rise to a highly varied appearance on ultrasound examination. The aim of this study was to assess the frequency of different morphological features in order to improve the accuracy of ultrasound diagnosis and aid in management planning. Methods: Our gynaecology ultrasound database and the histopathology department were retrospectively searched for MTCs. All women with a histological diagnosis of MCT and preoperative ultrasound images were included in the study. The images were reviewed by a single observer who recorded the presence and extent of common and rare features of MCTs. Results: A total of 133 cysts were found in 117 women. 15/117 (12.8%) had bilateral MCTs. Hyperechoic cyst contents consistent with sebum were present in 94.7% of cysts. Other common ultrasound features included hair (91.7%), acoustic shadowing (83.5%), and healthy ovarian tissue seen at one edge of the cyst (‘‘the ovarian crescent sign’’) 75.9%. The amount of sebum within the cyst was significantly higher in older women and it was inversely proportional to the size of the cyst (P < 0.05). Conclusions: Sebum and hair are present in more than 90% of MCTs, which facilitates a correct pre-operative diagnosis on ultrasound scan. The amount of sebum within the cyst can be used to estimate the potential of the cyst to grow and require surgical intervention in the future.

P138A case of bilateral mature cystic teratoma with calcified elements in an old age postmenopausal woman

BackgroundDermoid cysts are interesting tumours in which all body tissues may be represented. Neither presence of calcified elements, nor postmenopausal age, nor bilaterality are usual for them. We present here, a case of postmenopausal woman in whom bilateral dermoid cysts were found with calcified elements. Ultrasonographic features, clinical presentation, differential diagnosis and treatment modalities of this rare case are presented and discussed.Case70‐year‐old woman gravida 0 para 0 was referred to our Department complaining of postmenopausal bleeding for the last two months. She was postmenopausal for the last 27 years during which she had never been treated with estrogen replacement therapy. On a gynaecologic examination, bilateral adnexal mass found. Ultrasonographic scanning demonstrated a normal sized anteverted uterus with an endometrial thickness of 4 mm with an hypoechoic ring around it. Transverse ultrasonogram showed bilateral adnexal highly reflective echogenic well circumscribed mass with solid and cystic components. Endometrial biopsy showed granulomatous endometritis. At surgery, a bilateral ovarian tumour measuring 4 × 5 cm in diameter was seen. A pathologic examination confirmed bilateral dermoid cysts with no malignant component. Peritoneal washing was also negative. Total abdominal histerectomy with bilateral salphingooopherectomy was performed. On discharging from Hospital, estrogen replacement therapy was given.