Primary lymphatic dissemination of malignant elements in a mature cystic ovarian teratoma

This case of malignant transformation in a mature cystic ovarian teratoma (dermoid cyst) is significant for the atypical manner in which the malignant elements metastasized to lymph nodes without evidence of intraperitoneal dissemination. The disease rapidly progressed and proved to be fatal in this premenopausal woman. The lesson learned is that lymph node inspection should be an integral component of the physical examination and exploratory laparotomy when this apparently benign ovarian neoplasm is encountered. Abnormal findings may be indicative of metastasis from an occult malignant transformation.