1. Intern 陳君豪 & 蔡佽學 Supervisor 2005/08/31
Intern Semina
Intern 陳君豪 & 蔡佽學
Supervisor
2005/08/31

2. Information Name: 賴 x 璇 Sex: female Age: 7 y/o
Admission Date: 94/07/11

3. Chief Complaint
Intermittent abdominal pain for 1 year

4. Brief History - 1 year : Intermittent abdominal pain
- 1 month: one abdominal mass
- 2 days ago: abdominal pain became severe, appetite and activity decreased, constipation,

5. Brief History
- GYN LMD : abdominal X-ray  one abdominal mass with calcification
- 奇美 Hospital: one abdominal mass
- Our ER: one firm, un-movable, 12x16 cm mass with tenderness

6. Birth History
G2P2
C/S
GA: Full-term
BBW: 3183 gm
DOIC (-)
PROM (-)

7. Past History Feeding: on full diet Vaccination: on schedule
Growth and Development:
- BW: 26.1 Kg (50-75th%)
- BL: cm (75-90th%)
Denied other major disease
Denied hospitalization history

8. PE
One 12x16 cm, firm, unmovable, well-defined margin, abdominal mass over anterior, middle abdomen
Tenderness (+)
Rebounding pain (-)

9. Lab Data Lymph 207.2 180 179 CRP ALK-P LDH 82.0% 363 4.19M 20.8K Seg
Plt
RBC
WBC
11.0%

10. Imagine - Plain Film

11. Imagine - Abdominal CT

12. Imagine - Abdominal CT

13. Imagine - Abdominal CT

14. Pathology Mature cystic teratoma 11.7x10.2x7.5 cm in size
475g in weight

15. Discussion
Teratoma of the Ovary

16. Teratoma
Teratomas are tumors comprising more than a type one germ layer

17. Location of Teratoma Sacrococcygeal (57%) Gonad (29%) Mediastinal (7%)
Retroperitoneal (4%)
Cervical (3%)
Intracranial (3%)

18. Teratoma of the Ovary Mature teratoma Immature teratoma
Monodermal teratomas

19. Mature Teratoma 95% Second and third decades of life
Ectodermal (skin, brain), mesodermal (muscle, fat), and endodermal (mucinous or ciliated epithelium)

20. Immature Teratoma Malignant teratoma, <1% First two decades of life
Immature or embryonic tissues

21. Immature Teratoma
Immature teratomas are typically larger (14–25 cm) than mature cystic teratomas (average, 7 cm)
Prominent solid component
Perforation of the capsule, which is not always well defined

22. Monodermal Teratomas Composed solely of one tissue type
Thyroid tissue in struma ovarii
Neuroectodermal tissue in carcinoid tumor

23. Epidemiology
Mature cystic teratomas account for 10-20% of all ovarian neoplasms
Most common ovarian neoplasm in patients younger than 20 years
8-15% bilateral
1-2% showed malignant degeneration

24. Clinical Symptom
Incidental findings on physical examination, during radiographic studies, or during abdominal surgery
Asymptomatic mature cystic teratoma of the ovaries have been reported at rates of 6-65% in various series.

25. Clinical Symptom Abdominal pain (47.6%),
Abdominal mass or swelling (15.4%)
Abnormal uterine bleeding (15.1%)
Bladder symptoms, gastrointestinal disturbances, and back pain are less frequent
Abdominal pain ranges from slight to moderate. Torsion and acute rupture commonly are severe pain

26. Lab
Elevated serum alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (HCG) levels may be indicative of malignancy
Within reference ranges in most patients with benign teratomas.

27. Imaging Studies - X-Ray
Soft tissue mass containing calcification (such as teeth)

28. Imaging Studies - US
Cystic components
Echogenic mass
Acoustic shadow

29. Imaging Studies - CT Cystic tumor with fat and calcification
Bullseye sign

30. Imaging Studies - MRI
Differentiate lipid density from other fluid and blood

31. Complications Torsion: 3.2-16% Rupture: 1-4%,
- leading to shock or hemorrhage
Infection: 1%,
- Coliform bacteria
Autoimmune hemolytic anemia
Malignant degeneration
- 1-2%, squamous, adenocarcinoma

32. Treatment
Mature cystic teratomas of the ovaries should be removed by simple cystectomy rather than salpingo-oophorectomy

33. Staging Stage 1 only in the ovary (or both ovaries)
Stage 2 spread into the fallopian tube, uterus, or elsewhere in the pelvis
Stage 3 spread to the lymph nodes or to the peritoneum
Stage 4 spread to distance organ

34. Thanks for your attention !!