Coexistence of Mature Cystic Teratoma and Endometrioma in An Ovarian Cyst - Coexistence of Mature Cystic Teratoma and Endometrioma in An Ovarian Cyst - Open Access Pub

A rare association mature cystic teratoma (MCT) with endometrioma in the left ovary is reported in English literature. Coexistence MCT and endometrioma in the same ovary is extremely rare and its diagnostic is a challenge clinically and radiologically. To our knowledge we report the third case coexistence of a nonneoplastic endometrioma and benign neoplastic mature cystic teratoma in ovary. DOI 10.14302/issn.2574-4526.jddd-17-1498 Association between mature cystic teratoma (MCT) and cyst endometrioma in the same ovary is extremely rare and less than five cases of this entity have been reported in the literature. Teratomas, habitually named dermoid cyst, predominantly occur in young women. They account for 10-20% of all ovarian tumors and are bilateral in 10 to 15 % of cases 1. They arise in the ovary but can be located at the midline and in paraxial regions of the body and unusual locations, including lungs or ilea, were described 2. Pathologically, they are composed of tissues derived from one or more of the three primitive germ layers and have often a cystic structure with a mean larger diameter of 8 cm. Typically it contains mature tissues of ectodermal (skin, brain), mesodermal (muscle, fat) and dermal (mucinous or ciliated epithelium) origin 3. The initial biological event that leads to teratoma is not yet understood. Stenens LC and Varnum DS,1974. 4 and Hiaro Y and Eppig JJ (1997) 5 postulated that teratomas were derived from oocytes that undergo maturation and spontaneous parthenogenic activation followed by embryonic development within the ovarian follicles. MCT is usually asymptomatic and doesn't have any specific symptoms. MCT can be associated with acute complications including torsion, rupture, infection or haemolytic anaemia 6. Malignant transformation occurs in 1% of cases 7. A transabdominal or transvaginal ultrasound reveals a large hyperechoic mass with posterior shadow-cone because of the sebaceous and hair materials or a hypoechoic cyst if it contains only sebaceous material liquid. The bones and teeth appear hyperechoic 8. MCT are sometimes difficult to distinguish on ultrasound from hemorrhagic cysts, mucinous cystic neoplasm and endometriomas 9. In these cases, the magnetic resonance imaging (MRI) plays an important role in diagnosis. Cystic teratoma appears as a large pelvic monocular cyst with a solid nodule named Rokitansky protuberance attached to a thin wall and protrudes in the cyst lumen. Figure 2 Standard T1 weighted images with fat saturated T1 weighted images establish the diagnosis when the fat removed and the fluid-fat