A maturing approach to the assessment of ovarian teratomas

A wide spectrum of ultrasonographic features for dermoid cysts and mature cystic teratomas of the ovary has been described by both radiologists and gynecologists. The nature of these lesions is later confirmed by Pathologists as being benign ovarian tumors. There is however a great difference in the surgical outcomes and ovarian preservation in pediatric and adolescent patients with benign teratomas. Clinicians focus on the tumor characteristics seen on scanning, with management decisions then based on that information. Whereas these tumors tend to have a cystic predominance, on occasion they can be solid, and can resemble a malignancy. Ovarian preservation is mostly based on the assumption by the surgeon that normal ovarian tissue surrounds the tumor (and that the cyst is benign). The clinical assessment can be positively influenced by the visualization of normal tissue on preoperative ultrasonography. This is called the Ovarian Crescent Sign, which is a most important finding, and which should be specifically and clearly reported as such. Once the Ovarian Crescent Sign is incorporated into the assessment, the presence of any accompanying oedema of the normal ovarian tissue can help in ensuring quick recognition of ovarian torsion in an otherwise benign tumor.