Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusu

Posted By Rui Gil
Mature cystic teratoma with high proportion of solid thyroid tissue: a controversial case with unusu

We describe a case of a mature cystic teratoma of the ovary with high proportion of solid thyroid tissue (but less than 50%) in a childbearing woman. The patient presented with non-specific symptom of abdominal bloating. Pelvic ultrasound and magnetic resonance imaging revealed a complex cystic-solid tumor confined to the left ovary with an anterior fat-containing locus compatible with mature cystic teratoma and a posterior predominantly solid component with low signal intensity on T2-weighted images that was histopatologically diagnosed as benign thyroid tissue. Thyroglobulin levels were in normal range. Although thyroid tissue is present in up to 20% of mature cystic teratomas, with exception of struma ovarii, it is not usually macroscopically nor radiologically identified. The differential diagnosis should include malignant transformation of mature teratoma, as well as T2-hypointense adnexal lesions associated with mature cystic teratoma.

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  • TERESA CUNHA 2017-04-15 15:44:22

    :smile:

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  • TERESA CUNHA 2017-04-15 15:42:58

    The tyroid tissue on the mature cystic teratoma behaved like a normal tyroid on MRI - low signal intensity on T2WI.

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  • TERESA CUNHA 2017-04-15 15:39:47

    :smile:

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  • Rui Gil 2017-01-20 10:32:42

    Dear Mr. Talanow,

    In the initial MRI report of this case the hypothesis of the presence of thyroid tissue was not considered since the lesion was complex, with an anterior locus compatible with a mature cystic teratoma and an indeterminate posterior component. However, after surgery and retrospectively evaluating the images, we realized that it was "radiologically" possible to admit that the posterior (predominantly) solid component corresponded to thyroid tissue because it had signal characteristics on MRI similar to what we usually find in the classic struma ovarii: solid component with low signal intensity on T2-weighted images, intermediate signal intensity on T-weighted images, and strong enhancement after contrast administration; mixed with a cystic small component with intermediate signal intensity on T1-weighted images and very low signal intensity on T2-weighted images (shading sign) due to colloid.

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  • Roland Talanow 2016-06-05 14:26:33

    Thank you for this case.

    How did you detect the thyroid tissue "radiologically"?

    Thank you.

    Reply