1
|
Jane Chua K, Barr A, Prints M, Ruskin R, Brooks R. Management of ruptured ovarian teratoma mimicking advanced ovarian cancer. Gynecol Oncol Rep 2024; 53:101386. [PMID: 38596159 PMCID: PMC11001759 DOI: 10.1016/j.gore.2024.101386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/29/2024] [Accepted: 03/30/2024] [Indexed: 04/11/2024] Open
Abstract
•Chronic chemical peritonitis caused by spontaneous rupture of a mature cystic teratoma may result in prolonged hospitalization and respiratory decline and can mimic a gynecologic malignancy.•Earlier surgical intervention for mature teratoma may prevent morbidity.•Inclusion of a gynecologic oncologist is advised for management discussions and/or surgical back-up.•Complex benign gynecologic surgeries may have some benefit for gynecologic oncologic trainees, which can be used for later oncologic cases.
Collapse
Affiliation(s)
- Katherine Jane Chua
- University of California, Davis Medical Center, Department of Gynecology Oncology, USA
| | - Alice Barr
- University of California, Davis Medical Center, Department of Gynecology Oncology, USA
| | - Miranda Prints
- University of California, San Francisco Fresno, Department of Obstetrics and Gynecology, USA
| | - Rachel Ruskin
- University of California, Davis Medical Center, Department of Gynecology Oncology, USA
| | - Rebecca Brooks
- University of California, Davis Medical Center, Department of Gynecology Oncology, USA
| |
Collapse
|
2
|
Abstract
Ovarian germ cell tumors are a diverse group of benign and malignant neoplasms that occur in a wide age range, but with a predilection for younger age group. The majority are represented by the frequently encountered mature cystic teratomas. Malignant germ cell tumors are uncommon, and in some cases have a characteristic clinical presentation. However, from a histologic standpoint these tumors can sometimes be challenging to diagnose due to overlapping morphology with epithelial, and in some cases sex cord tumors. In these cases, a panel of immunohistochemical stains often facilitates the correct diagnosis. This review article discusses the clinicopathologic findings and pertinent ancillary studies of both common and uncommon germ cell tumors of the ovary.
Collapse
Affiliation(s)
- Preetha Ramalingam
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas. USA.
| |
Collapse
|
3
|
Ruptured dermoid cyst of ovary developing into chronic peritonitis; a rare complication diagnosed by contrast CT: A case study. Ann Med Surg (Lond) 2022; 82:104700. [PMID: 36268424 PMCID: PMC9577650 DOI: 10.1016/j.amsu.2022.104700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/05/2022] [Accepted: 09/09/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction Dermoid cyst also called Mature cystic teratoma is the most common ovarian germ cell tumor of pre-menopausal females, composed of skin, hair, teeth, and sebum covered by thick fibrous tissue. It can present with complications like torsion, rupture, infection, and autoimmune hemolytic anemia. The case highlights the role of imaging in the diagnosis of ruptured dermoid cyst which can have subtle clinical features. Case Presentation Herein we present a case of 53 years multiparous postmenopausal female who presented with lower abdominal pain. Examination findings at presentation were normal. 2 years back patient was evaluated for the abdominopelvic mass which was diagnosed radiologically as an ovarian dermoid cyst. This time, Ultrasonography (USG) of the abdomen and pelvis followed by Contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed the features consistent with a ruptured dermoid cyst. Exploratory laparotomy and histopathological examination of the specimen confirmed the diagnosis. Clinical Discussion Rupture of a dermoid cyst is a very infrequent complication. Following rupture patient may present with peritonitis which may be acute or chronic. Chronic peritonitis may not show any clinically distinguishable features such that the clinical diagnosis of the rupture dermoid cyst is difficult to make. The radiological assessment helps to make an accurate diagnosis so that appropriate surgical intervention can be instituted. Conclusion Following the rupture of the dermoid patients may progress to a stage of chronic peritoneal inflammation. At this stage, the radiological assessment may be crucial for appropriate diagnosis and thus further management. Dermoid cyst is the most common ovarian germ cell tumor of pre-menopausal females. Rupture of an ovarian dermoid cyst is a rare complication. Rupture of the dermoid cyst may present with very subtle and marginal symptoms that are not clinically distinguishable. The ruptured teratoma can be accurately diagnosed by the contrast CT and hence the appropriate management can be made.
Collapse
|
4
|
Granulomatous peritonitis caused by iatrogenic spillage of ovarian dermoid cystectomy: a case report and literature review. Obstet Gynecol Sci 2020; 63:543-547. [PMID: 32550736 PMCID: PMC7393756 DOI: 10.5468/ogs.19189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/18/2019] [Indexed: 12/30/2022] Open
Abstract
A 39-year-old nulliparous woman experienced continuous mild fever and abdominal pain since undergoing laparoscopic ovarian dermoid cystectomy 3 months previously in a local hospital. Abdominal computed tomography revealed diffuse heterogeneous fat infiltrations with numerous micronodules in the greater and lesser omentum, combined with ascites with thickening of the parietal peritoneum. The patient underwent exploratory laparoscopy, which included partial pelvic peritonectomy, excision of granulomas, and adhesiolysis with massive irrigation. The patient was treated successfully with laparoscopic surgery and all reproductive structures were spared without operative complications. To avoid peritonitis, complete removal of cyst contents and massive irrigation should be performed during ovarian dermoid cystectomy. Conservative surgical treatment may be a good choice for treating granulomatous peritonitis induced by iatrogenic rupture.
Collapse
|
5
|
Bužinskienė D, Mongirdas M, Mikėnas S, Drąsutienė G, Andreika L, Sakalauskaitė I. Chemical peritonitis resulting from spontaneous rupture of a mature ovarian cystic teratoma: a case report. Acta Med Litu 2019; 26:217-226. [PMID: 32355460 DOI: 10.6001/actamedica.v26i4.4207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Mature cystic teratomas (dermoid cysts) are the most common germ cell tumours with 10-25% incidence of adult and 50% of paediatric ovarian tumours. The aetiology of dermoid cysts is still unclear, although currently the parthenogenic theory is most widely accepted. The tumour is slow-growing and in the majority of cases it is an accidental finding. Presenting symptoms are vague and nonspecific. The main complication of a dermoid cyst is cyst torsion (15%); other reported complications include malignant transformation (1-2%), infection (1%), and rupture (0.3-2%). Prolonged pressure during pregnancy, torsion with infarction, or a direct trauma are the main risk factors for a spontaneous dermoid rupture that can lead to acute or chronic peritonitis. The diagnosis of mature cystic teratoma is often made in retrospect after surgical resection of an ovarian cyst, because such imaging modalities as ultrasound, computer tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign and malignant pathology. Materials and methods We present a report of a clinical case of a 35-years-old female, who was referred to the hospital due to abdominal pain spreading to her feet for three successive days. She had a history of a normal vaginal delivery one month before. Abdominal examination revealed mild tenderness in the lower abdomen; no obvious muscle rigidity was noted. Transvaginal ultrasound showed a multiloculated cystic mass measuring 16 × 10 cm in the pelvis. In the absence of urgency, planned surgical treatment was recommended. The next day the patient was referred to the hospital again, with a complaint of stronger abdominal pain (7/10), nausea, and vomiting. This time abdominal examination revealed symptoms of acute peritonitis. The ultrasound scan differed from the previous one. This time, the transvaginal ultrasound scan revealed abnormally changed ovaries bilaterally. There was a large amount of free fluid in the abdominal cavity. The patient was operated on - left laparoscopic cystectomy and right adnexectomy were performed. Postoperative antibacterial treatment, infusion of fluids, painkillers, prophylaxis of the thromboembolism were administered. The patient was discharged from the hospital on the seventh postoperative day and was sent for outpatient observation. Results and conclusions Ultrasound is the imaging modality of choice for a dermoid cyst because it is safe, non-invasive, and quick to perform. Leakage or spillage of dermoid cyst contents can cause chemical peritonitis, which is an aseptic inflammatory peritoneal reaction. Once a rupture of an ovarian cystic teratoma is diagnosed, immediate surgical intervention with prompt removal of the spontaneously ruptured ovarian cyst and thorough peritoneal lavage are required.
Collapse
Affiliation(s)
- Diana Bužinskienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | - Saulius Mikėnas
- Clinic of Gastroenterology, Nephro-Urology and Surgery, Centre of Urology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Urology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Gražina Drąsutienė
- Clinic of Obstetrics and Gynaecology, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Linas Andreika
- Centre of Obstetrics and Gynaecology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Indrė Sakalauskaitė
- Clinic of Rheumatology, Orthopaedics Traumatology and Reconstructive Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Centre of Plastic and Reconstructive Surgery, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| |
Collapse
|
6
|
Badru F, Saxena S, Munoz-Abraham AS, Guzman MA, Bansal S, Chatoorgoon K. Peritoneal Nodules in a Pediatric Patient with Benign Teratoma. A Case Report and Review of Literature. J Pediatr Adolesc Gynecol 2018; 31:632-636. [PMID: 29990549 DOI: 10.1016/j.jpag.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 06/29/2018] [Accepted: 07/02/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Mature ovarian teratomas are common in children. These well differentiated tumors are typically confined to the ovary. In rare cases, they can rupture leading to granulomatous peritonitis that mimics carcinomatosis. Ovarian tumors with peritoneal/omental implants suggest malignant pathology with a different prognosis. CASE A 15-year-old girl presented with 5 months of abdominal pain, and weight loss. Computed tomography (CT) imaging of the abdomen revealed a large mass filling the abdomen. Slightly elevated lactate dehydrogenase (LDH) and carcinoma antigen 125 (CA125). On laparotomy an ovarian tumor with peritoneal and omental implants was identified. Left salpingo-oophorectomy, omentectomy, and peritoneal washing were performed. Pathology revealed a benign cystic teratoma. SUMMARY AND CONCLUSION Although ovarian teratomas are typically benign, they might mimic carcinomatosis. In patients with unexpected finding of peritoneal implants, histologic diagnosis is recommended before proceeding with a full oncologic ovarian resection.
Collapse
Affiliation(s)
- Faidah Badru
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| | - Saurabh Saxena
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| | - Armando Salim Munoz-Abraham
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri.
| | - Miguel A Guzman
- Department of Pathology, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| | - Samiksha Bansal
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| | - Kaveer Chatoorgoon
- Department of Pediatric Surgery, Cardinal Glennon Children's Medical Center, Saint Louis University School of Medicine, St Louis, Missouri
| |
Collapse
|
7
|
Iatrogenic Teratoma Rupture during TVOR Complicated with Peritonitis, Pleuritis, and Septic Shock. Case Rep Obstet Gynecol 2018; 2018:3126436. [PMID: 30275993 PMCID: PMC6151369 DOI: 10.1155/2018/3126436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Accepted: 08/09/2018] [Indexed: 11/24/2022] Open
Abstract
Objective To obtain a better understanding of the clinical course and the subsequent complications of teratoma rupture. Case We report a rare case of chemical peritonitis and pleuritis caused by teratoma rupture during ultrasonographically guided transvaginal oocyte retrieval (TVOR). The patient initially presented with nonspecific and digestive symptoms after TVOR, but the condition deteriorated rapidly after three weeks with peritonitis and septic shock. Thus, exploratory laparoscopy was performed with the findings of a ruptured teratoma at left adnexa, severe adhesions, and purulent fluid in her peritoneal cavity. Bilateral pleuritis was also noted after the operation, which was suspected to be caused by chemical irritation of the spilled contents of the teratoma. The patient's condition improved after surgical treatment and was discharged 28 days after admission. Conclusion Our case showed that the timing of peritoneal irritation caused by teratoma rupture converting to severe chemical peritonitis was approximately 3 weeks. Physicians should avoid cyst puncture during TVOR and closely observe or even perform surgical treatment when iatrogenic teratoma ruptures are suspected.
Collapse
|
8
|
Iftikhar H, Idu S, Omer A. Teratodermoid mimicking cholecystitis. Clin Case Rep 2016; 4:494-8. [PMID: 27190615 PMCID: PMC4856244 DOI: 10.1002/ccr3.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 06/01/2015] [Accepted: 08/13/2015] [Indexed: 11/16/2022] Open
Abstract
An acute abdomen assessment in pregnancy is complicated. Pain can have obstetric and nonobstetric causes. Cholecystitis is a common cause of pain in pregnancy with significant morbidity if not managed promptly. We report a case of a ruptured, torted, right ovarian teratodermoid erroneously diagnosed as cholecystitis in pregnancy.
Collapse
Affiliation(s)
- Hina Iftikhar
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Shareen Idu
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| | - Abdel Omer
- Surgery Ipswich Hospital NHS trust Ipswich Suffolk UK
| |
Collapse
|
9
|
Infliximab for the treatment of granulomatous peritonitis. Dig Dis Sci 2013; 58:3397-9. [PMID: 23817923 DOI: 10.1007/s10620-013-2726-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/15/2013] [Indexed: 12/09/2022]
|
10
|
A case of chemical peritonitis and pleuritis caused by spontaneous rupture of a benign cystic ovarian teratoma that improved without surgical intervention. Clin J Gastroenterol 2013; 6:274-80. [PMID: 26181730 DOI: 10.1007/s12328-013-0391-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
Rupture of a benign cystic ovarian teratoma may result in severe chemical granulomatous peritonitis, a condition mimicking peritonitis carcinomatosa, with patients complaining of common abdominal symptoms. As the precipitating cause of rupture is often indeterminate and the rupture itself is hard to recognize, it is difficult to differentiate from peritonitis of other etiologies, such as gastrointestinal malignancy. We report the case of a 72-year-old female who presented with recurrent pyrexia and abdominal distension. Laboratory data showed signs of inflammation and a high level of carbohydrate antigen 125. Imaging examinations showed left-side-dominant pleural effusion, ascites with peritoneal adhesions, and a left cystic ovarian teratoma. Repeat paracentesis of both the pleural effusion and ascites demonstrated exudative characteristics, but there was no indication of malignancy or signs of infection, including those of tuberculosis. Although exploratory laparotomy was then recommended for conclusive diagnosis and ruling out such gynecological malignancy, the patient declined. Fortunately, laboratory data, radiological images, and other clinical findings gradually improved over the following 12 months. Moreover, a retrospective review of the computed tomography images revealed lipid particles in the ascites, indicative of teratoma rupture. The final diagnosis was chemical peritonitis and pleuritis caused by spontaneous rupture of the benign cystic teratoma. The present case was extremely rare with regard to its diagnosis and clinical progression. Our experience suggests that chemical peritonitis should be included in the differential diagnosis of peritonitis.
Collapse
|
11
|
Liu DSH, Mignanelli E. Granulomatous peritonitis after ruptured teratoma mimicking peritoneal carcinomatosis. ANZ J Surg 2012. [DOI: 10.1111/j.1445-2197.2012.06307.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- David Shi Hao Liu
- Department of Surgery; Austin Hospital; Heidelberg; Victoria; Australia
| | - Emilio Mignanelli
- Department of General Surgery; Royal Hobart Hospital; Hobart; Tasmania; Australia
| |
Collapse
|
12
|
Lee AY, Poder L, Qayyum A, Wang ZJ, Yeh BM, Coakley FV. Imaging malignant and apparent malignant transformation of benign gynaecological disease. Clin Radiol 2010; 65:1031-7. [PMID: 21070909 DOI: 10.1016/j.crad.2010.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2010] [Revised: 07/07/2010] [Accepted: 07/14/2010] [Indexed: 11/17/2022]
Abstract
Common benign gynaecological diseases, such as leiomyoma, adenomyosis, endometriosis, and mature teratoma, rarely undergo malignant transformation. Benign transformations that may mimic malignancy include benign metastasizing leiomyoma, massive ovarian oedema, decidualization of endometrioma, and rupture of mature teratoma. The aim of this review is to provide a contemporary overview of imaging findings in malignant and apparent malignant transformation of benign gynaecological disease.
Collapse
Affiliation(s)
- A Y Lee
- Department of Radiology, University of California San Francisco, San Francisco, CA 94143-0628, USA
| | | | | | | | | | | |
Collapse
|
13
|
Malignant transformation of a mature cystic teratoma of the ovary with rupture. Jpn J Radiol 2010; 28:372-5. [PMID: 20585926 DOI: 10.1007/s11604-010-0434-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Accepted: 02/26/2010] [Indexed: 10/19/2022]
Abstract
Malignant transformation or tumor rupture is a rare complication of ovarian mature cystic teratomas. We present computed tomography (CT) images of a 52-year-old woman that revealed a large, predominantly cystic mass filled with fat and enhanced solid components located in the lower abdomen. Ten days later, the cystic mass ruptured, and massive ascites was observed on magnetic resonance imaging (MRI). Resulting from the rupture, MRI revealed reduced size and thickening wall of the tumor. After resection, the mass ruptured, and malignant transformation (squamous cell carcinoma) was observed. To our knowledge, there are no reports describing before and after images of a ruptured cystic teratoma with malignant transformation.
Collapse
|
14
|
Tanaka Y, Hori H, Gorai I. Chemical peritonitis caused by an iatrogenic rupture of mature cystic teratoma of the ovary during labor: a report of a case didactic to all the maternity health care workers. J Matern Fetal Neonatal Med 2010; 24:388-90. [PMID: 20459340 DOI: 10.3109/14767058.2010.482626] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A 37-year-old postpartum woman was presented with abdominal pain supposed to be caused by uterine involution or puerperal endometritis after vaginal delivery. During the pregnancy, she was suspected to have a subserosal myoma by ultrasound examination. The pain was finally revealed to be originated from the chemical peritonitis caused by the rupture of the mature cystic teratoma of the ovary by Kristeller's maneuver performed during vaginal delivery. When a pregnant or puerperal woman complains about abdominal pain, we need to consider the possibility of chemical peritonitis resulting from the rupture of mature cystic teratoma of the ovary.
Collapse
Affiliation(s)
- Yaku Tanaka
- Department of Obstetrics and Gynecology, Hori Hospital, Yokohama City, Kanagawa Prefecture, Japan.
| | | | | |
Collapse
|
15
|
Wang PC, Yang TL, Pan HB. CT images of a malignant-transformed ovarian mature cystic teratoma with rupture: a case report. Korean J Radiol 2009; 9:458-61. [PMID: 18838856 PMCID: PMC2627209 DOI: 10.3348/kjr.2008.9.5.458] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A malignant transformation or a tumor rupture is a rare complication of ovarian mature cystic teratoma (MCT). A tumor rupture in a malignant-transformed MCT has never been reported in the literature. We present the CT images of a 39-year-old woman showing a large, predominantly cystic mass in the lower abdomen, with fat-fluid-level ascites. A contrast-enhanced solid component, with regional discontinuity within the cystic lesion, is also demonstrated. The pathologic diagnosis of the ruptured MCT unveils the malignant transformation (squamous cell carcinoma) and mesenteric carcinomatosis.
Collapse
Affiliation(s)
- Po Chin Wang
- Department of Radiology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | | | | |
Collapse
|
16
|
Maiti S, Fatima Z, Anjum ZK, Hopkins RE. Ruptured ovarian cystic teratoma in pregnancy with diffuse peritoneal reaction mimicking advanced ovarian malignancy: a case report. J Med Case Rep 2008; 2:203. [PMID: 18549490 PMCID: PMC2435545 DOI: 10.1186/1752-1947-2-203] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2007] [Accepted: 06/12/2008] [Indexed: 11/25/2022] Open
Abstract
Introduction This case illustrates the unusual complication of granulomatous peritonitis following rupture of a dermoid cyst in pregnancy resembling disseminated ovarian carcinoma. To the best of the authors' knowledge, this is the first report of this complication during advanced pregnancy in the literature. Case presentation A dermoid cyst ruptured during surgical removal in the second trimester of pregnancy in a 27-year-old primigravida. Postoperatively the patient suffered pulmonary embolism and leakage of sebaceous material through the abdominal wound. She gradually developed significant abdominal distension, gastrointestinal symptoms and lost more than 8 kg of weight in the 12 weeks postoperatively. The baby was delivered at 31 weeks by a technically challenging caesarean section owing to severe dense adhesions obscuring the uterus. Bowel resection was performed for suspected malignant infiltration and adhesion causing obstruction. She had a protracted convalescence with an ileostomy and mucus fistula. Histology confirmed granulation without malignancy. One year following the surgical treatment, she had recovered well and was planning her next pregnancy. Conclusion Although granulomatous peritonitis following rupture of a dermoid cyst is very rare, awareness is the key to diagnosis and appropriate management. Per-operative frozen section may be helpful.
Collapse
|
17
|
Maurer T, Schnelzer A, Kremer M, May F, Hartung R. Kolikartige Unterbauchbeschwerden durch reifes Ovarialteratom. Urologe A 2007; 46:284-6. [PMID: 17068669 DOI: 10.1007/s00120-006-1206-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Colicky lower abdominal pain can have several causes. Besides the typical urological reasons, differential diagnosis should include surgical, internal, and gynecological causes. In particular, in cases of ambiguous calcifications on plain abdominal films - as shown in the presented case - a mature teratoma of the ovary should be taken into consideration.
Collapse
Affiliation(s)
- T Maurer
- Urologische Klinik und Poliklinik, Technische Universität, Ismaninger Strasse 22, 81675, München, Deutschland.
| | | | | | | | | |
Collapse
|