Case Presentation

History:woman alleging physical assault

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there's right adnexal mass,there's fluid density,soft tissue density,fat density and a tooth-shaped calcific density within the mass

Differentials are;

1-Mature cystic teratoma

2-Immature Teratoma

3-Torsed Ovary

4-TOA

5-Ovarian carcinoma

Discussion:

Ovarian teratomas are the most common germ cell neoplasm.  Teratomas comprise a number of histologic types of tumors, all of which contain mature or immature tissues of germ cell (pluripotential) origin. The most common of these tumors, the mature cystic teratoma (also known as dermoid cyst), typically contains mature tissues of ectodermal (skin, brain), mesodermal (muscle, fat), and endodermal (mucinous or ciliated epithelium) origin. In monodermal teratomas, one of these tissue types (e.g., thyroid tissue in struma ovarii, neuroectodermal tissue in carcinoid tumor) predominates.
Mature cystic teratomas (a more appropriate term than the commonly used "dermoid cysts") are cystic tumors composed of well-differentiated derivations from at least two of the three germ cell layers (ectoderm, mesoderm, and endoderm). They affect a younger age group (mean patient age, 30 years) than epithelial ovarian neoplasms.  Most mature cystic teratomas are asymptomatic. Abdominal pain or other nonspecific symptoms occur in the minority of patients. They grow slowly at an average rate of 1.8 mm each year.
Most mature cystic teratomas can be diagnosed at US. However, the US diagnosis is complicated by the fact that these tumors may have a variety of appearances. Three manifestations occur most commonly. The most common manifestation is a cystic lesion with a densely echogenic tubercle (Rokitansky nodule) projecting into the cyst lumen. The second manifestation is a diffusely or partially echogenic mass with the echogenic area usually demonstrating sound attenuation owing to sebaceous material and hair within the cyst cavity. The third manifestation consists of multiple thin, echogenic bands caused by hair in the cyst cavity.
At CT, fat attenuation within a cyst, with or without calcification in the wall, is diagnostic for mature cystic teratoma.
Immature teratomas are composed of tissues derived from the three germ layers. They differ from mature cystic teratomas in that they demonstrate clinically malignant behavior, are much less common (<1% of ovarian teratomas), affect a younger age group (usually during the first 2 decades of life), and are histologically distinguished by the presence of immature or embryonic tissues. At initial manifestation, immature teratomas are typically larger (14–25 cm) than mature cystic teratomas (average, 7 cm).
Monodermal teratomas are composed predominantly or solely of one tissue type. There are three main types of ovarian monodermal tumors: struma ovarii, ovarian carcinoid tumors, and tumors with neural differentiation. Struma ovarii is composed predominantly or solely of mature thyroid tissue that demonstrates acini filled with thyroid colloid. Carcinoid tumors of the ovary are uncommon. They may be insular (islet tumors), trabecular, or mucinous. All types are frequently associated with a mature cystic teratoma or mucinous tumor. Because these are solid tumors, they would be expected to be indistinguishable from solid malignancies, although necrosis is less common in the former. .
The morphologic features of the tumors differ in that mature cystic teratomas (dermoid cysts) are predominantly cystic, whereas immature teratomas are predominantly solid with small foci of fat.

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