PMC5227152_01
Magnetic resonance imaging findings. (a) T1-weighted transverse image, revealing an ovarian mature cystic teratoma (arrowhead). T2-weighted transverse (b) and sagittal (c) images, demonstrating heterogeneous signal intensity at the posterior wall (arrowheads). (d) Diffusion-weighted transverse image, demonstrating low signal intensity at the septum (arrow).
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T1-weighted images demonstrated slightly high signal intensity corresponding to the capsule of the cyst, as well as shading within the cyst, suggesting hemorrhagic contents (Figure 1(a)). Heterogeneous signal intensity at the posterior wall of the cyst, indistinguishable from solid tissue or clotting because of nonenhancement, was recognized on T2-weighted images (Figures 1(b) and 1(c)). Diffusion-weighted images demonstrated slightly high signal intensity of the whole tumor, but low signal intensity of the septum (Figure 1(d)).
Fluorodeoxyglucose-positron emission tomography findings. Fused coronal (a) and transverse (b) images, demonstrating a maximum standardized uptake value of 2.9 in the ovarian mature cystic teratoma (arrow) (white arrowhead = endometrium).
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However, FDG-PET demonstrated a maximum standardized uptake value of 2.9 in the cyst (Figures 2(a) and 2(b)), which suggested a benign tumor rather than malignancy.
Macroscopic and pathologic findings. (a) Macroscopic findings. (b) Hematoxylin and eosin staining (magnification x30). (c) Hematoxylin and eosin staining (magnification x150). (d) Immunohistochemistry, showing positive results for CD10 (magnification x150). (e) Immunohistochemistry, showing positive results for CD34 (magnification x150). (f) Immunohistochemistry, showing positive results for Bcl-2 (magnification x150).
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Macroscopically, the left ovary had a unilocular cystic lesion, which contained a solid portion, approximately 4 cm in diameter, inside the cyst wall (Figure 3(a)). The solid portion beneath the epithelium demonstrated well-circumscribed epithelial and mesenchymal proliferation (Figure 3(b)). There was no cleft formation between the epithelial nests and stroma (Figure 3(c)). Bcl-2 was expressed in both the stroma and epithelial nests (Figure 3(f)). Based on these findings, we reached a diagnosis of TE arising in an ovarian MCT.