Presentation
Abdominal pain.
Patient Data
A predominately cystic pelvic lesion with fluid and soft tissue contents with internal calcifications. It measures about 9 x 8 x 12 cm in AP, SS and CC dimensions.
Mild free ascites is noted.
A well define large right adnexal mixed lesion with fat, fluid, and soft tissue signals. Cyst fluid is of hypointense signal on T1 WI and high signal intensity on T2 WI. Soft tissue content is of intermediate signal on presented pulse sequences. Fat content is evidenced by high T1 and T2 WI signals with complete suppression on fat-saturated sequences. There are low signal intensity linear foci inside in all pulse sequences corresponding to calcifications. It measures about 9 x 8 x 12 cm in AP, SS, and CC dimensions. It compresses the urinary bladder, displacing intestinal loops around, and mildly indenting rectum posteriorly.
Normal left ovary. Normal infantile uterus. Mild free fluid in the pelvis.
Case Discussion
Features of immature ovarian teratoma, epicentered on right adnexa. There is no clear evidence of rupture or metastatic disease. It is an uncommon ovarian germ cell tumor, which differs from the far more common mature ovarian teratomas. It appears on CT as a large cystic lesion with solid components that show coarse calcifications and linear streaks of fat. It is important to assess the possibility of cyst rupture or abdominal metastasis.