Written By: IJCP Editorial Team

Published On: 05 Mar, 2025 4:07 PM | Updated On: 06 Mar, 2025 12:05 PM

Diagnostic Challenges of a Detached Mature Cystic Teratoma in the Pouch of Douglas

Germ cell tumors (GCTs) make up 15-20% of all ovarian tumors in children and young women, with mature cystic teratoma, or dermoid cyst, being the most prevalent type. This report discussed a rare case of a completely detached mature cystic teratoma found in the pouch of Douglas, which presented a diagnostic challenge and was surprising during surgery.

A 41-year-old woman, who had two pregnancies and two live births, presented with a one-year history of lower abdominal pain and abdominal distension. An initial ultrasound at another facility indicated uterine fibroids and signs of bilateral endometriomas, leading to conservative treatment. After nine months of persistent symptoms, she sought further evaluation at our hospital. A repeat ultrasound revealed multiple uterine fibroids and a left endometriotic cyst, while a contrast-enhanced CT scan identified multiple fibroids and a left dermoid cyst. The patient underwent laparotomy, where surgeons observed serosal fibroids on the uterus and a detached cystic mass, approximately 9 x 4 x 2 cm, in the pouch of Douglas. A total abdominal hysterectomy, bilateral salpingectomy, and en bloc removal of the cystic mass were performed. Histopathological analysis confirmed the mass as a dermoid cyst.

This case highlighted a diagnostic dilemma, as the ultrasound suggested ovarian endometriosis despite the absence of related symptoms. Reports on detached ovarian dermoids located in the pouch of Douglas are scarce, making its occurrence particularly puzzling.

To summarize, gynecologists should be made more aware regarding such masses, along with thorough preoperative evaluations and intraoperative decisions, which is essential for appropriate patient management.

Source: Mathew R A, Navada M H, Wonder of the wandering dermoid cyst. Indian J Obstet Gynecol Res 2025;12(1):164-167.