Large, Complex, Benign Cystic Teratoma in an Adolescent
Large, Complex, Benign Cystic Teratoma in an Adolescent
Germ cell tumors make up 15% to 20% of all ovarian tumors, 95% of which are dermoid cysts, also known as benign cystic teratomas. Primarily ectodermally derived, tissues can grow from any of the germ cell layers. Tumors occur bilaterally in 10% of cases, and there appears to be an increased rate of sterility in patients with cystic teratomas. These tumors are found in women of reproductive age, undergo malignant transformation only rarely (<1%), and are most conducive to surgical cure.
We report an unusual case of an asymptomatic, advanced benign cystic teratoma in a young adolescent.
A 14-year-old girl, who was born at home, had her first interaction with the medical system when she arrived complaining of a possible abdominal tumor. During the previous 6 months she had noticed an increasing fullness in her abdomen, which had progressed to the point that it was difficult for her to take a deep breath. Other than a physically enlarged abdomen, there had been no dyspepsia or nausea, pain, constipation or diarrhea, fever, fatigue, or other constitutional symptoms. She reported no unusual weight gain or loss. Her menses had been regular, and she was not sexually active.
The patient was in no acute distress; she was alert and oriented, pleasant, with a full affect, and exhibited a more mature interaction than many adolescents her age. When examined, she had a distended abdomen consistent with a full-term pregnancy. Her abdomen was not tender and had normal bowel sounds. There was an equivocal fluid wave. Findings on examination of her heart and lung were unremarkable. She had a normal vulva with an intact hymenal ring. Her cervix was nulliparous, and there was no cervical motion tenderness or discharge. Her adnexa were not tender, and her ovaries were not palpably distinct from a pelvic abdominal mass. A urine chorionic gonadotropin assay was negative for pregnancy, and an abdominal plain film (Figure 1) showed left-sided opacities consistent with Rokitansky nodules. The diagnosis of a large dermoid cyst was made.
(Enlarge Image)
Figure 1.
Abdominal plain film showing Rokitansky nodules.
(Enlarge Image)
Figure 2.
Patient's abdominal profile (a) before and (b) after excision of the dermoid cyst.
The cyst, which was opened in the operating room, was an exceptionally complex structure of multiloculation and cysts within cysts, each filled with fluids of differing colors, consistencies, and viscosities. There was more than 2.5 L of additional fluid. The cyst also contained a great amount of sebaceous material and hair (Figure 3). Several tooth-like structures were grossly apparent.
(Enlarge Image)
Figure 3.
Gross appearance of the dermoid cyst with large quantities of hair and sebaceous material.
Histologically, this large dermoid cyst was composed of tissues derived from all germ layers: respiratory mucosa with bronchial type cartilage, squamous mucosa, gastric mucosa, intestinal mucosa, prominent skin and skin adnexal structures, fat, smooth muscle, tooth-like structures, and mature central nervous system-type tissue. There was no evidence of immature elements or malignancy.
Germ cell tumors make up 15% to 20% of all ovarian tumors, 95% of which are dermoid cysts, also known as benign cystic teratomas. Primarily ectodermally derived, tissues can grow from any of the germ cell layers. Tumors occur bilaterally in 10% of cases, and there appears to be an increased rate of sterility in patients with cystic teratomas. These tumors are found in women of reproductive age, undergo malignant transformation only rarely (<1%), and are most conducive to surgical cure.
We report an unusual case of an asymptomatic, advanced benign cystic teratoma in a young adolescent.
Case Report
A 14-year-old girl, who was born at home, had her first interaction with the medical system when she arrived complaining of a possible abdominal tumor. During the previous 6 months she had noticed an increasing fullness in her abdomen, which had progressed to the point that it was difficult for her to take a deep breath. Other than a physically enlarged abdomen, there had been no dyspepsia or nausea, pain, constipation or diarrhea, fever, fatigue, or other constitutional symptoms. She reported no unusual weight gain or loss. Her menses had been regular, and she was not sexually active.
The patient was in no acute distress; she was alert and oriented, pleasant, with a full affect, and exhibited a more mature interaction than many adolescents her age. When examined, she had a distended abdomen consistent with a full-term pregnancy. Her abdomen was not tender and had normal bowel sounds. There was an equivocal fluid wave. Findings on examination of her heart and lung were unremarkable. She had a normal vulva with an intact hymenal ring. Her cervix was nulliparous, and there was no cervical motion tenderness or discharge. Her adnexa were not tender, and her ovaries were not palpably distinct from a pelvic abdominal mass. A urine chorionic gonadotropin assay was negative for pregnancy, and an abdominal plain film (Figure 1) showed left-sided opacities consistent with Rokitansky nodules. The diagnosis of a large dermoid cyst was made.
(Enlarge Image)
Figure 1.
Abdominal plain film showing Rokitansky nodules.
(Enlarge Image)
Figure 2.
Patient's abdominal profile (a) before and (b) after excision of the dermoid cyst.
The cyst, which was opened in the operating room, was an exceptionally complex structure of multiloculation and cysts within cysts, each filled with fluids of differing colors, consistencies, and viscosities. There was more than 2.5 L of additional fluid. The cyst also contained a great amount of sebaceous material and hair (Figure 3). Several tooth-like structures were grossly apparent.
(Enlarge Image)
Figure 3.
Gross appearance of the dermoid cyst with large quantities of hair and sebaceous material.
Histologically, this large dermoid cyst was composed of tissues derived from all germ layers: respiratory mucosa with bronchial type cartilage, squamous mucosa, gastric mucosa, intestinal mucosa, prominent skin and skin adnexal structures, fat, smooth muscle, tooth-like structures, and mature central nervous system-type tissue. There was no evidence of immature elements or malignancy.
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