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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 1  |  Page : 48-49

An unusual presentation of ovarian teratoma


1 Department of OBG, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India
2 Department of Pathology, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna-14, Bihar, India

Date of Web Publication10-Dec-2020

Correspondence Address:
Dipali Prasad
Assistant Professor, Department of Obst. & Gynae., Indira Gandh Institute of Medical Sciences, Sheikhpura, Patna - 14, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Benign cystic ovarian teratoma is the most common ovarian neoplasm accounting for 10-25% of all ovarian tumours. They may remain asymptomatic and may be discovered as an incidental finding on ultrasound of pelvis or can present as acute abdomen in case of torsion (16%), infection (1%) or rupture. It can rupture into the bladder, small bowel, rectum, sigmoid colon, vagina, anterior abdominal wall and peritoneal cavity[1]. Symptom develop once complication set in. Invasion into adjacent viscera such as the rectum, the small bowel, the peritoneum and the Urinary bladder is extremely rare. We present a rare case of mature cystic teratoma perforating into the urinary bladder. Presenting with irritative lower Urinary tract symptoms characterized by Urgency, frequency, dysuria, poor urinary stream.

Keywords: Ovarian teratoma, Urinary Bladder invasion


How to cite this article:
Prasad D, Smita, Nish S, Goel N, Choudhary V, Anshuman. An unusual presentation of ovarian teratoma. J Indira Gandhi Inst Med Sci 2018;4:48-9

How to cite this URL:
Prasad D, Smita, Nish S, Goel N, Choudhary V, Anshuman. An unusual presentation of ovarian teratoma. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2022 Jan 20];4:48-9. Available from: http://www.jigims.co.in/text.asp?2018/4/1/48/302985




  Case Report : Top


A 33 years old woman presented with a history of irritative lower Urinary tract symptoms, characterized by Urgency, frequency and dysuria along with a poor urine stream for the last 1 year as well as occasional episode of haematuria for last 6 months. She had regular menstrual cycle and three full term normal deliveries, last being 3 years ago after which she had under gone tubal ligation. On Per abdomen examination, suprapubic tenderness and lump of 14-week size was present. On vaginal examination, the Cervix was normal. A tender mass was felt through the anterior fornix approx. 4x5cm size. The mass was inseparable from the uterus. Right fornix free and left fornix tenderness was present. Routine haematological investigation were normal. The urine was chalky white and turbid. Examination of Urine revealed a large number of leukocytes and E. coli was grown on urine culture. Abdominal sonography suggested a mixed echogenic mass with irregular margins (size 48 x 44mm) in the Urinary bladder. Fine sand like granular structure was also seen. Bladder wall was thickened. The uterus and right Ovary were normal and no normal ovarian tissue was seen on the left side. A diagnosis of left Ovarian teratoma invading into the Urinary bladder was suggested. Computerized tomography(CT) revealed an irregular margin heterogenous enhancing complex solid cystic lesion of size 55x48x72mm size in left adnexa protruding into left lateral wall of Urinary bladder with some part in bladder lumen. The lesion showed heterogenous hypodense contents with areas of fat density and hyperdense tooth like structure likely mature ovarian teratoma. A confident diagnosis of a mature teratoma invading into urinary bladder was made. On cystoscopy, a 3-4cm mass with a with a tuft of hair in a whitish background attached to the dome of Urinary bladder was seen on the left side. Laparotomy was done. The uterus and right ovary were found normal. A left ovarian solid cystic mass was seen adhered with gut (sigmoid colon) and bladder. Gut adhesion was separated by blunt and sharp dissection. The left ovarian teratoma adherent to the bladder was separated during the procedure. The bladder was opened up and part of ovarian cyst in the bladder lumen was removed. Left side salpingo-oophorectomy was done and the Urinary bladder was closed in two layers. The catheter was removed on the 14th postoperative day. Post-operative period was uneventful. The patient voided with a good stream. Histopathological report of the specimen confirmed it as mature teratoma.
Figure 1: C.T Scan plate showing heterogenous enhancing lesion in left adnexa protruding into the lateral wall of Urinary Bladder with area of fat density and hyperdense tooth and soft tissue density- feature suggestive of Mature Teratoma

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Figure 2: C.T Scan plate showing heterogenous enhancing lesion in left adnexa protruding into the lateral wall of Urinary Bladder with area of fat density and hyperdense tooth and soft tissue density- feature suggestive of Mature Teratoma

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Figure 3: High power field showing area of glands and Low power field showing area of glands, adipose tissue and fibromuscular stroma a feature of Mature Teratoma

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Figure 4: High power field showing area of glands and Low power field showing area of glands, adipose tissue and fibromuscular stroma a feature of Mature Teratoma

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  Discussion : Top


Uncomplicated ovarian teratoma are usually asymptomatic, symptoms mostly appear after secondary complications develop. Reported complication include torsion (16%), rupture (1-4%), malignant transformation (1-2%), infection (1%), invasion into adjacent viscera and autoimmune haemolytic anaemia (<1%)[2]. Of these spontaneous ruptures into the adjacent viscera is one of the least common[3]. However, when such a communication occurs the Urinary bladder is the commonest site[4].

Patients with spontaneous rupture of dermoid cyst in bladder may present with complaints of passage of hair in urine (pilimiction), pyuria, repeated urinary tract infection, passage of other material from Ovarian teratoma and at times repeated episodes of urinary retention due to blockage of urethral meatus by hairs[5]. On ultrasound imaging, a mature Ovarian steratoma appears as a thick-walled cystic mass with echogenic contents and calcification[6]. CT scan is the preferred diagnostic tool as it clearly demonstrates fats with calcification[7]. Surgical resection of the lesion with bladder repair is the definitive treatment and histopathological examination is essential to exclude malignant transformation. A high index of suspicion along with the help of imaging modalities are needed to arrive at a correct preoperative diagnosis.



 
  References Top

1.
Sardesai S, Raghoji V, Dabade R, Sheikh H. Benign cystic teratoma of ovary perforating into urinary bladder: a rare case. J Obstet Gynaecol India2012; 62:S54-S55.  Back to cited text no. 1
    
2.
Park SB, KimJK, Kim KR,ChoKS. Imaging findingsof complications and unusal manifestations of ovarian teratomas. Radiographics2008; 28:969-983.  Back to cited text no. 2
    
3.
Godara R, Karwasra RK, Garg P, Sharma N. Pilimiction: A diagnostic symptom of ovarian dermoid cyst. Internet J Gynecol Obstet 2006;6(1).  Back to cited text no. 3
    
4.
Okada S, Ohaki Y, Inone K, Nakajo H, Kawamata H, Kumazaki T, Acase of dermoid cyst of the ovary with malignant transformation complicated with small intestinal fistula formation. Radiat Med Park, 2005;23:443-446.  Back to cited text no. 4
    
5.
Poopola AA, Adewole A, Ibikunle DE, Agboola JA, Buhari MO. Recurrent urinary retention in a woman from perforation of ovarian teratoma into urinary bladder: a case report. Androl Gynecol. Corr Res2013; 1:4.  Back to cited text no. 5
    
6.
Tandon, A., K. Gullería, et al. (2010). “Mature ovarian dermoid cyst invading the urinary bladder.” Ultrasound Obstet Gynecol 35(6): 751-753.  Back to cited text no. 6
    
7.
S. B., J. K. Kim, et al. (2008). “Imaging findings of complications and unusual manifestations of ovarian teratomas.” Radiographics 28(4): 969-983.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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