Presentation
The patient has experienced progressive abdominal distension over time. For the past three days, she has had dull lower abdominal pain and palpated a mass in the hypogastric region.
Patient Data
Two well-defined, multilocular space-occupying masses are observed in the mid and lower abdomen, measuring approximately 195 × 125 × 184 mm and 90 × 96 × 75 mm, respectively. The masses exhibit mixed density with solid components, coarse calcifications, macroscopic fat, and low-density fluid. The solid components and septal margins show contrast enhancement after contrast administration. The larger mass originates from the left adnexa, while the smaller mass arises from the right adnexa. No signs of torsion are observed. A small amount of fluid accumulation is noted in the pelvic region.
Laboratory findings:
serum Alpha-Fetoprotein (AFP) quantification: 107.31 ng/mL (elevated)
serum CA 125, HE4, and Beta-hCG levels are within normal limits
Ultrasound findings:
a heterogeneous echogenic mass in the hypogastric region, suggestive of an ovarian dermoid tumour, with no signs of torsion
mild to moderate free fluid in the abdominal cavity
Surgery report:
approximately 150 mL of dark yellow peritoneal fluid was noted
the left ovary contained a 20 × 25 cm tumour with a small rupture site leaking fluid. The tumour exhibited an irregular inner surface, a thin capsule, and no residual normal ovarian tissue. The left fallopian tube was stretched and adherent to the ovary
the right fallopian tube appeared normal, while the right ovary harboured an 8 × 10 cm cystic mass with a smooth surface and no exophytic nodules
twenty millilitres of ascitic fluid was collected for cell block analysis, revealing no malignant cells
a total left adnexectomy and right ovarian cystectomy were performed, preserving healthy ovarian tissue. Intraoperative frozen section analysis showed no evidence of malignancy
Macroscopic:
The specimen measures 20 × 20 × 15 cm, light brown in colour, with a mixture of solid and cystic components.
Microscopic:
The structure consists of a cyst lined by epidermal epithelium, containing numerous hair follicles, sebaceous gland clusters, mature bone, cartilage, and adipose tissue. Some areas also contain gastrointestinal epithelium.
Conclusion:
Mature teratoma of the ovary.
Macroscopic:
The specimen measures 10 × 10 × 8 cm, light brown in colour, containing abundant hair and sebaceous material.
Microscopic:
The structure consists of a cyst lined by epidermal epithelium, containing numerous hair follicles, sebaceous gland clusters, mature bone, cartilage, and adipose tissue. Some areas also contain gastrointestinal epithelium.
Conclusion:
Mature teratoma of the ovary.
Case Discussion
Imaging and histopathological findings are consistent with a mature cystic ovarian teratoma.
There is a discrepancy between the histopathological diagnosis (mature teratoma) and the elevated AFP (107.31 ng/mL), as mature cystic teratomas typically do not produce significant AFP.
The elevated AFP warrants close follow-up and histopathological reassessment to rule out an immature or malignant germ cell component or extra-ovarian pathology.
Unable to process the form. Check for errors and try again.