Mature cystic teratoma without intratumoral fat: A diagnostic dilemma

Abstract

Teratomas are the most common benign ovarian neoplasms in young women. Typical computed tomography imaging findings include fat, fat fluid level, tooth or calcification, rokitansky nodule, floating balls sign, and tufts of hair. They can have unusual imaging features leading to diagnostic dilemmas. Studies have shown the presence of intratumoral fat to be specific to ovarian cystic teratoma. However, there are reports in the literature of mature cystic teratoma that do not contain fat in the lumen of the cyst which can hinder an accurate diagnosis. They can be associated with various complications like torsion, rupture, malignant transformation, infection, and autoimmune hemolytic anemias. Presented here is a case of mature cystic teratoma without visible intracystic fat which underwent torsion.

Keywords: CT; Dermoid; Intratumoral fat; Teratoma; Torsion.

Fig. 1

A 57-year-old who came with lower abdominal pain for 1 day. Coronal and sagittal sections show a large well defined abdominopelvic cystic thick walled lesion towards left side (red arrow).

Fig. 2

Axial CT images show chunky calcifications in the posterior aspect of the lesion. No septations or solid areas noted within the lesion (green arrow).

Fig. 3

Axial CT image shows the pedicle of the lesion appearing thickened, edematous and twisted (red star).

Fig. 4

Postcontrast axial CT image shows no significant contrast enhancement of the wall of the lesion as well as the pedicle.

Fig. 5

Histopathology specimens (At 2X and 40X original magnification using hematoxylin-eosin stain) show skin with keratinized squamous epithelium (yellow arrow), hair follicle (black arrow) and sebaceous gland (green star).