Imaging in gynecological disease (24): clinical and ultrasound characteristics of ovarian mature cystic teratomas

Abstract

Objective To describe the clinical and ultrasound features of ovarian mature cystic teratomas (MCTs). Methods This was a retrospective study. From the International Ovarian Tumor Analysis (IOTA) database, we identified patients with a histologically confirmed diagnosis of MCT who had undergone transvaginal ultrasound examination between 1999 and 2016 (IOTA phases 1, 2, 3 and 5) in one of five centers. Ultrasound was performed by an experienced examiner who used the standardized IOTA examination technique and terminology. In addition to extracting data from the IOTA database, available two‐dimensional grayscale and color or power Doppler images were reviewed retrospectively to identify typical ultrasound features of MCT described previously and detect possible new features using pattern recognition. All images were reviewed by two independent examiners and further discussed with two ultrasound experts to reach consensus. Results Included in the study were 454 patients with histologically confirmed MCT. Median age was 33 (range, 8–90) years and 66 (14.5%) patients were postmenopausal. Most MCTs were described by the original ultrasound examiner as unilocular (262/454 (57.7%)) or multilocular (70/454 (15.4%)) cysts with mixed echogenicity of cystic fluid (368/454 (81.1%)), acoustic shadowing (328/454 (72.2%)) and no or little vascularization on color Doppler (color score 1, 240/454 (52.9%); color score 2, 123/454 (27.1%)). The median largest lesion diameter was 66 (range, 15–310) mm. A correct preoperative diagnosis of MCT was suggested by the original ultrasound examiner in 372/454 (81.9%) cases. On retrospective review of ultrasound images of 334 MCTs that had quality sufficient for assessment, ‘dots and/or lines’ and/or ‘echogenic white ball’ (typical features according to the literature) were present in 271/334 (81.1%) masses. We identified four new ultrasound features characteristic of MCT: ‘cotton wool tufts’, ‘mushroom cap sign’, ‘completely hyperechogenic lesion’ and ‘starry sky sign’. At least one classical or novel ultrasound feature was present in 315/334 (94.3%) MCTs. Twenty‐nine (8.7%) MCTs manifested vascularized solid tissue, of which seven exhibited no typical features. Conclusion We provide a comprehensive overview of conventional and newly described ultrasound features of MCTs. Only a small proportion of MCTs did not manifest any of the typical features. © 2022 International Society of Ultrasound in Obstetrics and Gynecology.

Clinical characteristics and laparoscopic surgical outcomes of ovarian dermoid cysts complicated by spontaneous rupture: nine cases and a literature review

“…CT has been advocated as an adjunct method for diagnosing dermoid cyst rupture when discontinuity of the cyst wall is confirmed, along with intraperitoneal fatty implant, commonly around the liver surface, and increased fat density in the peritoneum. 1,12 However, the sensitivity of CT for detecting peritoneal inflammatory changes due to cyst rupture was lower in the current study (66.7%) than in a previous case review (88%). 6…”

“…Ultrasonography is widely accepted in gynecological practice as the initial imaging modality of choice for evaluating acute abdominal events. 1 However, despite recent improvements in the resolution of ultrasound devices and imaging techniques, the method has limited sensitivity for differentiating between cyst rupture and torsion. 6 A diagnosis of a ruptured ovarian dermoid cyst can thus only be made solely by ultrasonography in a small number of cases.…”

“…2,3 Dermoid cysts are slow-growing tumors 4 that typically present as an asymptomatic adnexal mass, detected incidentally during routine pelvic ultrasound examination 1 or by the identification of a fat component and/or calcification on pelvic computed tomography (CT). 1,2 The major complication of dermoid cysts is torsion, while other less-frequent secondary complications include malignant transformation, infection, and rupture. 3,4 Torsion or rupture of dermoid cysts poses a diagnostic and therapeutic challenge and requires timely surgical intervention.…”

“…Dermoid cysts or mature cystic teratomas, originating from primordial germ cells, 1 account for 10% to 25% of all ovarian tumors. 2,3 Dermoid cysts are slow-growing tumors 4 that typically present as an asymptomatic adnexal mass, detected incidentally during routine pelvic ultrasound examination 1 or by the identification of a fat component and/or calcification on pelvic computed tomography (CT). 1,2 The major complication of dermoid cysts is torsion, while other less-frequent secondary complications include malignant transformation, infection, and rupture.…”

Ovarian Masses: The Value of Acoustic Shadowing on Ultrasound Examination

“…The net effect is a focal hyperechogenic area that gradually attenuates sound and results in a characteristic gradual acoustic shadow 32 . Heremans et al 33 observed that most (81%) of mature teratoma had mixed cyst contents, and most (72%) manifested acoustic shadowing with no or minimal color Doppler signals.…”