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.