Rare multiple teratomas of the omentum and giant fused teratomas of the bilateral ovaries: a case report and review of the literature

Abstract

Teratoma usually forms plates on or encompasses the ovaries and/or adnexa; however, teratomas of the omentum are so rare that only up to 46 cases have been described in nearly 200 years. Here, we report the case of a 47-year-old woman admitted to hospital with intermittent distending pain and discomfort. At the admission, an ultrasonic examination revealed an irregular cystic space–occupying lesion on the bilateral adnexa area. Laparoscopic ovarian cystectomy was selected as the treatment option. However, coexistence of multiple teratomas on the greater omentum and 2 giant, fused bilateral ovarian teratomas measuring over 20 cm were found during operation, thus needing laparotomy, hysterectomy, bilateral salpingooophenrectomy, omentectomy, appendicectomy, and enterolysis. Three years after the operation, no recurrence has yet been found. We report a rare case with multiple teratomas of the omentum and giant fused teratomas of the bilateral ovaries. Histopathological studies confirmed the diagnosis of teratomas, and surgery completely resolved the original symptoms. There are no standard diagnostic criteria or operative options for teratomas of the omentum, which increases the likelihood of misdiagnosis and of insufficient preoperative planning for the appropriate procedures. Ultrasound, CT, MRI and possibly also the PET may aid in the diagnosis. A definitive diagnosis is possible following histopathological examination, which must differentiate between mature and immature teratoma. Although, malignant transformation (MT) of the omentum teratoma has been described, the risk is very rare. Surgical excision of omentum teratoma is the treatment of choice, and most surgeons perform laparoscopy with tumor dissection. The surgical technique remains particularly important especially in young women, in whom the most conservative approach is crucial, to preserving fertility and minimizing surgical morbidity. The management depends upon the maturity of the teratoma. For mature teratoma, complete excision is curative and no further treatment is required. Immature teratomas are potentially malignant, so the patient may require chemotherapy and