Presentation
Palpable abdominal mass with abdominal pain
Patient Data
There is a large cystic hypodense mass lesion with minimal rim enhancement seen at the left-sided abdomen likely arising from the right ovary. Minimal fat component, tooth-like calcification, and thick internal septations were seen with this mass lesion. Anteriorly, the mass lesion is partially compressing the left abdominal wall muscle and causing minimal bulging of the left-sided abdominal wall. Posteriorly, the mass lesion is partially compressing the left psoas muscle. Clear demarcation is seen between the mass lesion and the uterus posteriorly. Medially, the mass lesion is displacing the urinary bladder dome to the right and compressing the distal sigmoid colon causing proximal large bowel distention. Laterally, the mass lesion is displacing the descending colon.
There is engorgement of the right parametrial vessels, unable to exclude torsion of the cystic mass lesion. No dilated gonadal veins bilaterally. The uterus is small in size and displaced posteriorly by the very distended urinary bladder. The left ovary is normal. No left adnexal lesion.
The liver, gallbladder, pancreas, spleen and adrenals are normal.
Mild hydronephrosis with hydroureter bilaterally. Abrupt tapering of the left distal ureter at the level of L5 vertebral body with mass effect from aforementioned left-sided abdominal mass lesion. No focal renal lesion, renal calculus or ureteric calculus bilaterally.
Minimal ascites in the pelvis.
No enlarged abdominal or pelvic lymphadenopathy.
The urinary bladder is very distended. No bladder calculus or thickened urinary bladder wall.
Case Discussion
Features are in keeping with mature cystic ovarian teratoma evidenced by fat, calcification, and cystic components.
The patient underwent an operation to remove a left ovarian cystic mass lesion. Intraoperative findings showed a large twisted right ovarian cystic mass. The left ovary and uterus are normal.
Histopathological examination shows:
MACROSCOPIC:
Received a collapsed cyst measuring 70 x 60 x 30 mm. Serial sections show a multiloculated cystic cavity containing straw-colored fluid measuring 30 mm to 75 mm in diameter. Also noted was a cystic cavity containing sebaceous material and hair, measuring 28 mm in maximum diameter. The cyst wall measures 1 mm to 4 mm thick.
MICROSCOPIC:
Sections show cyst wall lined by benign keratinized stratified squamous epithelium. There are thick walls containing skin appendages and adipose tissue, moderately infiltrated by lymphocytic inflammatory cells. Ovarian stroma is present. There are other cyst walls lined by flattened to cuboidal and mucinous columnar epithelium. Mature neuroglial tissue is seen. There is no immature component or evidence of malignancy.
INTERPRETATION:
Right ovary: benign mature cystic ovarian teratoma.
The patient recovered well after surgery and followed up in the pediatric surgical clinic.
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