Presentation
Lower abdominal pain
Patient Data
A sizable pelvi-abdominal adnexal multilocular complex cystic lesion measuring about 12 x 18 x 23 cm in its largest AP, side to side and cephalo-caudal dimensions, respectively. It has a heterogeneous matrix; mainly cystic with multiple enhancing septa of variable thickness, multiple intralesional soft tissue nodules, scattered fat components and calcific elements. The lesion exerts mass effect in the form of displacement of bowel loops laterally and compression upon the urinary bladder.
There is another smaller lesion at the right side of Douglas pouch with fat content, probably another fat-containing ovarian lesion, suggestive of mature cystic teratoma.
Mild free ascites seen at the right peri-hepatic space and pouch of Douglas.
Case Discussion
Immature ovarian teratoma represents less than 1% of ovarian teratomas. It is an uncommon ovarian germ cell tumor, which differs from the far more common mature ovarian teratomas (dermoid cysts). It is usually seen in young females, as in this example. It appears on CT as a large cystic lesion with solid components that shows coarse calcifications and streaks of fat.
Immature ovarian teratoma can be associated with another mature or immature cystic teratomas 1.
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