Huge teratoma in a teenager

Abstract

Mature cystic teratoma is the most common ovarian tumor in young females. We are presenting a 13-year-old African–American female with abdominal distension. Computed tomography of the abdomen showed midline cystic mass. Diagnosis was confirmed after laparoscopic left salpingo-oophorectomy. Malignant transformation of mature cystic teratoma is rare.

Full text

Oxford Medical Case Reports, 2017;8, 140–141
doi: 10.1093/omcr/omx040
Clinical Image
CLINICAL IMAGE
Huge teratoma in a teenager
Zain Alamarat
1
, Nkechi Onwuzurike
2
, Qazi Azher
3
and Samer Al Hadidi
4,
*
1
Department of Pediatrics, Hurley Medical Center, MI, USA,
2
Department of Pediatrics Hematology Oncology,
Hurley Medical Center, MI, USA,
3
Department of Pathology, Hurley Medical Center, MI, USA, and
4
Department
of Internal Medicine, Hurley Medical Center, MI, USA
*Correspondence address. Department of Internal Medicine, Hurley Medical Center, MI, USA. Tel: +810-262-9682; Fax: +810-262-7245;
E-mail: salhadi1@hurleymc.com
Abstract
Mature cystic teratoma is the most common ovarian tumor in young females. We are presenting a 13-year-old African–American
female with abdominal distension. Computed tomography of the abdomen showed midline cystic mass. Diagnosis was
confirmed after laparoscopic left salpingo-oophorectomy. Malignant transformation of mature cystic teratoma is rare.
A 13-year-old African–American female presented to outpatient
clinic complaining of abdominal distension and pain of 3 weeks
duration. She was diagnosed with constipation 1 week before
presentation for which she was taking stool softener resulting in
bowel movement every 2 days. Review of systems was positive
for heavy menses since menarche, which started at age of 12.
Otherwise her medical and surgical histories are unremarkable.
Her physical examination showed normal vital signs.
Abdominal exam showed distension with large midline mass.
There was no tenderness or guarding. Computed tomography
(CT) of the abdomen and pelvis showed a large 25.2×17.3 ×10.2 cm
midline cystic mass extending superiorly from the pelvis to the
abdomen (Fig. 1). Laparoscopic left salpingo-oophorectomy was
done. The cyst obscured the view. About 2.6l of clear fluid were
Figure 1: CT of the abdomen (axial view) showing fat in the right side and calcification in the left side as indicated by arrows.
Received: March 4, 2017. Revised: May 26, 2017. Accepted: June 10, 2017
© The Author 2017. Published by Oxford University Press.
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140

aspirated. The cyst was decompressed and the opening into the
cyst was sealed with a Vicryl suture to avoid any spillage. Mature
cystic teratoma consisting of mature dermal, bronchial, cartilagin-
ous, osseous and brain tissue was determined by histopathology
(Fig. 2). Patient recovered after surgery without complication.
Abdominal cystic masses in pediatric age group include choledo-
chal cysts, cystic diseases of kidney, lymphangioma, duplication
cyst, cystic teratoma, pseudocyst, pancreatic cyst, hydatid cyst,
ovarian cyst and urachal cyst. CT findings in mature cystic tera-
toma include fat (areas with very low Hounsfield values) in 93% of
the cases (Fig. 1). [1].
Mature cystic teratoma is the most common ovarian tumor
in young females. It is almost benign and asymptomatic [2].
Definitive diagnosis will be made at the time of surgical exci-
sion [3]. Surgery is the mainstay of treatment. Malignant trans-
formation of mature cystic teratoma is rare [4].
KEY LEARNING POINTS
•Computed tomography has excellent sensitivity to diagnose
mature cystic teratoma because of ability to detect fat.
•Definitive diagnosis of mature cystic teratoma will be made
at the time of surgical excision.
CONFLICT OF INTEREST STATEMENT
None declared.
REFERENCES
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2. Ayhan A, Bukulmez O, Genc C, Karamursel BS, Ayhan A.
Mature cystic teratomas of the ovary: case series from one
institution over 34 years. Eur J Obstet Gynecol Reprod Biol 2000;
880:153–7.
3. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic
teratoma of the ovary: diagnostic value of sonography. AJR
1998;171:1061–5.
4. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature
cystic teratoma: clinicopathologic evaluation of 517 cases and
review of the literature. Obstet Gynecol 1994;84:22–8.
Figure 2: Histopathological slide showing bone tissue (star) and cartilage tissue
(arrow).
Huge teratoma
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