Mature ovarian dermoid cyst invading the urinary bladder

Pilimiction, a Rare Presentation of Ovarian Teratoma: A Case Report

Background

Case Presentation

Conclusion

Controversies in the management of ovarian tumours in prepubertal children - A BAPS and UK CCLG Surgeons Cancer Group National Survey

BACKGROUND

No clear treatment and follow-up protocols have been established for prepubertal patients with ovarian tumours. The lack of adequate prospective data in the literature includes all aspects of their management. A significant number of children with ovarian masses present out of hours as a surgical emergency and are initially managed by paediatric surgeons without special interest in surgical oncology. Clear guidance on the management of such tumours is therefore fundamental. We hypothesised that - owing to the lack of clear guidelines - the current approach to prepubertal ovarian tumours amongst paediatric surgeons is highly heterogenous.

METHODS

An eleven-item multiple choice questionnaire was distributed amongst all BAPS consultant paediatric surgeons in the UK and simultaneously to all paediatric surgical oncology members of the UK Children's Cancer and Leukaemia Group in order to survey the management of ovarian masses in children. We aimed to compare the management approaches in both groups.

RESULTS

63 consultants participated in the survey; 49% with a special interest in surgical oncology, 48% with different subspecialty interests. The majority of participants (56%) performed 1-5 operations on ovarian tumours per year. Preoperative imaging of choice for the oncology surgeons was US and MRI (77.3%) versus 41.4% in the group of surgeons with different special interests. Surgeons with different special interests were more likely to request Ca125 as a preoperative tumour marker (62.1% vs 32.3%). 19.3% of oncology surgeons, and 27.6% of surgeons with other special interest stated they would never remove an ovarian tumour via the laparoscopic approach. Follow-up practise was highly variable amongst survey participants in both surgeon groups regarding frequency, duration and further investigations during follow-up. Almost 50% of participants follow their patients up according to personal practice protocols.

CONCLUSION

This first national survey on the management of prepubertal ovarian tumours demonstrates great heterogeneity in the current approach amongst UK paediatric surgeons. Better evidence is needed to formulate clear guidance for the management of such tumours. We propose instigation of a multicentre registry for ovarian tumours to generate prospective data and clarify guidance for the future.

LEVEL OF EVIDENCE STATEMENT

This is a level II evidence study. In itself it is a retrospective study, with the literature review including one large, high-quality prospective cohort study, and further prospective cohort studies of ordinary quality.

Mature Cystitic Teratoma of the Bladder Masquerading as a Distal Ureteral Stone

A 27-year woman presented with irritative lower urinary tract symptoms and alleged small right distal ureteric stone that had been diagnosed with KUB and non-contrast spiral CT.

Patient was scheduled for ureteroscopic lithotripsy, revealing absence of the presumed stone, while cystoscopy showed unexpected 2 cm pedunculated grayish white lesion, situated on the right lateral wall of the bladder with sparse hairs covering it.

An incomplete TURBT was done; the histological findings correlated with the gross picture seen on cystoscopy.

Following CT urography, the patient went an open partial cystectomy and right oophorectomy; the histopathology was consistent with mature bladder teratoma.

Management of Familial Ovarian Teratoma: The Need for Guidance

Ovarian teratomas in prepubertal females are uncommon, but familial ones are exceedingly rare. We report an ovarian teratoma in an 8-year-old girl, her mother, and her maternal grandmother. The risk of a metachronous tumor and subsequent complications (such as torsion) in the contralateral ovary remain unclear. There is no clear guidance on follow-up management of patient and family members in the literature. We have reviewed the literature and discuss the challenges for the pediatric surgeon arising from such cases.

Ovarian mature cystic teratoma with fistula formation into the rectum: a case report

Background

While ovarian mature cystic teratomas are benign ovarian germ-cell tumors and the most common type of all ovarian tumors, the formation of fistulas into surrounding organs such as the bladder and the intestinal tract is extremely rare. This report documents a case of ovarian mature cystic teratoma with a rectal fistula, thought to be caused by local inflammation.

Case description

A pelvic mass was diagnosed as an ovarian mature cystic teratoma of approximately 10 cm in diameter on transvaginal ultrasound and magnetic resonance examinations. Endoscopic examination of the lower gastrointestinal tract to investigate diarrhea revealed an ulcerative lesion with hair in the rectal wall adjacent to the ovarian cyst, and formation of a fistula from the ovarian teratoma into the rectum was suspected. Laparotomy revealed extensive inflammatory adhesions between a left ovarian tumor and the rectum. Left salpingo-oophorectomy and upper anterior resection of the rectum were performed. The final pathological diagnosis was ovarian mature cystic teratoma with no malignant findings, together with severe rectal inflammation and fistula formation with no structural disorders such as diverticulitis of the colon or malignant signs.

Discussion

The formation of fistulas and invasion into the neighboring organs are extremely rare complications for ovarian mature cystic teratomas. The invasion of malignant cells into neighboring organs due to malignant transformation of the tumor is reported as the cause of fistula formation into the neighboring organs. A review of 17 cases including the present case revealed that fistula formation due to malignant transformation comprised only 4 cases (23.5 %), with inflammation as the actual cause in the majority of cases (13 cases, 76.5 %).

Conclusion

Although malignancy is the first consideration when fistula formation is observed between ovarian tumors and surrounding organs, in mature cystic teratoma, local inflammation is more likely than malignant transformation.

Laparoscopic excision of a preperitoneal incidentaloma

BACKGROUND

Dermoid cysts are rare well-differentiated benign tumors derived from ectodermal cell origins. Usually caught incidentally, they have the potential for mass effect, malignant degeneration, and rupture. Dermoid cysts can often present a unique surgical challenge.

CASE REPORT

A 69-year-old male brought to the emergency department after a motor-vehicle accident had a preperitoneal incidental mass discovered on imaging. The patient was asymptomatic from the mass, though it was expanding in size. He was advised to have the mass removed, because of the possibility of malignant degeneration and rupture, and he was taken for laparoscopic surgical excision of the mass.

DISCUSSION

Dermoid cysts develop from embryonic migration of ectodermal tissue to aberrant locations or implantation of epidermal tissue. Dermoid cysts in the abdominal cavity are rare, and only case reports exist characterizing these tumors. Rupture can result in a chemical granuloma when localized and can cause peritonitis when the rupture is throughout the entire abdomen. Rare reports of malignant degeneration are also reported in the literature. Surgical excision is the standard of care minimizing risk of rupture with removal.