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Ovarian Teratoma


KEY FACTS

Terminology

  • Synonyms

    • Dermoid tumor, dermoid cyst, mature cystic teratoma

  • Definition

    • Teratomas made up of variety of parenchymal cell types from > 1 germ cell layer, usually all 3

Imaging

  • Best clue: Heterogeneous pelvic mass containing Ca²⁺, hair, fat, & cystic components

    • Bilateral in up to 15%

  • Typically well-defined margins without surrounding inflammatory changes

  • US 1st-line modality for female pelvic pain &/or mass

    • Multiple classic signs described for teratoma

      • –

        Dermoid plug: Echogenic nodule protruding into cyst

      • –

        Dermoid mesh: Linear/punctate echogenic foci of hair

      • –

        Tip of iceberg: Echogenic superficial interfaces obscure deeper components of mass

  • Radiographs showing tooth-like Ca² strongly suggestive

  • MR & CT best demonstrate fat, confirming teratoma

Clinical Issues

  • Most common ovarian germ cell tumor

  • Most common ovarian neoplasm < 20 years old

  • Often incidental finding on physical exam or during imaging for unrelated symptoms

    • With torsion or rupture, acute onset of pain typical

    • If large, may cause palpable mass, swelling, or urinary or gastrointestinal complaints

  • Treatment: Surgical resection, ovary-sparing surgery

    • Laparoscopic surgery preferred

  • Prognosis generally excellent following resection

  • Complications: Ovarian torsion, rupture causing chemical peritonitis (which can lead to severe adhesions), malignancy (2%), paraneoplastic encephalitis

AP radiograph of the abdomen shows several Ca²⁺ resembling teeth
in the pelvis of a 22-year-old woman with no current abdominal complaints. The right groin central venous catheter is for treatment of an unrelated chronic health condition.

Axial CECT in the same patient shows the well-encapsulated, mixed density mass in the left adnexa between the iliac vessels & the uterus. This combination of fat
& Ca²⁺
in the adnexal region is typical of an ovarian teratoma.

Longitudinal US of the left ovary in a 14-year-old girl shows a mixed cystic & solid mass with hyperechoic foci
& curvilinear septations.

Coronal SSFSE T2 MR in the same patient (performed for other medical issues) shows the heterogenous lesion centrally
within the left ovary. It was subsequently surgically shelled out of the ovary (i.e., an ovarian-sparing resection) & found to be a mature teratoma.

TERMINOLOGY

Definitions

  • Teratomas are made up of various parenchymal cell types from > 1 germ layer, usually all 3

    • Cells differentiate along various germ lines, essentially recapitulating any tissue of body

  • Term dermoid comes from skin-like lining found in many of these tumors

IMAGING

Radiographic Findings

  • May be occult

  • ± Ca²⁺; those resembling teeth or bone strongly suggest teratoma

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