Huge Mature Cystic Teratoma With Compression and Obstructive Outcome

Abstract

Mature cystic teratoma generally presents in a predictable and favorable course. Patients are usually asymptomatic, and the tumor is slow growing. We highlight a case of huge right ovarian teratoma with an unusual presentation with extensive compression disease, which results in the complexity of the case management. A 45-year-old woman, para 4, presented with suprapubic mass 10 × 10 cm with sudden onset lower abdominal pain for 1 day. Pain suddenly subsided, and we diagnosed it as torsion de-torsion. Within 2 months’ duration prior to the scheduled surgery, the tumor progressively increases in size to 24 × 20 cm. The features were also suspicious of malignancy, with bilateral obstructive uropathy causing renal impairment and extensive bilateral lower limb and pelvic vein thrombosis. We inserted a bilateral nephrostomy tube followed by antegrade stenting, and intravenous infusion (IVI) of heparin was changed to subcutaneous (S/C) Clexane 40 mg, twice a day (BID) until the renal function normalized. Surgery was delayed for 6 weeks while she was closely monitored. Intraoperatively the right ovarian tumor has ruptured, features consistent with teratoma. She recovered well postoperatively. Mature cystic teratoma, although generally having a benign course, may present with a fast-growing tumor, with severe bilateral obstructive uropathy and extensive pelvic vein thrombosis.

J Clin Gynecol Obstet. 2022;11(4):113-116
doi: https://doi.org/10.14740/jcgo828