PMC7193198_01
A 32-year-old woman presenting with progressively worsening abdominal pain subsequently diagnosed with bilateral teratomas (immature and mature). Coronal reformats of contrast- enhanced CT of the abdomen and pelvis (a) demonstrates a large, heterogeneous soft-tissue mass (arrow) with a small amount of fat and calcifications. Omental fat stranding (arrowheads) is seen along the right superolateral aspect of mass along with small volume ascites (a). Additional coronal image (b) demonstrates a well- circumscribed mass in the right adnexa (arrow) with intralesional fat and calcifications.
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F1
A computed tomography (CT) abdomen and pelvis were performed per discretion of the ordering emergency room physician, which revealed a large heterogeneous mass in the left adnexa measuring 19 x 17 x 10.4 cm, containing fat, calcification, and soft-tissue consistent with a teratoma [Figures 1a-1b, 2a-b]. However, there was a significant mass effect, mesenteric/omental stranding, and ascites concerning for malignant transformation and peritoneal carcinomatosis versus intraperitoneal rupture with resultant granulomatous peritonitis [Figures 1a and 2a].
A 32-year-old woman presenting with progressively worsening abdominal pain subsequently diagnosed with bilateral teratomas (immature and mature). Axial contrast-enhanced computed tomography of the abdomen and pelvis (a) demonstrates a large heterogeneous soft-tissue pelvic mass (arrow) with internal fat with surrounding omental fat stranding (arrowhead). Additional axial image (b) demonstrates a large heterogeneous soft-tissue pelvic mass with small amount of fat and calcification, consistent with immature teratoma.
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F2
A computed tomography (CT) abdomen and pelvis were performed per discretion of the ordering emergency room physician, which revealed a large heterogeneous mass in the left adnexa measuring 19 x 17 x 10.4 cm, containing fat, calcification, and soft-tissue consistent with a teratoma [Figures 1a-1b, 2a-b]. However, there was a significant mass effect, mesenteric/omental stranding, and ascites concerning for malignant transformation and peritoneal carcinomatosis versus intraperitoneal rupture with resultant granulomatous peritonitis [Figures 1a and 2a]. Further findings included a mature ovarian teratoma measuring 5.4 x 5.4 x 6.9 cm in the right adnexa [Figure 2b].
A 32-year-old woman presenting with progressively worsening abdominal pain subsequently diagnosed with bilateral teratomas (immature and mature). Two separate teratomatous areas (a-b and c-d) in the left ovary include neurotubules (black arrow) and neuroepithelial rosettes (white arrow). (Original magnification: (a,c): x100; (b,d): x400).
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F3
Microscopically, the left ovary revealed a solid tumor with areas of neurotubules and neuroepithelial rosettes [Figure 3a-d] along with mature components including skin appendages, cartilages, and pancreatic and neural glial tissues [Figure 4a-c].
A 32-year-old woman presenting with progressively worsening abdominal pain subsequently diagnosed with bilateral teratomas (immature and mature). Mature teratomatous components in the left ovary (a-c) and right ovary (d-e) include skin appendages (a, white arrow), cartilage (e), thyroid glands (d, arrow head), and respiratory epithelia (b,c,f, black arrow) (Original magnifications: x100).
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F4
Microscopically, the left ovary revealed a solid tumor with areas of neurotubules and neuroepithelial rosettes [Figure 3a-d] along with mature components including skin appendages, cartilages, and pancreatic and neural glial tissues [Figure 4a-c]. The right ovary, on the other hand, consisted of all mature components and, therefore, represented a mature cystic teratoma [Figure 4d-f].
A 32-year-old woman presenting with progressively worsening abdominal pain subsequently diagnosed with bilateral teratomas (immature and mature). Nodules in the rectal peritoneum (a,b) and omentum (c,d) were composed of mature glia tissue with bland looking glial cells (black arrow) forming nodules (white arrow). (Original magnification: a,c: x100; b,d: x400)
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F5
The nodules in the uterine serosa, rectal peritoneum, and omentum were composed of mature, predominantly gliomatosis admixed with adipose tissue [Figure 5a-d], which occurs in about one-third of the cases with immature teratoma.