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A Journal on Surgery

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Chirurgia 2005 June;18(3):137-40

language: Italian

Bilateral ovarian cystic teratoma with adnexial torsion: case report

Vergara V., Volpini F., Pastorcich A., Costa G. L., Sangiacomo G.


Benign cystic teratomas represent one of the most common ovarian neoplasms in women. This cystic tumor is bilateral in 10-20% of cases. Partial or total pedicle torsion is the most frequent complication. The diagnosis of such a complication or a malignant transformation is often difficult. The case of a young woman who presented in emergency for a sudden onset of acute abdominal pain is reported. Ultrasonography examination and CT scans revealed a voluminous and complex intra-abdominal tumor arising from the left ovary, with solid structure, 20x16 cm in size. A second 8 cm dermoid tumor in the right ovary was detected. Ascites in the pelvic cavity and in the hepatorenal recess were also present. An echo color Doppler examination showed a larger vascular component within the tumor wall with an irregular pedicle flow. A torsion of the ovarian pedicle with a malignant component in the main tumor was suspected. A left salpingo-ovariectomy was performed; the right ovarian cystic teratoma was removed, preserving a good portion of ovarian parenchyma. Histopathologic examination of the specimen revealed bilateral ovarian cystic teratomas, both mature, containing necrotic hemorrhagic areas within the main tumor. The current status of the art is then analysed in relation to diagnostic possibilities, the presence of such a complication and the unusual size of the tumor.

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