\nThis is a 20-year old female who visited the emergency department because of pain in the left lower quadrant of her abdomen. She had no significant past medical problems, but on examination had an excessive amount of hair on her lips, chest, and lower belly. Her pubic hair, though also excessive, was feminine in its distribution. While in the emergency department she had\u00a0contrast-enhanced CT scan\u00a0of her abdomen and pelvis, but had no other imaging studies. Measurements of her testosterone while on admission were normal. Later, she underwent open laparotomy and had her abdominal mass removed.<\/span><\/p>\n
Radiologic findings<\/span><\/strong><\/p>\n This is a single axial section through the patient’s false pelvis showing a midline, thin-walled (1mm), complex\u00a0 mass. The mass measures 12cm\u00a0x 13cm x 13cm and at\u00a0its 10 to 12 o\u2019clock position is a heterogeneous mass of tissue (Rokitansky protuberance, dermoid plug) comprising a high-density rectangular structure (coarse calcification, mal-formed tooth), and lobules of tissue isodense to subcutaneous fat (fat). The preponderance of the mass, however, is hypodense to enhanced muscle but slightly hyperdense to noncontrast urine (not shown); it is fatty debris. The mass is anterior to the rectum, straddles the pelvis and displaces the small bowel to the sides. The ovaries are not discernible. The appearance of the mass is pathognomonic for a mature teratoma.<\/strong><\/span><\/p>\n Differential radiologic diagnosis<\/span><\/strong> Gross pathologic findings<\/span><\/strong> Final pathologic diagnosis<\/span><\/strong> Discussion<\/span><\/strong> Teratomas are the most common tumors of the ovary in children and adolescents although they may present at any age in life. They may be mature (cystic) or immature (solid, a.k.a embryonal) and carry a 0.25-1.5% risk of malignant degeneration, representing 1% of malignant ovarian tumors. The risk of malignant degeneration is predicted by the presence of neuroectodermal remnants, which the present case lacks. <\/span><\/p>\n Two-thirds (67%) of the cases present as an abdominal mass (as in this case) and 10% \u2013 15% are bilateral. Other modes of presentation include abdominal pain (our case), ovarian torsion, nausea, vomiting and, rarely, ascites. There may be\u00a0rare association with hyperprolactinemia, hemolytic anemia, hyperthyroidism (struma ovarii) or Mayer-Rokitansky-Kuster-Hauser syndrome. The latter consists of a lack of mullerian development, congenital absence of the vagina and rudimentary uterus (typically bicornuate remnants), with normal uterine tubes, ovaries,\u00a0secondary female sex characteristics and normal growth.\u00a0 There was mention to me by one of the patient’s physicians that she had a small uterus and was hirsute. I doubt that we can invoke Mayer-Rokitansky-Kuster-Hauser syndrome in this case because of the absence of the other features and I doubt that her alleged hirsutism has any relationship to the teratoma. She recuperated well from her surgery and went home in good condition.<\/span><\/p>\n References<\/span><\/strong> History This is a 20-year old female who visited the emergency department because of pain in the left lower quadrant of her abdomen. She had no significant past medical problems, but on examination had an excessive amount of hair on her lips, chest, and lower belly. Her pubic hair, though also excessive, was feminine in […]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[48],"tags":[],"class_list":["post-1166","post","type-post","status-publish","format-standard","hentry","category-from-my-teaching-files","pmpro-has-access"],"_links":{"self":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1166","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=1166"}],"version-history":[{"count":14,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1166\/revisions"}],"predecessor-version":[{"id":2736,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=\/wp\/v2\/posts\/1166\/revisions\/2736"}],"wp:attachment":[{"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=1166"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=1166"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.medradclinics.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=1166"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}![\"benign_cystic_ovarian_teratoma1\"](\"\/wp-content\/uploads\/2013\/06\/benign_cystic_ovarian_teratoma1.jpg\")
<\/p>\n
\nThere is no differential diagnosis. The radiologic features of the lesion\u00a0are pathognomonic for benign cystic teratoma of the ovary.<\/span><\/p>\n
\nA large mass which on sectioning revealed:<\/span>
\n 1. Cheesy liquid debris.<\/span>
\n 2. A solitary tooth.<\/span>
\n 3. Thick golden-yellow congealed fatty tissue.<\/span>
\n 4. A loch of hair.<\/span>
\n Please see below.<\/span><\/p>\n![\"benign_cystic_ovarian_teratoma2\"](\"\/wp-content\/uploads\/2013\/06\/benign_cystic_ovarian_teratoma2.jpg\")
<\/p>\n
\nMature (Benign) Cystic Teratoma.<\/span><\/p>\n
\nTeratomas (teratos<\/em><\/strong>, Greek for monster) are congenital tumors of derivatives of all three germ layers. They arise from pluripotent embryonal cells and occur in the ovaries, testes, mediastinum, retroperitoneum, and the sacrococcygeal region, in order of decreasing frequency. The location of the tumor in our case suggests that it is ovarian in origin; presacral or retroperitoneal origins are less likely alternatives. <\/span><\/p>\n
\n1. Friedman AC, Pyatt RS, Hartman DS et al 1982. CT of benign cystic teratomas. AJR 138: 659-665.<\/span>
\n 2. Buy JN et al. Cystic Teratoma of the ovary: CT detection; Radiology 171: 699-701.\u00a0 1989<\/span>
\n 3. Kallenberg GA et al. Ectopic hyperprolactinemia resulting from an ovarian teratoma: JAMA, 263: 2472-2474.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"