A rare case study by Dr. Ruby Sehra an ivf specialist in punjabi bagh new delhi ,india about coexisting endometrioma & teratoma

A rare case study by dr. ruby sehra an ivfspecialist in punjabi bagh new delhi ,india about coexisting endometrioma & teratoma.

Endometriosis & mature cystic teratoma are both common diseases in reproductive age group but co-existence of both entities in the same ovary is of rare occurance. We hereby report a rare case of  co-existing mature teratoma & endometrioma in the same patient , in the same ovary.

CASE HISTORY

      
A 25 year nulliparous woman married for 8 months presented in our OPD with complaints of recurrent urinary tract infection and dysmenorrhea since 2-3 years ,painful intercourse & mild abdominal discomfort for  1 year .She had been wandering to various physicians & gynaecologists for repeated bouts of pain  in the lower abdomen & fever off & on whence she was prescribed various  antibiotics presuming the newly wed woman to be suffering from honeymoon cystitis but after 2-3 months of treatment she was advised to get an ultrasound done for the same complaints. She was diagnosed to be a case of right ovarian cyst measuring 5.4 ×4.5 cm within haemorrhagic component  thereafter she came to our hospital & was advised to undergo MRI of whole abdomen & ca125 done MRI showed right ovariancystmeasuring10.2X8.5X8.4cm

  Her CA 125 was raised to 162.5 units. Her urine culture was sterile. We advised her to undergo laparoscopic ovarian cystectomy with frozen section.
After creating a pneumoperitoneum a big ovarian cyst of 10x8x8 cm was seen arising from the right ovary whereas normal rt. Ovary could be seen lying in the lower part of ovarian hanging down from the ovarian ligament. It was not adhering to intestine or bladder or pouch of Douglas. On incising the cyst capsule, chocolate material came out which was sucked out. Considering the patient to be nulliparous, we tried to save her ovary by peeling off the cyst wall from ovarian capsule. At the lower part of the cyst A solid mass consisting of sebaceous material & bunch of hair was seen .The whole cyst wall with solid cystic structure was separated from the normal ovarian tissue& put in the endobag & sent for frozen section which confirmed the diagnoses of mature cystic teratoma. D& C & chromotubation was done & the curetting’s obtained were sent for histopathology & PCR with AFB culture .Bilateral tubes were normal in calibre & length. Left ovary& uterus were normal there were few endiometriotic  spots in pouch of Douglas which were fulgurated.The patient recovered normally. On follow up there was no dysparunia or lower abdominal pain.