Cystic Teratoma

Ariane Staub Neish, MD
Margaret Phillips, MD

July 12, 1995

Presentation

Imaging Findings

Coronal T1-weighted MRI: A multilocular mass is present superior to the uterus. The mass has a dominant lobulated portion which contains a heterogeneous internal component (arrow). This mass is inseparable from the left ovary. A 3 cm homogeneous mass arises from the right ovary with moderate intensity signal. No ascites nor hydronephrosis are evident. The liver cannot be evaluated on these images.

Axial T1 weighted MRI with fat suppression and contrast enhancement: One of the lobulated portions of the left adnexal mass contains a fluid-fluid level (high signal in the nondependent position). The left adnexal mass suppresses with fat suppression and demonstrates no significant enhancement (arrow). The right ovarian mass does not contain fat and has high signal intensity consistent with hemorrhagic or proteinaceous fluid (arrow).

Computed Tomography: A left adnexal mass with Hounsfield units consistent with fat has a more heterogeneous component within the dominant lobulated portion (arrow). A 4 cm soft tissue density mass arises from the right ovary.

Diagnosis

Discussion

Cystic teratomas are the single most common ovarian neoplasm and represent 60% of benign ovarian neoplasms (next most common are serous cyst adenoma at 25% and mucinous cyst adenoma at 12%). While ultrasound often reveals echogenic areas secondary to fat, pure sebum tends to be anechoic or hypoechoic (2). While the patient's age and size of the lesion put her in a worrisome risk group for malignancy, these lesions are almost universally benign. About 10-15% of cystic teratomas are bilateral.

The diagnosis is cystic teratoma.

The right adnexal mass is an endometrioma. The apparent enhancement on post-gadolinium T1-weighted images is an artifact of manipulation of the MRI windows.

References

2. Callen PW. Ultrasonography in obstetrics and gynecology. Philadelphia: WB Saunders Co,1994:637.

3. Rumack CM, Wilson SR, Charboneau WJ. Diagnostic ultrasound, Vol I. St Louis: Mosby Yearbook, 1991:396-405.

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