Ruptured grade 3 mixed ovarian teratoma mimicking acute ovarian torsion: a case report

Ovarian teratomas are common germ cell neoplasms, yet the simultaneous occurrence of mature and high-grade immature components in a single ovary remains rare. We report a 29-year-old female presenting with acute pelvic pain. Imaging suggested ovarian torsion; however, emergency laparotomy revealed a ruptured 130 mm mass. Histopathology confirmed a mixed teratoma with 25% Grade 3 immature neuroectodermal elements (FIGO Stage IC2) and 75% mature elements. Postoperative alpha-fetoprotein was 90.5 ng/ml. Following multidisciplinary review, the patient underwent completion surgery and adjuvant chemotherapy (BEP). This case underscores the clinical imperative for meticulous pathological grading and the necessity of maintaining a high index of oncological suspicion in the management of acute adnexal events.