Ovarian Torsion Due to Mature Cystic Teratoma During the Early Postpartum Period: A Rare Case Report

Abstract

Mature cystic teratoma (MCT) is a benign and unilateral ovarian neoplasm usually seen in premenopausal women. Its most common complication, torsion, is a well-known cause of acute abdominal pain. However, it is rare in the early postpartum period. In this paper, we present a case of ovarian torsion due to MCT, which was diagnosed radiologically in the early postnatal period and surgically confirmed. A 25-year-old woman vaginally delivered a healthy baby on time and without any problems. She presented with acute abdominal pain in the right lower quadrant on the postpartum 5th day. Abdominal ultrasound (US) and computed tomography (CT) demonstrated an ovarian mass containing fat and calcification in the right adnexa and non-enhancing ovarian parenchyma. The patient was discharged on the 5th day after the salpingo-oophorectomy operation without any complications. US and CT provided crucial information to make an accurate and rapid management decision in ovarian torsion due to MCT.

Keywords: adnexal torsion; computed tomography; early postpartum; mature cystic teratoma; pregnancy.

Figure 1

Ultrasound (US) images of a 25-year-old woman with a mature cystic teratoma. B-mode transabdominal US image showing a heterogeneous lesion with an echogenic mural nodule (dermoid plug) (red arrow).

Figure 2

Axial contrast-enhanced abdominopelvic computed tomography images showing presence of enlarged uterus (red arrow) (A) consistent with early postpartum period and a normal appendix (red arrow) (B). Also note the non-enhancing ovarian mass (white arrow).

Figure 3

Axial contrast-enhanced abdominopelvic computed tomography image revealing intralesional fat (white arrow) and calcification (red arrow). Note the non-enhancing component of the lesion (arrowhead).

Figure 4

Surgical specimens showing unilocular cysts filled with sebaceous material, hair, and focal solid area with calcification area.

Figure 5

Low power microscopic view (A) showing tissue lined by stratified squamous epithelium with associated hair follicles and sebaceous glands. High power microscopic view (B) showing in the surface lined by stratified squamous epithelium with associated hair follicles and sebaceous glands. Microscopic (C); hair shaft material. Extensive hemorrhage, congestion, dilated blood vessels, and ischemia of mucosa and parenchyma (D).