Carcinoma arising in a partially ruptured giant cystic terat
Mature cystic teratomas are the most common ovarian germ cell tumors and represent 70% of the benign ovarian tumors occurring in women under age 30. In less than 2% of cases, these tumors can transform into malignancies.

This case report, published in the Radiology Case Reports describes the common presentation, imaging, and pathologic findings of a mature cystic teratoma with 2 uncommon associated complications.

A 55-year-old postmenopausal woman presented to her gynecologist for her first routine exam in 10 years. She complained of vague abdominal fullness, early satiety, and 40 pound weight loss in the prior 8 months.

Upon presentation, the patient stated, she had a 3-day long episode of postmenopausal bleeding. On physical examination, she was noted to have a large nontender palpable mass in her abdomen. A nontender right vulvar mass was also seen during her pelvic examination.

Subsequently, the patient underwent a contrast-enhanced computed tomography of the abdomen and pelvis which revealed a large, at least 17 cm, right adnexal mass demonstrating a fat/fluid level, most consistent with a mature cystic teratoma. Surgical planning was swiftly initiated and the patient underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, Bartholin's cyst excision, and pelvic/para-aortic lymph node dissection.

Histologic sections showed features of a benign dermoid cyst; however, a separate solid component within a dominant mass demonstrated hallmark characteristics of in situ and invasive high-grade SCC arising within a MCT of the right ovary. The ovarian capsule was intact, but focal ovarian surface involvement was present. In addition, there was lipogranulomatous reaction associated with the teratoma and in the fallopian tube suggestive of preoperative rupture.

The postoperative course was complicated by development of a right vulvar hematoma which was evacuated operatively. The patient recovered from the hematoma excision and was discharged shortly thereafter.

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