Mature cystic teratomas: a pictorial review
Number:28ESURABS0137
Type:Educational Electronic Presentation
Authors: Maja Stankov, Marijana Basta Nikolic, Ivan Adjic
Keywords:mature cystic teratoma, ovarian pathology, MRI, CT
SECTIONS
Educational objective

To review the main imaging findings of mature cystic teratomas, to present MR and CT findings of mature cystic teratomas based on reports from our institution, and to sumarize mimics of mature cystic teratomas seen on CT and MR images.

Topic Review

Teratomas are the most common germ cell neoplasm and accounts for about 20% of all ovarian neoplasms. Ovarian teratomas include mature cystic teratomas, immature teratomas, monodermal teratomas and fetiform teratomas. Teratomas may appear cystic, solid or mixed.

The majority of the teratomas are mature cystic teratomas, which are usually found in young women. They are encapsulated unilocular tumors, which contain at least two mature germ cell layers (ectoderm, mesoderm and endoderm). Skin derivates, muscle, bone, teeth or cartilage usually grow within the protuberance called the Rokitansky nodule.

Most mature cystic teratomas are asymptomatic. They are bilateral in a small percent of cases (10-15%). If present, symptoms are nonspecific and often include abdominal or pelvic pain. They are slow growing and require surgery only when their size is affecting adjacent organs...

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Figure 1. A case of a 60-year-old woman with a palpable pelvic mass. Axial non-enhanced (a) and contrast enhanced (b) CT images. A mostly hypodense (fat signal) oval lesion in the pelvis (asterisk) with mural calcifications (arrow). Floating nodules probably corresponding to hair follicles (dashed arrow). There is no appreciable contrast enhancement.
Figure 2. A case of 39-year-old woman with dysmenorrhea. Axial non-enhanced CT (a), axial T1W (b) and T1W FS (c) images and post contrast T1W FS image (d). A well demarcated hypodense lesion in the left ovary seen on CT (a). On MRI the lesion is T1W hyperintense with signal suppression on T1W FS and no mural or nodular contrast enhancement (arrow).
Conclusions

Radiology plays an important role in localization and characterization of ovarian lesions due to wide range of the adnexal pathology. The presented features of mature cystic teratomas are important for radiologists to be familiar with in order to avoid mimics and establish precise diagnosis. In addition, CT and MR imaging allows determination of the relationship between the lesion and surrounding structures, which is beneficial for treatment planning.