Discussion:
Mature cystic teratoma is one of the most germ cell neoplasms that
approximately includes 10-20 % of all ovarian neoplasms and 60 % of
all benign neoplasms. It is also known as benign cystic teratoma or
dermoid cyst [6,7]. Ectodermal element derivations are the most
predominant findings in the microscopic investigation of mature cystic
teratoma, but endodermal and mesodermal elements also can be found
[2]. Mature cystic teratoma may contain hair follicles, skin, sweat
glands, bones, teeth, nails, sebum, and blood. Dermoid cysts may be
asymptomatic or present with abdominal pain, discomfort, and swelling
due to cyst enlargement and compressive effect or cyst wall rupturing
and secretion of its contents into the abdominal cavity [1,8].
According to advances in diagnostic methods, MCT over 10 cm is rare and
unusual. Ovarian cysts larger than 5 cm are called large; if they grow
more than 15 cm, they are called giant. MCT is a slow-growing cyst that
can grow between 1.8 to 4 mm yearly [2,9].
Numerous complications can occur due to this disease, such as: torsion
(16%), rupture (1-4%), malignancy (1-2%), infection (1%) and
autoimmune hemolytic anemia (<1%) [10,11]. Some studies
showed a relationship between size and the risk of malignant
transformation; however, it is a rare condition and occurs in just 2%
of cases, usually in older women [2].
There are different imaging methods to evaluate MCT, such as
ultrasonography, computed tomography (CT) scan, and magnetic resonance
imaging (MRI). However, the most widely used and available method is
ultrasonography, which can help physicians diagnose and evaluate this
problem early [1,2].
In this case, the surgical team faced a huge MCT, approximately 245 x
205 x 121 mm, which occupied large space of the abdominal cavity from
the right ovary to the epigastrium. After clinical investigation, and
due to the patient’s clinical presentation and general tenderness which
appeared during daily physical examination, which was caused by cystic
wall rupture, and based on the patient’s age, the surgical team
preferred salpingo-oophorectomy between other surgical methods and
removed it completely.