Presentation
Abdominal pain with distension
Patient Data
The MRI sequences demonstrate a huge well-defined abdominopelvic cystic mass of complex signal intensity. The main component appears of high signal on T1I/T2 with low signal sediment on T2 (blood products). The mural components are of intermediate signal on T1, intermediate-to high signal on T2. The largest mural nodule (Rokitansky nodule) shows a peripheral rim of high signal on T1, attenuated on T1 fat saturation (fatty component) with moderate heterogeneous enhancement on postcontrast sequences.
Normal appearance of the uterus.
Minimal intraperitoneal effusion.
Case Discussion
Ovarian dermoid cyst is usually seen in the reproductive age group; rare cases are reported in prepuberty age group 1.
Considering the age of the patient, the large size of the mass with abdominal extension, and the complexity of the signal with intracystic hemorrhage, a serum tumor marker alpha-fetoprotein (AFP) was requested.
The AFP was negative in this case which excludes the possibility of malignant transformation into endodermal sinus tumors from a pre-existing ovarian dermoid cyst.
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