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Mature cystic teratomas, also called dermoid cysts, are the most common germ-cell ovarian neoplasms in children. On average, ovarian dermoid cysts are slow-growing neoplasms with a mean size between 6.4 and 7.0 cm that enlarge at a rate of 1.8 mm/year; however, these can reach large dimensions. Giant ovarian tumors are defined as those having a maximum diameter equal to or more than 15 cm; these represent a therapeutic challenge as they increase the risk of wide wound size and surgical invasiveness. In this paper, we present a case of a 10-year-old Hispanic female that complained of abdominal pain, distension, and nausea. Physical examination revealed a mass on the left side of the abdomen and an axial computed tomography found a large pelvic tumor extending to the abdominal region. After a laparotomy approach, pathology evaluation confirmed the diagnosis of mature cystic teratoma. The patient recovered thoroughly and had no complications at a 6-month follow-up. We conducted a literature review including English and Spanish reports about giant ovarian teratomas; we retrieved 16 cases from 2003 to 2023. We concluded that giant ovarian tumors may be underreported, particularly in resource-limited areas where tumors might grow unrecognized, and that English-language bias might play a substantial role in literature reviews involving case reports and case series.

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Massas anexiais representam grande desafio diagnóstico, devido a seu caráter geralmente assintomático¹. Traz-se caso peculiar de paciente que evoluiu com sintomas exuberantes de rápida evolução, situação característica de cistoadenomas, tumores benignos de origem epitelial²,³. Realizada laparotomia, com achados macroscópicos que revelaram conteúdo mucinoso e presença de pelos e neovascularização em seu interior. O anatomopatológico confirmou o diagnóstico de cistoadenoma associado a teratoma ovariano, sendo assim considerado um tumor de colisão ovariana.

Adnexal masses represent a major diagnostic challenge due to its usually asymptomatic characteritcs¹. We present a peculiar case of a patient who evolved with exuberant symptoms of rapid evolution, characteristic of cystadenomas, benign tumors of epithelial origin²,³. Laparotomy was performed, with macroscopic findings that revealed mucinous content and the presence of hairs and neovascularization inside. Pathology confirmed the diagnosis of cystadenoma associated with ovarian teratoma, thus being considered an ovarian collision tumor.

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Resumen El teratoma inmaduro se describió por primera vez en 1960 y puede ser puro o estar mezclado con un componente maduro. Es la segunda neoplasia maligna más común de células germinales de todos los cánceres de ovario (representa <1%). Alrededor del 50% de los teratomas inmaduros puros del ovario ocurren en mujeres entre las edades de 10 y 20 años. Se debe considerar el tratamiento para preservar su fertilidad futura porque la mayoría de los tumores de células germinales de ovario son curables con la cirugía conservadora y la quimioterapia combinada de seguimiento. La mayoría de los pacientes diagnosticados con un teratoma inmaduro se curan de su enfermedad. Sin embargo en todas las pacientes, se recomienda un seguimiento cercano, particularmente en los primeros 2 años después del diagnóstico, donde existe una mayor probabilidad de recurrencia.

Abstract The immature teratoma was first described in 1960 and cay be pure or mixed with a mature component. It is the second most common malignant germ cell neoplasm of all ovarian cancers (representing <1%). About 50% of pure immature teratomas of the ovary occur in women between the ages of 10 and 20 years. Treatment should be considered to preserve future fertility because the majority of ovarian germ cell tumors are curable with conservative surgery and combined combination chemotherapy. Most patients diagnosed with an immature teratoma are cured of their disease. However, in all patients, we recommend close follow-up, particularly in the first 2 years after diagnosis, where there is a greater chance of recurrence.

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RESUMEN CASO CLÍNICO: la encefalitis anti receptor N-metil D-aspartato (NMDAR) es un trastorno autoinmune con un amplio espectro de síntomas neuropsiquiátricos. Se presenta el caso de una mujer de 22 años con una encefalitis anti-NMDA que cursó con amnesia, crisis parciales complejas y alteraciones del comportamiento asociado a un teratoma ovárico. La evolución fue adecuada con cirugía e inmunosupresores. A los tres años se objetivó un teratoma contralateral, sin recidiva de encefalitis; que fue extirpado tras estimulación ovárica para criopreservación de ovocitos. CONCLUSIONES: el teratoma ovárico debe ser sospechado ante la presencia de una encefalitis atípica. Antes de realizar cirugías ováricas repetidas, debe valorarse la opción de vitrificación ovocitaria si los deseos genésicos de la mujer no están cumplidos.

ABSTRACT CLINICAL CASE: anti-N-methyl-D-aspartate-receptor (NMDAR) encephalitis is an autoimmune disorder with a wide sprectrum of neuropsyquiatric symtoms. A case of a 22 years old woman with NMDAR encephalitis presenting with amnesia, focal complex seizures and behavior disturbances associated with an ovarian teratoma is reported. Three years after the first episode, a contralateral teratoma was observed, with no recurrence of the encephalitis; teratoma excision was performed, after controlled ovarian stimulation for oocyte cryopreservation. CONCLUSIONS: ovarian teratoma must be suspected when atypical encephalitis occurs. Before performing repetead ovarian surgeries, oocyte vitrificaction must be considered as a fertility-sparing option in women who have not completed their childbearing wishes.

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Mature cystic teratoma is the most common kind of ovarian germ cell tumor. Malignant transformation is uncommon, with thyroid cancer rarely found. Papillary thyroid microcarcinoma has rarely been described as associated with ovarian teratomas. We report a case of a 34-year-old woman who presented with abdominal pain and an ovarian mass. After surgery, the patient was diagnosed with a follicular variant papillary thyroid microcarcinoma that arose within a mature cystic ovarian teratoma. Based on the small size of the primary lesion and patient preferences, no further treatment was performed. To our knowledge, this is the third reported case of papillary thyroid microcarcinoma arising within a mature ovarian teratoma without struma ovarii. There is no consensus on the surgical approach and postoperative management of this condition. Whether further therapy with total thyroidectomy and radioiodine ablation may be beneficial is unknown. In conclusion, papillary thyroid microcarcinoma can also arise within mature ovarian teratomas. Although a favorable prognosis is anticipated, there is limited information about its history or prognosis.

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In cattle, abdominal tumors leading to partial or total intestinal obstruction are rare. Here, it is described the clinico-pathological findings of two cows with intestinal obstruction by neoplasms. A crossbred cow presented apathy, weight loss, constipation, enophthalmos, ruminal and intestinal hypomotility, and abdominal distension in the right ventral quadrant. Pathological examination revealed bilateral ovarian teratoma. The other case was a cow that in the past 2 years had several episodes of squamous cell carcinoma in the third eyelid and vulva. During the 6 days prior to investigation, clinical signs of constipation and tenesmus were noted. Nodular and friable masses were located in the vulva, right third eyelid and cranially to the right kidney that were identified as poorly differentiated metastatic carcinoma of the adrenal cortex. To our knowledge, these are probably the first reports of ovarian teratoma and adrenal carcinoma causing clinical signs of intestinal obstruction in cattle.(AU)

Em bovinos, tumores abdominais que levam à obstrução intestinal parcial ou total são raros. Neste relato, descrevemos os achados clínico-patológicos de duas vacas com obstrução intestinal por neoplasias. Uma vaca mestiça apresentava apatia, perda de peso, constipação, enoftalmia, hipomotilidade ruminal e intestinal e distensão abdominal no quadrante ventral direito. O exame patológico revelou teratoma ovariano bilateral. O outro caso foi uma vaca que, nos últimos 2 anos, teve episódios de carcinoma de células escamosas na terceira pálpebra e vulva. Durante 6 dias antes da investigação, foram observados constipação e tenesmo. Massas nodulares e friáveis foram localizados na vulva, terceira pálpebra direita e cranial ao rim direito, que foram identificadas como carcinoma metastático pouco diferenciado do córtex adrenal. Ao nosso conhecimento, estes são os primeiros relatos de teratoma ovariano e carcinoma adrenal causando sinais clínicos de obstrução intestinal em bovinos.(AU)

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Abstract Mature cystic teratomas, or dermoid tumors, are the most common benign ovarian neoplasms in young women. Malignant transformation is rare, and occurs in less than 2% of the cases. The heterogeneous histological composition of these tumors may be responsible for the occasional elevation of various tumor markers, such as Ca19-9 and Ca125. We describe one case of mature cystic teratoma in a 50-year old woman with the second highest level of Ca19-9 (8922.76 UI/mL) described in the literature. We concluded that abnormal levels of Ca19-9 are not necessarily associated with ovarian malignancy, and may lead to unnecessary medical intervention and patient anxiety. Therefore, the clinical features, imaging studies and antigen testing should be interpreted carefully, and should not limit the surgical approach.

Resumo Os teratomas maduros císticos do ovário, ou tumores dermoides, são as neoplasias benignas mais frequentes em mulheres jovens. A sua transformação maligna é rara, e ocorre emmenos de 2% dos casos. A composição histológica heterogénea destes tumores pode ser responsável pela ocasional elevação de marcadores tumorais, como o Ca19-9 e o Ca125. Descrevemos umcaso de teratoma maduro cístico do ovário numa paciente de 50 anos com o segundo valor mais elevado de Ca19-9 (8922,76 UI/mL) descrito na literatura. Concluímos que níveis anormalmente elevados de Ca19-9 não estão necessariamente associados a tumores malignos, e podem conduzir a intervenções médicas desnecessárias e contribuir para o aumento da ansiedade da paciente. Portanto, as características clínicas, os estudos imagiológicos e os marcadores tumorais devem ser interpretados cuidadosamente, e não devem limitar o tipo de conduta cirúrgica.

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ABSTRACT: In cattle, abdominal tumors leading to partial or total intestinal obstruction are rare. Here, it is described the clinico-pathological findings of two cows with intestinal obstruction by neoplasms. A crossbred cow presented apathy, weight loss, constipation, enophthalmos, ruminal and intestinal hypomotility, and abdominal distension in the right ventral quadrant. Pathological examination revealed bilateral ovarian teratoma. The other case was a cow that in the past 2 years had several episodes of squamous cell carcinoma in the third eyelid and vulva. During the 6 days prior to investigation, clinical signs of constipation and tenesmus were noted. Nodular and friable masses were located in the vulva, right third eyelid and cranially to the right kidney that were identified as poorly differentiated metastatic carcinoma of the adrenal cortex. To our knowledge, these are probably the first reports of ovarian teratoma and adrenal carcinoma causing clinical signs of intestinal obstruction in cattle.

RESUMO: Em bovinos, tumores abdominais que levam à obstrução intestinal parcial ou total são raros. Neste relato, descrevemos os achados clínico-patológicos de duas vacas com obstrução intestinal por neoplasias. Uma vaca mestiça apresentava apatia, perda de peso, constipação, enoftalmia, hipomotilidade ruminal e intestinal e distensão abdominal no quadrante ventral direito. O exame patológico revelou teratoma ovariano bilateral. O outro caso foi uma vaca que, nos últimos 2 anos, teve episódios de carcinoma de células escamosas na terceira pálpebra e vulva. Durante 6 dias antes da investigação, foram observados constipação e tenesmo. Massas nodulares e friáveis foram localizados na vulva, terceira pálpebra direita e cranial ao rim direito, que foram identificadas como carcinoma metastático pouco diferenciado do córtex adrenal. Ao nosso conhecimento, estes são os primeiros relatos de teratoma ovariano e carcinoma adrenal causando sinais clínicos de obstrução intestinal em bovinos.

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Objetivos: el objetivo de este estudio es conocer las características anatomopatológicas y la frecuencia del teratoma ovárico respecto a otras patologías no neoplásicas y neoplásicas de tipo no-teratoma en piezas quirúrgicas producto de ooforectomía en el departamento de patología del IGBJ. Métodos: para este fin se revisaron los registros de piezas quirúrgicas del Seguro Universal de Maternidad y Niñez (SUMI) del Instituto Gastroenterológico Boliviano Japonés. Resultados: se obtuvo como resultados que los teratomas ováricos corresponden a un 8% de todas las patologías de ovario, en el 95% de los casos es de presencia unilateral y el grupo etáreo con mayor afectación corresponde a mujeres de 21 a 30 años. Durante el proceso de recolección de datos, en algunos reportes histopatológicos no se identificó la variable de localización anatómica (derecha ó izquierda) esto por omisión en la solicitud de envió de muestras lo cual dificulto la obtención datos estadísticos más adecuados y exactos. Conclusiones: con lo que se pudo concluir que la incidencia de teratomas en nuestro medio coincide con la literatura expuesta a nivel internacional.

Objectives: the aim of this study was to determine the anatomical and pathological characteristics and frequency of ovarian teratoma compared to other non-neoplastic and neoplastic pathologies of type non- teratoma in product oophorectomy surgical specimens in the pathology department of IGBJ. Methods: for this purpose we reviewed the records of surgical specimens Universal Mother and Child Insurance of Boliviano Japanese Gastroenterological Institute. Results: it was obtained as ovarian teratomas results correspond to 8% of all ovarian pathologies in 95 % of cases are unilateral and presence age group most affected are women of 21-30 years. During the data collection process , in some histopathological reports did not identify the variable anatomic location (right vs. left) this omission in the application for sending samples making it difficult to obtain adequate statistical data and accurate. Conclusions: with it was concluded that the incidence of teratomas in our literature matches internationally exposed.

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Presentar dos casos con malignización de teratoma maduro de ovario. Con clínica inicial inespecífica y aumento progresivo de la circunferencia abdominal. En ambos el ultrasonido y la TAC de abdomen revelaron imágenes de aspecto tumoral por lo que se realizaron otros estudios, no identificando enfermedad a distancia. La biopsia definitiva de la intraoperatoria del anexo derecho e izquierdo respectivamente de cada caso, concluyó adenocarcinoma bordeline mucinoso y adenocarcinoma borderline seroso en un teratoma maduro de ovario. El estadio clínico fue IIIC y recibieron quimioterapia adyuvante. Ambos se mantienen libres de enfermedad

The malignancy of an ovarian mature teratoma is a rare find. We present two cases with nonspecific initial clinical and progressive increase in abdominal girth. In both ultrasound and CT of the abdomen revealed tumor-like images so other studies were conducted to identify distant disease. The final biopsy Annex intraoperative right and left respectively of each case, borderline mucinous adenocarcinoma concluded borderline serous adenocarcinoma in a mature teratoma of the ovary. Clinical stage was IIIC and received adjuvant chemotherapy. Both patients remain free disease

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Apresenta-se o caso de uma mulher de 45 anos com massa abdominal no hipocôndrio direito. O estudo de imagem com tomografia computadorizada de abdômen forneceu o diagnóstico de teratoma ovariano bilateral. Acrescentam-se imagens obtidas com a ecografia e a ressonância magnética, que também podem ser úteis para o diagnóstico.

A woman with 45 years old woman with abdominal mass in the right hypochondrium is presented. The imaging studies with computed tomography of the abdomen provided the diagnosis of bilateral ovarian teratoma. In addition, images obtained with ultrasound, and magnetic resonance imaging can also be useful for diagnosis.

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