Highlights
- •Mature cystic teratomas (MCTs) are the most common germ cell neoplasm.
- •Only 1-2% of MCTs will undergo malignant degeneration.
- •Fistulization of MCTs into adjacent bowel has been reported in only 29 prior cases.
- •Small bowel obstruction (SBO) related to a MCT has been reported in 7 prior cases.
- •We report MCT-related SBO, fistula, and malignant degeneration occurring together.
Abstract
Dermoid cysts, or mature cystic teratomas, are complicated by malignant degeneration
in only 1–2% of cases. Rarely, dermoid cysts result in complications of small bowel
obstruction or entero-ovarian fistula formation. In the current report we present
the case of a 59-year-old female with a known dermoid cyst who presented with leukocytosis
and was discovered to have a small bowel obstruction at the level of an ileo-ovarian
fistula. The patient was taken to the operating room and was treated with total abdominal
hysterectomy, bilateral salpingo-oopherectomy, and short segment small bowel resection.
Review of the surgical pathology revealed areas of malignant degeneration within the
dermoid cyst to squamous cell carcinoma. To our knowledge, this is only the second
reported case of an ovarian dermoid cyst complicated by small bowel obstruction, entero-ovarian
fistula formation, and malignant degeneration.
Keywords
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References
- Atypical CT and MRI manifestations of mature ovarian cystic teratomas.AJR Am J Roentgenol. 2004; 183 (Epub 2004/08/31 PMID: 15333365): 743-750https://doi.org/10.2214/ajr.183.3.1830743.PubMed
- Laparoscopic repair of a rectal fistula due to a benign ovarian dermoid cyst.Obstetrics & Gynecology Science. 2017; 60 (Epub 2017/08/10 PubMed PMID: 28791272; PubMed Central PMCID: PMCPMC5547088): 383-386https://doi.org/10.5468/ogs.2017.60.4.383
- Imaging findings of complications and unusual manifestations of ovarian teratomas.Radiographics. 2008; 28 (Epub 2008/07/19 PubMed PMID: 18635624): 969-983https://doi.org/10.1148/rg.284075069
- Squamous cell carcinoma arising in mature cystic teratoma of the ovary: a case series and review of the literature.Gynecol Oncol. 2007; 105 (Epub 2007/01/24 PubMed PMID: 17240432): 321-324https://doi.org/10.1016/j.ygyno.2006.12.008
- Squamous cell carcinoma arising from mature cystic teratoma of the ovary: a clinicopathologic analysis.Obstet Gynecol. 1997; 89 (Epub 1997/06/01. PubMed PMID: 9170484): 1017-1022
- Squamous cell carcinoma arising from dermoid cyst: case reports and review of literature.Int J Gynecol Cancer. 2003; 13 (Epub 2003/08/13. PubMed PMID: 12911740): 558-563
- Ovarian teratoma presenting as small bowel obstruction in an elderly lady-a case report.Int J Surg Case Rep. 2011; 2 (Epub 2011/11/19 PubMed PMID: 22096674; PubMed Central PMCID: PMCPMC3199617): 6-8https://doi.org/10.1016/j.ijscr.2010.07.004
- Cystic ovarian teratoma in a girl of 5 years presenting as acute intestinal obstruction.J Indian Med Assoc. 1977; 68 (Epub 1977/06/01. PubMed PMID: 915319): 235-236
- Ovarian dermoid presenting as acute intestinal obstruction: a rare case report and review of literature.Int Surg J. 2015; 2: 283-285https://doi.org/10.5455/2349-2902.isj20150533
- Mature ovarian teratoma presenting as small bowel obstruction.The Indian J Surg. 2013; 75 (Epub 2014/01/16 PubMed PMID: 24426491; PubMed Central PMCID: PMCPMC3824780): 411-413https://doi.org/10.1007/s12262-012-0502-z
- Benign cystic ovarian teratoma with a fistula into the small and large bowel.Obstet Gynecol. 2012; 119 (.(Epub 2012/01/25 PubMed PMID: 22270429)): 434-436https://doi.org/10.1097/AOG.0b013e3182319185
- An unusual case of small bowel obstruction.Internet J Gastroenterol. 2006; 6
- Squamous cell carcinoma arising from ovarian mature cystic teratoma and causing small bowel obstruction.J Cancer Res Ther. 2014; 10 (Epub 2014/10/15 PubMed PMID: 25313782): 770-772https://doi.org/10.4103/0973-1482.136051
- Spontaneous rupture of benign cystic teratomas.Obstet Gynecol. 1981; 57 (Epub 1981/03/01. PubMed PMID: 7465151): 363-366
- Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature.Am J Obstet Gynecol. 1955; 70 (Epub 1955/08/01. PubMed PMID: 13238472): 368-382
- Pathology and classification of ovarian tumors.Cancer. 2003; 97 (Epub 2003/05/07 PubMed PMID: 12733128): 2631-2642https://doi.org/10.1002/cncr.11345
- Female reproductive system.in: Damjanov I. Linder J. Anderson W. Anderson's pathology. 10 ed. Mosby, St Louis, Mo1996: 2231-2309
- Cystic teratoma of the ovary: CT detection.Radiology. 1989; 171 (Epub 1989/06/01 PubMed PMID: 2717741): 697-701https://doi.org/10.1148/radiology.171.3.2717741
- CT depiction of ovarian dermoid showing spontaneous fistulous communication with small bowel.Egypt J Radiol Nucl Med. 2018; 49: 292-294https://doi.org/10.1016/j.ejrnm.2017.09.002
- Ovarian teratomas: tumor types and imaging characteristics.Radiographics. 2001; 21 (Epub 2001/03/22 PubMed PMID: 11259710): 475-490https://doi.org/10.1148/radiographics.21.2.g01mr09475
- A giant gas-filled abdominal mass in an elderly female: a case report.World J Gastroenterol. 2011; 17 (Epub 2011/10/12 PMID: 21987615; PubMed Central PMCID: PMCPMC3180025): 3659-3662https://doi.org/10.3748/wjg.v17.i31.3659.PubMed
- Dermoid cyst of the ovary with perforation of the urinary bladder and of the sigmoid.Am J Obstet Gynecol. 1939; 37: 148-153https://doi.org/10.1016/S0002-9378(16)40975-0
- Benign ovarian dermoid cyst complicated with rectal fistula formation: an unusual case.Arch Gynecol Obstet. 2009; 279 (Epub 2008/05/02 PubMed PMID: 18449552): 179-181https://doi.org/10.1007/s00404-008-0659-7
- A dermoid cyst fistulating with the transverse colon.Ann R Coll Surg Engl. 2012; 94 (Epub 2012/10/04 PubMed PMID: 23031759; PubMed Central PMCID: PMCPMC3954269)e230–1https://doi.org/10.1308/003588412x13373405385935
- Rectovesical fistula following an ovarian dermoid with recurrent vesical calculus: a case report.J Urol. 1967; 97 (Epub 1967/01/01. PubMed PMID: 6016216): 85-87
- Benign solid teratoma of the ovary with rupture into the rectum.Can J Surg. 1982; 25 (Epub 1982/01/01. PubMed PMID: 7055769): 77-78
- Endoscopic diagnosis of secondary rectal teratoma in a young woman with constipation and positive fecal occult blood test.Endoscopy. 2010; 42: 254-255https://doi.org/10.1055/s-0030-1255645
- Report of two cases of sigmoidal fistula complicating tubo-ovarian disease.Dis Colon Rectum. 1966; 9 (Epub 1966/03/01. PubMed PMID: 5908767): 107-108
- Ovarian dermoid tumour communicating with the rectum.Montreal Med J. 1908; 37: 176-177
- Dermoid perforation of the colon.Gastrointest Radiol. 1978; 3 (Epub 1978/06/25. PubMed PMID: 669189): 221-222
- A hairy intruder into colon.J Dig Endosc. 2014; 5: 159-161https://doi.org/10.4103/0976-5042.150667
- An unusual presentation of ovarian teratoma: a case report.Case Rep Emerg Med. 2012; 2012: 845198https://doi.org/10.1155/2012/845198
- Ovarian mature cystic teratoma with fistula formation into the rectum: a case report.Springer Plus. 2016; 5 (Epub 2016/10/21 PubMed PMID: 27757372; PubMed Central PMCID: PMCPMC5047864): 1700https://doi.org/10.1186/s40064-016-3426-4
Landmann DD, Lewis RW. Benign cystic ovarian teratoma with colorectal involvement. Report of a case and review of the literature. Dis Colon Rectum 1988; 31 (10): 808–13. Epub 1988/10/01. PubMed PMID: 3048937.
Livesey SA, Conn PC, Dunn DC. Benign cystic teratoma of the ovary rupturing into the rectum: a rare problem. Br J Clin Pract 1989; 43(2): 77–9. Epub 1989/02/01. PubMed PMID: 2803904.
Lowe GH, Jr., Dixon CF, Piper MC. Perforating ovarian cystic teratomas; report of an unusual case. Proc Staff Meet Mayo Clin 1947; 22(6): 117–20. Epub 1947/03/19. PubMed PMID: 20290039.
Mitui AH, Fujita R, Sugata F, Kienebuchi M, Suzuki K, Sagawa F. A case of ovarian dermoid cyst with malignant transformation perforated into the rectosigmoid colon and small intestine. Endoscopy. 1983; 15(5): 331–3. Epub 1983/09/01. doi:https://doi.org/10.1055/s-2007-1021548. PubMed PMID: 6628346.
Sasaki H, Nagasako K, Harada M, Kobayashi S, Uetake K. Benign cystic teratoma of the ovary with rupture into the rectum: report of a unique rectal tumor. Dis Colon Rectum 1979; 22(4): 248–51. Epub 1979/05/01. PubMed PMID: 467179.
Shiels WE, Dueno F, Hernandez E. Ovarian dermoid cyst complicated by an entero-ovarian fistula. Radiology. 1986; 160(2): 443–4. Epub 1986/08/01. doi:https://doi.org/10.1148/radiology.160.2.3726124. PubMed PMID: 3726124.
Singh R, Joshi S, Hatimi H, Somani P, Rath P, Joshi RM. Rectal fistula due to ovarian teratoma. Endoscopy. 2012; 44 Suppl 2 UCTN: E260. Epub 2012/07/21. doi:https://doi.org/10.1055/s-0032-1309394. PubMed PMID: 22814909.
Song W, Conner M. Squamous cell carcinoma arising within a mature cystic teratoma with invasion into the adjacent small intestine: a case report. Int J Gynecol Pathol 2012; 31(3): 272–5. Epub 2012/04/14. doi:https://doi.org/10.1097/PGP.0b013e31823b6f53. PubMed PMID: 22498945.
- Case reports. Case 1: dermoid cyst with openings into the urinary bladder, sigmoid, appendiceal abscess, and ileum.J Urol. 1930; 23: 587-604https://doi.org/10.1016/S0022-5347(17)72993-X
Article info
Publication history
Published online: March 08, 2019
Accepted:
March 7,
2019
Received in revised form:
February 13,
2019
Received:
December 27,
2018
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
