Ovarian Teratoma

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Clinical :
Cystic teratomas are commonly asymptomatic, although pain may result in the event of torsion or rupture. Larger lesions may produce an abdominal mass or swelling.

Ultrasonography :
Sonographically, dermoids can range from totally anechoic to a hyperechoic mass. Most commonly, they appear as complex masses. The majority of dermoids are very echogenic and they may shadow. Benign cystic teratomas characteristically show an anechoic cystic component and a shadowing density that corresponds to a dermoid plug. Strong acoustic attenuation occurs in the presence of bone, teeth, and hair in the plug, sometimes producing the "tip-of-the-iceberg" sign. This intensely echogenic focus is the cystic teratoma's most defining feature. Other distinctive sonographic features include a fat-fluid level and hyperechoic lines and dots generated by hair. The size of the dermoid plug varies from a few mm to that occupying the entire mass.
Color Doppler sonography may be helpful in differentiation of benign and malignant cystic teratomas. Blood flow in benign cystic teratomas is typically found only in the periphery because the cyst contains mostly avascular fat and hair. Conversely, malignant teratomas show intratumoral blood flow significantly more frequently than benign teratomas, with the exception of struma ovarii, a rare and typically benign form of cystic teratoma that contains highly vascular thyroid tissue .

Differential :
Benign cystic teratomas have variable appearances that may mimic hemorrhagic cysts, endometriomas, primary ovarian neoplasms, and metastatic tumors. Teratomas, however, often have two or more features characteristic of dermoids, and sonographically similar lesions usually have no more than one. Différential :
* Haemorrhagic ovarian cyst.
* Endometrioma.
* Fibroma and fibrothecoma.
* Arrhenoblastoma.
* Granulosa cell tumour.
* Mucinous or serous cystadenomas or cystadenocarcinoma.
* Endometroid carcinoma.
* Adenocarcinoma without serous or mucous collection.
* Krukenberg's tumeurs.
* Lymphoma of ovaries.

Treatment :
Cystic teratomas are often surgically removed, but because of their typically slow growth rate, patient fertility concerns may be considered. Wherever possible, lesions are excised without removal of the involved ovary; in fact, surgery can sometimes be delayed until patients have completed their families.

Reference :
* 1: Cass DL. Ovarian torsion. Semin Pediatr Surg. 2005 May;14(2):86-92.
* 2: Kocak M, Dilbaz B, Ozturk N, Dede S, Altay M, Dilbaz S, Haberal A. Laparoscopic management of ovarian dermoid cysts: a review of 47 cases. Ann Saudi Med. 2004 Sep-Oct;24(5):357-60.
* 3: de Silva KS, Kanumakala S, Grover SR, Chow CW, Warne GL. Ovarian lesions in children and adolescents--an 11-year review. J Pediatr Endocrinol Metab. 2004 Jul;17(7):951-7. Review.
* 4: Sait K, Simpson C. Ovarian teratoma diagnosis and management: case presentations. J Obstet Gynaecol Can. 2004 Feb;26(2):137-42.
* 5: Wu TT, Wang HC, Chang YC, Lee YC, Chang YL, Yang PC. Mature mediastinal teratoma: sonographic imaging patterns and pathologic correlation. J Ultrasound Med. 2002 Jul;21(7):759-65.
* 6: Zalel Y, Seidman DS, Oren M, Achiron R, Gotlieb W, Mashiach S, Goldenberg M. Sonographic and clinical characteristics of struma ovarii. J Ultrasound Med. 2000 Dec;19(12):857-61.
* 7: Serafini G, Quadri PG, Gandolfo NG, Gandolfo N, Martinoli C, Derchi LE. Sonographic features of incidentally detected, small, nonpalpable ovarian dermoids. J Clin Ultrasound. 1999 Sep;27(7):369-73.
* 8: Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratomas of the ovary: diagnostic value of sonography. AJR Am J Roentgenol. 1998 Oct;171(4):1061-5.
* 9: Zalel Y, Caspi B, Tepper R. Doppler flow characteristics of dermoid cysts: unique appearance of struma ovarii. J Ultrasound Med. 1997 May;16(5):355-8.