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