A Case of Ovarian Dermoid Cyst with Malignant Transformation Perforated into the Rectosigmoid Colon and Small Intestine

Abstract

A 72-year-old female was admitted to hospital with diarrhea containing hair. The abdominal plain film showed teeth-like structures in the right lower quadrant. Barium enema and endoscopic examination were performed, and the results indicated a possible dermoid cyst perforated into the rectosigmoid colon and small intestine. The operation revealed a dermoid cyst of the right ovary perforated into the rectosigmoid colon and small intestine. Histopathologically, a dermoid cyst and in part well-differentiated squamous cell carcinoma invading the rectosigmoid and small intestine were demonstrated.

Ovarian dermoid presenting as acute intestinal obstruction: a rare case report and review of literature

“…In addition, there were intra-operative features of peritonitis also. Although such an occurrence has been described previously in association with malignant transformation, 9,11,14 macro and microscopic examination confirmed that this was not the case here and that the cyst had directly infiltrated the bowel wall causing intraluminal obstruction in the form of a pedunculated tumor. It seems probable that a similar mechanism to that proposed for fistula formation had occurred, possibly precipitated by the recent pregnancy.…”

“…8 In contrast, rupture, infection and secondary malignant change are uncommon complications and dermoid cysts only very rarely present with bowel involvement. In this regard, entero-ovarian fistulae have been described involving both the small [9][10][11] and large [12][13][14][15] bowel. Such patients may present with pain, rectal bleeding or the passage of dermoid cyst contents such as hair and teeth within the stool.…”

Benign Cystic Ovarian Teratoma With a Fistula Into the Small and Large Bowel

“…4 There is only one previous report of an ovarian teratoma with fistulae to both the small and large bowel simultaneously, as was seen in our patient. 5 However, in that case, the ovarian teratoma had malignant components, a finding not noted in the final pathology of our specimen.…”

“…3 It is important to note that such rare findings associated with teratomas may suggest malignancy. 5 Surgeons should be prepared to perform staging surgery in the event that malignancy is identified on rapid frozen section evaluation. 6 …”

Ovarian Teratoma in Routine Biopsy Material During a Five-Year Period

“…Th e treatment of teratomas is surgical (salpingo-oophorectomy or resection of the ovary), and depends upon the age of the patient and the volume of the tumor. Immature teratomas are treated by a combination of surgery and multimodal chemotherapy 3,5,6 . Th e aim of this study was to determine the number of ovarian teratomas in the routine biopsy material received and diagnosed at Ljudevit Jurak Clinical Department of Pathology, Sestre milosrdnice University Hospital Center during a 5-year period, as well as their clinical, gross and microscopic characteristics.…”