Malignant immature ovarian teratoma, with intraperitoneal rupture
Presentation
Abdominal distension.
Patient Data
Massive, complex left ovarian mass containing peripheral enhancing lobulated soft tissue and fluid, and fat centrally with fat/fluid layer filling the majority of the abdominal cavity. The mass has ruptured along its superior margin where there is a greater amount of enhancing tissue, resulting in multiple implants along the anterior upper abdominal peritoneal lining and also along the lower liver margin and inferior spleen. Several other smaller implants within the peritoneal cavity. Mixed-density fluid with fluid fat with large volume ascites in the peritoneal cavity. The small bowel and upper abdominal vasculature are displaced and compressed in the upper abdomen. Mild right hydroureteronephrosis due to midureteral compression/obstruction, presumably related to peritoneal implants.
Case Discussion
Dramatic presentation of a large ruptured ovarian teratoma, which resulted in peritoneal spread of tumor. The numerous fat/fluid levels within the ascites are particularly noteworthy and can be a cause of chemical peritonitis. When evaluating the ovarian origin of such a mass, it is particularly helpful to follow the gonadal veins for confirmation, which can be seen supplying the inferior margin of the mass. Additionally, the substantial upward displacement and compression of the small bowel helps to direct the review toward a pelvic source of the tumor.
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