IS Case 562: Mature cystic teratoma identified on plain radiography

Jeremy Duda MD

Imaging Sciences URMC

Imaging Sciences URMC 2010
Publication Date: 2011-11-16


Patient is a 15-year-old female presenting with right lower quadrant pain, nausea, vomiting, fever and leukocytosis.


Radiography of the abdomen showed a normal abdominal gas pattern and a rounded, well marginated, finely calcified 2.6 x 1.7 cm lesion overlying the right sacral wing.


Mature cystic teratoma identified on plain radiography


Mature cystic teratoma (MCT), formerly referred to as a dermoid cyst, is the most common form of germ cell tumor and is the most common form of ovarian neoplasm in children. MCTs are comprised of at least two layers of germ cells, either ectoderm, mesoderm or endoderm. They usually contain components of squamous epithelium, hair, muscle, bone, fat, and may contain tissue types such as bronchial and gastrointestinal epithelium as well as thyroid tissue. Ultrasound is the imaging modality most suited for visualization of the adnexa, and MCTs may be identified by several findings including cysts, echogenic bands representing hair, or calcific objects representing bone or teeth. On plain radiograph a radiopaque lesion representing these calcific structures may be evident, as in the above case. MRI may also be performed. The differential diagnosis for such findings includes the much less common immature cystic teratoma, a malignant lesion, which are usually larger and more indistinct in appearance but are otherwise indistinguishable. Although MCTs are usually asymptomatic, complications include tumor rupture, torsion or the affected ovary, and malignant degeneration of its squamous components (degeneration into an immature teratoma is rare).


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