Torsion of dermoid cyst in a perimenopausal woman: a case report


  • Kondareddy Radhika Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
  • Sonam Singh Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India
  • Munikrishna M. Department of Obstetrics and Gynecology, Sri Devaraj Urs Medical College, Kolar, Karnataka, India



Perimenopausal, Teratoma, Torsion


Mature cystic teratoma comprise 20-30% of all ovarian tumours. They are mostly seen in patients between 20 and 40 years of age and are mostly asymptomatic. Incidence of malignancy is high in perimenopausal and postmenopausal group. Here, authors report a case of torsion of dermoid cyst presenting unusually in a 45-year-old perimenopausal woman with acute abdomen. A 45-year-old perimenopausal woman presented with lower abdominal pain of 8 hours duration and 3-4 episodes of vomiting. Abdominal examination revealed a regular, firm to cystic, tender abdomino-pelvic mass corresponding to the size of 28 weeks gravid uterus by palpation. Abdominal ultrasonography revealed the presence of right ovarian cyst measuring 12.9x12.8x10.1 cm. Total abdominal hysterectomy with bilateral salpingo oopherectomy was done. Histopathological examination confirmed mature cystic teratoma. Although mature cystic teratoma is rare after 40 years age, especially in perimenopausal women and are usually malignant in that age group, it can have an unusual age presentation at 45 years with benign nature as in present case.


Shia Salem. The uterus and adnexa. In: Rumack CM, Wilson SR, eds. Diagnostic ultrasound. 2nd ed, 1st vol; 1998:558.

Wittich AC. Adnexal torsion presenting as an acute abdomen in a patient with bilateral cystic teratoma of the ovary. Am Osteopath Assoc. 2002;102(4):231-3.

Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics. 2001;21(2):475-90.

Ornvold K, Detlefsen GU, Horn T, Rorth M. Immature ovarian teratoma in a postmenopausal woman. Acta Obstet Gynecol Scand. 1987;66:473-6.

Doss BJ, Jacques SM, Qureshi F, Chang CH, Christensen CW, Morris RT, et al. Immature teratomas of the genital tract in older women. Gynecol Oncol. 1999;73:433-8.

Laufer M, Goldstein D. Benign and malignant ovarian masses. In: Emans S, Laufer M, Goldstein D, eds. Pediatric and Adolescent Gynecology, vol 5. Philadelphia: Lippincott Williams and Wilkins; 2005:706-710.

Caspi B, Appelman Z, Rabinerson D, Zalel Y, Tulandi T, Shoham Z. The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women. Fertil Steril. 1997;68:501-5.

Hibbard LT. Adnexal torsion. Am J Obstet Gynecol. 1985;152:456-61.

Nichols DH, Julian PJ. Torsion of the adnexa. Clin Obstet Gynecol. 1985;28:375-80.

Cass DL, Hawkins E, Brandt ML, Chintagumpala M, Bloss RS, Milewicz AL, et al. Surgery for ovarian masses in infants, children, and adolescents: 102 consecutive patients treated in a 15-year period. J Pediatr Surg. 2001;36:693-9.

Graif M, Itzchak Y. Sonographic evaluation of ovarian torsion in childhood and adolescence. AJR Am J Roentgenol. 1988;150(3):647-9.

Shadinger LL, Andreotti RF, Kurian RL. Preoperative sonographic and clinical characteristics as predictors of ovarian torsion. J Ultrasound Med. 2008;27:7-13.

Lee AR, Kim KH, Lee BH, Chin SY. Massive edema of the ovary: imaging findings. AJR Am J Roentgenol. 1993;161(2):343-4.

Vijayaraghavan SB. Sonographic whirlpool sign in ovarian torsion. J Ultrasound Med. 2004;23(12):1643-9.

Lee EJ, Kwon HC, Joo HJ, Suh JH, Fleischer AC. Diagnosis of ovarian torsion with color Doppler sonography: depiction of twisted vascular pedicle. J Ultrasound Med. 1998;17:83-9.

Rosado WM Jr, Trambert MA, Gosnik BB, Pretorius DH. Adnexal torsion: diagnosis by using Doppler sonography. AJR Am J Roentgenol. 1992;159:1251-3.






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