Research Article

The predictive value of the preoperative diagnostic tests in mature cystic teratomas of the ovary

Hanife Saglam, Funda Atalay*, Ayse Filiz Avsar and Hüseyin Levent Keskin

Published: 19 December, 2018 | Volume 1 - Issue 2 | Pages: 073-081

Aim: The aim of this study was to determine the sensitivity of the tumor markers and diagnostic methods used in the preoperative period for dermoid cysts, the most common benign neoplasm of the ovary.

Material and Methods: 136 patients who were operated for any reason and reported as ovarian dermoid cyst in the Department of Obstetrics and Gynecology, Ankara Atatürk Training and Research Hospital between January 2004 and September 2005 were included in the study. The medical records of the cases were obtained retrospectively from Ankara-Atatürk Training and Research Hospital, HIS, archive files and patient numbers where necessary.

Results: In the preoperative period, 119 patients underwent ultrasonographic examination, 33 underwent Computed Tomography, and 17 underwent Magnetic Resonance Imaging.10 of the cases only underwent CT, while 3 of the cases underwent only MRI 22 of them underwent both USG and CT, USG and MRI were performed on 13 cases and only 1 case underwent all three of the imaging methods. Tumor markers were CEA, CA 125, CA 19-9, CA 15-3 and AFP.

Conclusions: The reviews of ultrasonography and / or computed tomography and / or magnetic resonance imaging (n = 132) revealed that 103 of the cases were put into operation and the sensitivity of the preoperative screening methods were calculated to be 75.5%. The sensitivity of the tumor marker CA 19-9 was calculated to be 31%.

Read Full Article HTML DOI: 10.29328/journal.cjog.1001013 Cite this Article Read Full Article PDF


Mature cystic teratoma; Ovary; Tumor markers: Radiologic imaging


  1. Katsube Y, Berg JW, Silverberg SG. Epidemiologic pathology of ovarian tumors: a histopathologic review of primary ovarian neoplasms diagnosed in the Denver Standard Metropolitan Statistical Area, 1 July-31 December 1969 and 1 July-31 December 1979. Int J Gynecol Pathol. 1982; 1: 3-16. Ref.: https://goo.gl/9VS41X
  2. Koonings PP, Campbell K, Mishell DR Jr, Grimes DA. Relative frequency of primary ovarian neoplasms: a 10-year review. Obstet Gynecol. 1989; 74: 921-926. Ref.: https://goo.gl/FySxpo
  3. Peterson WF, Prevost EC, Edmunds FT, Hundley JM Jr, Morris FK. Benign cystic teratomas of the ovary; a clinico-statistical study of 1,007 cases with a review of the literature. Am J Obstet Gynecol. 1955; 70: 368-382. Ref.: https://goo.gl/d9MJpd
  4. Ayhan A, Bukulmez O, Genc C, Karamursel BS, Ayhan A. Mature cystic teratomas of the ovary: case series from one institution over 34 years. Eur J Obstet Gynecol Reprod Biol. 2000; 88: 153-157. Ref.: https://goo.gl/vF4rN8
  5. Pantoja E, Rodriguez-Ibanez I, Axtmayer RW, Noy MA, Pelegrina I. Complications of dermoid tumors of the ovary. Obstet Gynecol. 1975; 45: 89-94. Ref.: https://goo.gl/W4iN2k
  6. Hoffman BL. Schorge JO, Schaffer JI, Halvorson LM, Bradshaw KD, et al. eds. Wiiliams Gynecology. Texas: Mc Graw Hill. 2012; 267. Ref.: https://goo.gl/M4dgvf
  7. Yoshioka T, Tanaka T. Immunohistochemical and molecular studies on malig­nant transformation in mature cystic teratoma of the ovary. J Obstet Gynaecol Res. 1998; 24: 83–90. Ref.: https://goo.gl/AQJXtT
  8. Caruso PA, Marsh MR, Minkowitz S, Karten G. An intense clinicopathologic study of 305 teratomas of the ovary. Cancer. 1971; 27: 343-348. Ref.: https://goo.gl/TY4E6A
  9. Ozgur T, Atik E, Silfeler DB, Toprak S. Mature cystic teratomas in our serieswith review of the literature and retrospective analysis. Arch Gynecol Obstet. 2012; 285: 1099-1101. Ref.: https://goo.gl/9sVnp1
  10. Bagolan P, Giorlandino C, Nahom A, Bilancioni E, Trucchi A, et al. The management of fetal ovarian cysts. J Pediatr Surg. 2002; 37: 25-30. Ref.: https://goo.gl/GhynQd
  11. Chiang AJ, La V, Peng J, Yu KJ, Teng NN. Squamous cell carcinoma arising from mature cystic teratoma of the ovary. Int J Gynecol Cancer. 2011; 21: 466-474. Ref.: https://goo.gl/hbohPb
  12. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994; 84: 22-28. Ref.: https://goo.gl/eDC874
  13. Breen JL, Maxson WS. Ovarian tumors in children and adolescents. Clin Obstet Gynecol. 1977; 20: 607-623. Ref.: https://goo.gl/Jie1x1
  14. Giorlandino C1, Bilancioni E, Bagolan P, Muzii L, Rivosecchi M, et al. Antenatal ultrasonographic diagnosis and management of fetal ovarian cysts. Int J Gynaecol Obstet. 1994; 44: 27-31. Ref.: https://goo.gl/ejMv5T
  15. Salman W, Singh M, Twaij Z. A case of papillary thyroid carcinoma in struma ovarii and review of the literature. Patholog Res Int. 2010; 2010: 352476. https://goo.gl/UJHLSx
  16. Lal S, Singh A, Goel N. Acute gynaecological emergency caused by ruptured der­moid. JEMDS. 2014; 3: 5705-5710. Ref.: https://goo.gl/fEmrba
  17. Artunc UB, Goker A, Pala HG, Ordu S. Abnormal elevated ca 19-9 in the dermoid cyst: a sign of the ovarian torsion? Case Rep Obstet Gynecol. 2013; 2013: 860505 Ref.: https://goo.gl/JnNTxM
  18. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature cystic teratoma: a clinicopathologic evaluation of 517 cases and review of the literature. Obstet Gynecol. 1994; 84: 22-28. Ref.: https://goo.gl/6SCsPM
  19. Sahin H, Abdullazade S2, Sanci M. Mature cystic teratoma of the ovary: a cutting edge overview on imaging features. Insights Imaging. 2017: 8: 227-241. Ref.: https://goo.gl/LUn7ff
  20. Patel MD, Feldstein VA, Lipson SD, Chen DC, Filly RA. Cystic teratoma of the ovary: diagnostic value of sonography. AJR Am J Roentgenol. 1998; 171: 1061–1065 Ref.: https://goo.gl/C1Ki8w
  21. Dooms GC, Hricak H, Tscholakoff D. Adnexal structures: MR imaging. Radiology. 1986; 158: 639-646. Ref.: https://goo.gl/Ax2kXj
  22. Mitchell DG, Mintz MC, Spritzer CE, Gussman D, Arger PH, et al. Adnexal masses: MR imaging observations at 1.5 T, with US and CT correlation. Radiology. 1987; 162: 319-324. Ref.: https://goo.gl/RFYAxm
  23. Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, et al. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol. 2009; 72: 454–463. Ref.: https://goo.gl/tp3VZG
  24. Togashi K, Nishimura K, Itoh K, FujisawaI, Sago T, et al. Ovarian cystic teratomas: MR imaging. Radiology. 1987; 162: 669–673. Ref.: https://goo.gl/kgcB16
  25. Nakamaya T, Yoshimitsu K, Irie H, Aibe H, Tajima T, et al. Diffusion- weighted echo-planar MR imaging and ADC mapping in the differential diagnosis of ovarian cystic masses: usefulness of detecting keratinoid substances in mature cystic teratomas. J Magn Reson Imaging. 2005; 22: 271–278. Ref.: https://goo.gl/CWRi7M
  26. Matsumoto F, Yoshioka H, Hamada T, Ishida O, Noda K. Struma ovarii: CT and MR findings. J Comput Assit Tomgr. 1990; Mr-Opr; 14: 310-312. Ref.: https://goo.gl/CDPsU4
  27. Mahomedy S, Bayat MR, Seedat M. Meat balls: a pathognomonic ultrasound and computed tomography finding in mature cystic teratoma. Australas Radiol. 2007; 51: B281–B283 Ref.: https://goo.gl/EXCEFB
  28. Hackethal A, Brueggmann D, Bohlmann MK. Et al. Squamous-cell carcinoma in mature cystic teratoma of the ovary: systematic review and analysis of published data. Lancet Oncol. 2008; 9: 1173-1780. Ref.: https://goo.gl/bhdJNk
  29. Yüksel MA, Abal› R, Aras Ö, Temel , Ünal F, Boran AB, Purisa S. Ovaryan Dermoid Kistlerde CA 19-9 Seviyesinin De¤erlendirilmesi. Türkiye Klinikleri Jinekoloji-Obstetrik Dergisi. 2011; 21: 190-194. Ref.: https://goo.gl/CAGWZy
  30. Günay E, Kalender HS, Cengizo¤lu B, Turan C, Ünal O. Adneksiyal Kitlelerde Tümör ‘’Marker’’lar› ve Cerrahi Sonuçlar›. Kartal e¤itim Arafl. Hast. T›p Dergisi. 2002; 3: 179-181 Ref.: https://goo.gl/cWTAJB
  31. Genç M, Şahin N, Karaarslan S. Mature Cystic Teratoma of the Ovary Clinical, Radiological and, Histopathologic Aspects. Journal of Clinical and Analytical Medicine. 2016; 370-374. Ref.: https://goo.gl/nCnCb8
  32. Mais V, Guerriero S, Ajossa S, Angiolucci M, Paoletti AM, et al. Transvaginal ultrasonography in the diagnosis of cystic teratoma. Obstet Gynecol. 1995; 85: 48-52. Ref.: https://goo.gl/eYdBTg
  33. de Kroon CD, van der Sandt HA, van Houwelingen JC, Jansen FW. Sonographic assesment of non-malignant ovarian cysts; does sonohistology exist? Hum Reprod. 2004; 19: 2138-2143. Ref.: https://goo.gl/nviKxF
  34. Tekin YB, Altınbaş ŞK, Dede S, et al. The parameters affecting accuracy of ultrasonographic diagnosis in dermoid cysts. Dicle Medical Journal. 2014; 41: 64-70.
  35. Andolf E, Jorgensen C. A prospective comparison of transabdominal and transvaginal ultrasound with surgical findings in gynecologic disease. J Ultrasound Med. 1990; 9: 71–75. Ref.: https://goo.gl/6U152N
  36. Hata K, Hata T, Manabe A, Sugimura K, Kitao M. A critical evaluation of transvaginal Doppler studies, transvaginal sonography, magnetic resonance imaging, and CA 125 in detecting ovarian cancer. Obstet Gynecol. 1992; 80: 922–926. Ref.: https://goo.gl/V96WPQ
  37. Kurjak A, Predanic M, Kupesic-Urek S, Jukic S. Transvaginal color and pulsed Doppler assessment of adnexal tumor vascularity. Gynecol Oncol. 1993; 50: 3-9. Ref.: https://goo.gl/JzBDVz
  38. Lerner JP, Timor-Tritsch IE, Federman A, Abramovich G. Transvaginal ultrasonographic characterization of ovarian masses with an improved, weighted scoring system. Am J Obstet Gynecol. 1994; 170: 81-85. Ref.: https://goo.gl/YXHJw3
  39. Quinn SF, Erickson S, Black WC. Cystic ovarian teratomas: the sonographic appearance of the dermoid plug. Radiology. 1985; 155: 477–478. Ref.: https://goo.gl/92kK3R
  40. Dodd GD, Budzik RF. Lipomatous tumors of the pelvis in women: spectrum of imaging findings. AJR Am J Roentgenol. 1990; 155: 317–322. https://goo.gl/QThLmR
  41. Sheth S, Fishman EK, Buck JL, Hamper UM, Sanders RC. The variable sonographic appearances of ovarian teratomas: correlation with CT. AJR Am J Roentgenol. 1988; 151: 331–334. Ref.: https://goo.gl/fTNPZ8
  42. Fridman AC, Pyatt RS, Hartmann DS, Downey EF, Olson WB. CT of benign cystic teratomas. AJR Am J Roentgenol. 1982; 138: 659–665. Ref.: https://goo.gl/7L8AR8
  43. Guerriero S, Mallarini G, Ajossa S, Risalvato A, Satta R, et al. Transvaginal ultrasound and computer tomography combined with clinical parameters and CA-125 determinations in the differential diagnosis of persistent ovarian cysts in premenopausal women. Ultrasound Obstet Gynecol. 1997; 9: 339–334 Ref.: https://goo.gl/5MbPtf
  44. Buy JN, Ghossain MA, Moss AA, Bazot M, Doucet M, et al. Cystic teratoma of the ovary: CT detection. Radiology. 1989; 171: 697–701. Ref.: https://goo.gl/iyRSXy
  45. Laufer M, Goldstein D. Benign and malignant ovarian masses. In: Emans S; La­ufer M Goldstein, D, editors. Pediatric and Adolescent Gynecology. 5th ed. Phila­delphia: Lippincott Williams and Wilkins; 2005. 706-710.
  46. Zeyneloğlu HB, Öktem M, Eroğlu D, Kuşçu E. Matür kistik teratomlara la­paroskopik yaklaşım: Başkent Üniversitesi deneyimi. J Turk Soc Obstet Gynecol. 2005; 2: 116-120. Ref.: https://goo.gl/kLKVkY
  47. Leibman AJ, Kruse B, McSweeney MB. Transvaginal sonography: comparison with transabdominal sonography in the diagnosis of pelvic masses. Am J Roentgenol. 1988; 151: 89–92. Ref.: https://goo.gl/FjzmuN
  48. Guttman PH Jr: In search of the elusive benign cystic ovarian teratoma: application of the ultrasound “tip of the iceberg” sign. J Clin Ultrasound. 1977; 5: 403-406. Ref.: https://goo.gl/VNEVR2
  49. Bronshtein M, Yoffe N, Brandes JM, Blumenfeld Z. Hair as a sonographic marker of ovarian teratomas: improved identifi cation using transvaginal sonography and simulation model. J Clin Ultrasound. 1991; 19: 351-355. Ref.: https://goo.gl/36yfQk
  50. Kikkawa F, Nawa A, Tamakoshi K, Ishikava H, Kuzuya K, et al. Diagnosis of squamous cell carcinoma arising from mature cystic teratoma of the ovary. Cancer. 1998; 82: 2249–2255. Ref.: https://goo.gl/6CNZ3A
  51. Kawai M, Kano T, Kikkawa F, Morikawa Y, Oguchi H, et al. Seven tumor markers in benign and malignant germ cell tumors of the ovary. Gynecol Oncol. 1992; 45: 248–253. Ref.: https://goo.gl/Fj3BcK
  52. Mikuni M, Makinoda S, Tanaka T, Okuda T, Domon H, et al. Evaluation of tumor markers in ovarian dermoid cyst. Acta Obstet Gynaecol Jpn. 1990; 42: 479–484. Ref.: https://goo.gl/F8y11Z
  53. Konishi I, Fujii S, Okamura H, Sakahara H, Endo K, et al. Analysis of serum CA125, CEA, AFP, LDH levels and LDH isoenzymes in patients with ovarian tumors—correlation between tumor markers and histological types of ovarian tumors. Acta Obstet Gynaecol Jpn. 1986; 38: 827–836. Ref.: https://goo.gl/hhhYM1
  54. Var T, Tonguc EA, Ugur M, Altinbas S, Tokmak A. Tumor markesrs panel and tumor size of ovarian dermoid tumors in reproductive age. Bratisl Lek Listy. 2012; 113: 95-98. Ref.: https://goo.gl/cSrtyE
  55. Dede M, Gungor S, Yenen MC, Alanbay I, Duru NK, et al. CA19-9 may have clinical significance in mature cystic teratomas of the ovary. Int J Gynecol Cancer. 2006; 16: 189-193. Ref.: https://goo.gl/Pv6G7E


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