Imaging Findings of Complications and Unusual Manifestations of Ovarian Teratomas

Abstract

Ovarian teratomas can be associated with various complications and demonstrate a wide spectrum of clinical and imaging features. The complications include torsion (16% of ovarian teratomas), rupture (1%-4%), malignant transformation (1%-2%), infection (1%), and autoimmune hemolytic anemia (<1%). These complications require different therapeutic strategies; therefore, timely and accurate diagnosis of these complications is important for optimal patient treatment. In cases of complicated ovarian teratomas, the clinical manifestations provide only limited information and often overlap with those of other diseases. Furthermore, ovarian teratomas may have unusual clinical and imaging manifestations, thereby leading to misdiagnosis. These unusual manifestations include immature teratomas, monodermal teratomas (struma ovarii), combination tumors and collision tumors containing teratomas, and mature cystic teratomas without demonstrable fat or with pure fatty components. To provide adequate treatment and prevent misdiagnosis, it is necessary to be familiar with the imaging findings of both the complications and the unusual manifestations of ovarian teratomas.

Persistent chemical peritonitis resulting from spontaneous rupture of an ovarian mature cystic teratoma

“…An accurate diagnosis of a ruptured ovarian teratoma can be accomplished when the discontinuity of the wall is noted at ultrasonography (US), CT, and magnetic resonance (MR) imaging [9]. The presence of ascites and a distorted or fl attened shape of the tumor suggest tumor rupture.…”

“…The presence of ascites and a distorted or fl attened shape of the tumor suggest tumor rupture. The diagnosis of ruptured ovarian teratomas using CT imaging is fairly straightforward because this modality is very sensitive for detection of intraperitoneal fatty implant, most commonly around liver surface [3,9,10]. However, the early diagnosis of intraperitoneal rupture of ovarian teratoma as happened in this case is diffi cult.…”

“…In the present case, we performed abdominal CT at short intervals and could detect apparent changes associated with tumor rupture, that is, decrease in tumor size, decreased amount of fat component within the cyst, intraperitoneal fatty implant around the cyst, thickening of peritoneum, diffuse wall thickening of small bowels, and increased amount of ascites. Acute or chronic peritonitis caused by rupture of an ovarian cystic teratoma can manifest as ascites, diffuse or focal omental infi ltration, and infl ammatory masses involving the omentum and bowel, which mimic peritoneal carcinomatosis and tuberculous peritonitis [4,9]. The treatment of choice, once rupture of an ovarian cystic teratoma is diagnosed, is surgical intervention.…”

Pilimiction in Ovarian Cystic Teratoma: a Rare and Diagnostic Complication of a Common Entity

“…2 Other uncommon complications include rupture, malignant transformation (1-2%), infection and rarely invasion into adjacent viscera and autoimmune hemolytic anemia (<1%). 3 Spontaneous rupture and infiltration into the adjacent viscera is a rare event simulating percreta type of the invasive placental tissue with Urinary bladder being the most common.…”

A comparative analysis of in vitro expansion of natural killer cells of a patient with autoimmune haemolytic anaemia and ovarian cancer with patients with other solid tumours

“…The association of AIHA with lymphoproliferative disorders and other haematological malignancies as a paraneoplastic phenomenon is well known (14). There have been numerous case reports in the literature documenting the association of AIHA with solid tumours (15,16), particularly ovarian tumours (17)(18)(19). The association of AIHA with ovarian tumours is less than 1% and it has been suggested to include ovarian teratoma as one of the differential diagnoses of AIHA (18).…”