Laparoscopic surgical management of ovarian teratoma with unusual histological characteristics: a case report

Abstract

Introduction. Ovarian dermoid cysts, which are also called mature cystic teratomas (MCTs), are the most common ovarian germ cell tumors in young women. Mature teratomas are composed of mature tissues representing elements derived from more than one embryonic germ layer (ectoderm, mesoderm, and endoderm), with ectodermal derivatives being the usual predominant component; however, the finding of a well-differentiated cerebellum is extremely rare. Case report. A 25-year-old woman was referred for evaluation of an ovarian mass. She presented with suddenonset lower abdominal pain, nausea, and vomiting. Gynecological history was unremarkable. Transvaginal ultrasound revealed a multilocular cystic mass in the left ovary with irregular contours and free fluid in the posterior cul-de-sac. Laparoscopic right ovarian cystectomy and adhesiolysis were performed. Intraoperatively, a left adnexal cyst was identified, which ruptured during enucleation, releasing bone, cartilage and hair content. Histopathology confirmed a mature cystic teratoma containing skin appendages, sebaceous glands, adipose tissue, cartilage, bone, intestinal-type mucinous glands, ganglion cells, cerebellar structures, and arachnoid mater components. Discussion. Early diagnosis and surgical management are crucial in preventing complications such as ovarian torsion, which can lead to ovarian necrosis or increase the risk of malignancy. Laparoscopic techniques offer a minimally invasive approach, reducing recovery time and postoperative complications. While the presence of skin, hair, and teeth is characteristic of mature teratomas, rare findings, such as cerebellar structures, highlight the diverse differentiation potential of these tumors. Conclusions. Mature ovarian teratomas can present with acute symptoms due to complications like torsion, necessitating prompt surgical intervention. This case highlights the role of laparoscopy in effectively managing these tumors. Awareness of rare histopathological findings expands understanding of their varied tissue composition, contributing to improved patient care.