Massive ovarian cystic teratomas diagnosed at a rural Nepal camp

This case report presents the findings of significantly large sized (> 8 cm) symptomatic unilateral cystic teratomas in two perimenopausal patients in remote Nepal. Ovarian dermoid cysts consist of cystic, solid and fat tissue. Traditionally, cells differentiate along the various germ lines, essentially recapitulating various body tissues. The characteristic sonographic features include a dermoid plug, dermoid mesh, a fat-fluid level and the "tip of the iceberg" sign. The presence of two or more of these typical features confidently supports an ultrasound-based diagnosis of ovarian dermoid cyst. The presence of intratumoral hair, teeth, fat, and skin tissue revealed at surgery confirmed the initial ultrasound based diagnosis.