Massive Mature Solid Teratoma of the Ovary with Gliomatosis Peritonei

EDITORIAL COMMENT: : We accepted this and the following case report for publication because they illustrate problems that may be associated with spontaneous or surgical spillage of contents of a cystic teratoma into the peritoneal cavity. The oncologist who reviewed this manuscript suggested that the editorial subcommittee publishes a statement that women with a large abdominal mass are unlikely to have their management altered by CT scan or MRI investigations although ultrasonography has usually been arranged by the referring practitioner. These women require prompt laparotomy, although chest X‐ray should be performed preoperatively to exclude metastatic disease. Diagnostic paracentesis which is often performed in women with abdominal masses, as in this patient, is potentially harmful and unnecessary in a patient fit and willing for surgery. Although most gynaecologists attempt to remove a cystic ovarian carcinoma intact, the literature is inconclusive about the risk of recurrence of a Stage 1 ovarian carcinoma if spillage of cyst contents occurs during surgery (A, B). It was also noted by the oncologist reviewer that most large solid teratomas are malignant and that a tumour of this size should be extensively sampled by the pathologist before a diagnosis of benign teratoma is made. Clinically, a large ovarian tumour can seem solid when it is cystic, and may also be mistaken for ascites as apparently was so in the patient reported here. (A) Sainz de la Cuesta R, Goff BA, Fuller AF, Nikrui N, Eichhorn JH, Rice LW. Prognostic importance of intraoperative rupture of malignant ovarian epithelial neoplasms. Obstet Gynecol 1994; 84: 1–7. (B) Sevelda P, Dittrich C, Salzer H. Prognostic value of the rupture of the capsule in Stage 1 epithelial ovarian carcinoma. Gynecol Oncol 1989; 35: 321–322. Summary: Glial implants on peritoneum and omentum may occur with mature solid teratoma of the ovary (gliomatosis peritonei). The case of a 17‐year‐old girl is presented, who had a massive solid ovarian teratoma with glial implants on visceral peritoneum and omentum. The massive size of the tumour posed difficulty in diagnosis. CT demonstrated a large teratoma. At laparotomy, the seedlings were initially thought to be evidence of malignancy and hysterectomy was offered which was refused by the parents. Oophorectomy was performed and the benign nature of the tumour and implants was seen on histopathology. It is important to recognize the benign nature of glial seedlings in such cases to avoid unnecessary extensive surgery.