ESPE Abstracts

Introduction: A 12-year-old girl has been accepted in our emergency room for persistent abdominal pain associated with nausea, dysuria and difficulty walking. Abdominal pain is localized on the left side and is acute, stabbing, intermittent and non radiating. The menstrual cycle is normal, both in duration and intensity. Family history does not reveal a significant background. The girl is apyretic with normal vital parameters. The abdomen appears expanded and prominent. Giordano's maneuver is positive, more to the left. On palpation, a hard mass of increased consistency is appreciated, not painful to palpation and expanded from the pelvis to the epigastrium.

Materials and Methods: Emergency laboratory tests are performed including tumor markers and pregnancy tests. An abdominal ultrasound is done for immediate evaluation of the suspected abdominal mass.

Results: The emergency blood tests (blood count, inflammatory indices, clinical biochemistry and coagulation function) are negative as well as the pregnancy test and tumor markers. Ultrasound shows the presence in the median area up to the left quadrants of a voluminous formation of 17 centimeters at least, extending from the epigastrium to the pelvis, with corpuscular fluid content, internal mobile septa and evidence of iso/hypoechoic solid components, partly fluctuating, lobulated and irregular, containing in turn some inscribed calcific cores. This formation compresses and moves down the bladder and uterus making it impossible to evaluate the adnexa. On the other hand, a bilateral calico-pyelo-ureterectasia is visible with an antero-posterior diameter of the right and left renal pelvis of 19 and 15 millimeters, respectively. After pediatric surgical consultation, teratoma excision is performed through laparotomy with Pfannenstiel incision. The histopathological picture describes immature and mature structures such as squamous, respiratory, bone, cartilage, bone marrow, lymph nodes, smooth muscle, nervous, fatty, glandular, lymphoid and gastric tissue.

Conclusion: The pathological picture confirms the diagnosis of mixed cystic ovarian teratoma. The postoperative course has no complications. The ultrasound follow-up shows the progressive resolution of the calico-pyelo-ureterectasia. Teratomas are embryonic neoplasms consisting of tissues of 2 or 3 germ layers (ectoderm, endoderm and mesoderm). Ovarian teratomas are the most common germline cancers, the most common of which in children is the mature cystic type (or dermoid cyst). In the presence of an ovarian mass, there are no specific symptoms or a characteristic physical examination for which diagnosis may be delayed. Ultrasound imaging is essential because if it occurs early it can avoid complications such as ureterohydronephrosis.