Uterine myometrial mature teratoma presenting as a uterine mass: a review of literature
- Emmanuel Kamgobe1,
- Anthony Massinde†1, 2,
- Dismas Matovelo1Email author,
- Edgar Ndaboine†1, 2,
- Peter Rambau†3 and
- Tito Chaula1
© Kamgobe et al. 2016
Received: 20 August 2015
Accepted: 23 February 2016
Published: 22 March 2016
Teratomas are a germ cell tumors composed of two or more tissues which originate from ectoderm, endoderm or mesoderm. These tumors commonly arise from the ovary although other extragonadal sites can be involved, especially in children.
We report a case of a 21-year-old female of Sukuma ethnicity from the northern region of Tanzania who presented with abdominal pain and distension, fever, and abnormal vaginal discharge for the previous three weeks. The patient was also lactating for the previous 8 months following cesarean section delivery. Pelvic ultrasound suggested pelvic abscess but after laparotomy and histological analysis of a bulky uterus removed a diagnosis of mature uterine teratoma was confirmed.
Although it is rare, uterine teratoma should be considered in differential diagnosis to any patient with uterine mass even without typical radiological findings.
KeywordsUterine mass Uterine mature teratoma
Teratomas are usually composed of two or more embryonic germ layers: ectoderm, endoderm, and mesoderm. Extragonadal teratomas are ectopic to the location in which they are found. Teratomas can be classified as mature or immature on the basis of the presence or absence of immature neuroectodermal tissues in the tumor. Mature tumors have far less tendency to develop into malignancy compared to immature tumors. Teratomas are the most common gonadal tumors. They usually arise in the gonads and often occur in infancy and childhood. Extragonadal teratomas are rare and commonly develop in midline structures . Uterine teratomas, which are part of extra gonadal teratomas of midline structures, account for 1–2 % of all teratomas. Complications during their surgical removal may occur depending on their location or if they are attached to any other structures. There is no documented evidence of metastatic potential [2, 3].
Primary teratomas of the uterus have rarely been reported since Mann’s first description of this entity in 1929 [1, 2]. Here we report a case of uterine mature teratoma in a 21-year-old woman with an exceptional presentation of this tumor.
A 21-year-old female of Sukuma ethnicity from the northern region of Tanzania presented at Bugando Medical Centre (BMC) outpatient clinic in Mwanza city with complaints of abdominal distension and pain, fever and abnormal vaginal discharge for the past 3 weeks. She was apparently lactating for the previous 8 months after cesarean section delivery of her first child. On physical examination, she appeared to be weak, febrile of about 38.5 °C with blood pressure of 110/70 mmHg. She was a blood group ‘A’ rhesus positive and her hemoglobin level was 6.3 g/dl.
Patient was counseled for emergency laparotomy. Intraoperatively, the uterus was found to be bulky with discharging sinus on left fundal position. Both ovaries were healthy-looking and there was no fluid in the pouch of Douglas. The transverse incision was made on the uterus at the level of the discharging sinus. The yellowish mucinous tenacious materials with hairy tissues were observed. The decision to perform a total hysterectomy was reached; in which the removed uterus had hairs and sticky sebaceous matter found freely in the cavity. After surgery, the patient was transfused one unit of blood and intravenous antibiotics ceftriaxone, Gentamycin and Metronidazole were given with an addition of prophylactic Heparin. The patient had an uneventful recovery.
The sample was sent for histological examination. At the pathology department, the bisected uterus of 18 cm × 9 cm × 4 cm with no adnexa was identified. There was a cystic mass of 10 cm on the left fundal position in the myometrium containing hairs, sebaceous material, and pus.
The patient has not shown any sign of disease recurrence for 8 months following hospital discharge.
Clinical and pathological characteristics of patients with primary uterine mature teratoma in the literature
Site of Tumour
Treatment of Relapse
Lim et al.,  
Mature teratoma with some lymphoid elements
Newsom-Davis et al., 
Mature& Immature Teratoma
Hysterectomy & bilateral salpingooophorectomy
Taxane, Etoposide & Cisplatin + Surgery
Cappelo et al.,  
Asymptomatic (Multiple uterine leiomyomas)
Mature teratoma with thyroid differentiation
Wang et al.,  
Abnormal uterine bleeding
Mature cystic teratoma
Papadia et al.,  
Endometrial polyp/Abnormal uterine bleeding
Mature cystic teratoma
Our patient was in reproductive age, recently delivered and lactating; the presentation which is likely to develop teratoma due to the possibility of products of conceptus being implanted at any part along the reproductive tract during the process of fertilization according to the Blastomere Theory [8–10]. Although it does not apply to the patient discussed here, it is also possible for teratoma to develop in a newborn by abnormal migratory pathway of primordial germ cells from fetal yolk sac endodermal to the gonadal ridge during early embryogenesis as explained by Parthenogenic theory [3, 5].
Ultrasound images of the patient suggested pelvic abscess, but an explorative laparotomy and histopathological analysis of the excised bulky uterus led to a diagnosis of teratoma. In centers with, CT and MRI, those imaging techniques could have led to a correct diagnosis because of their higher accuracy compared to the ultrasound imaging . Again, our hospital do not have Colour Doppler ultrasound which is superior to other imaging modalities with highest positive predictive value of 9.6 compared to 7.6 for MRI and 3.6 for CT16 .
Due to its rarity of occurrence, there is no standard guideline for management of mature uterine teratoma. The few case reports, however, suggest that the best management is complete tumor excision or total abdominal hysterectomy [3, 4, 6–8].
Although it is rare, uterine teratoma should be considered in differential diagnosis in any patient with uterine mass even without typical radiological findings.
"Written informed consent was obtained from the patient for publication of this Case report and any accompanying images. A copy of the written consent is available for review by the Editor of this journal".
Bugando Medical Centre
Hematoxylin & Eosin
The authors would like to thanks all the doctors and nurses at the BMC Emergency unit and Gynecological ward for taking good care of the patient and follow-up.
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
- Cortes J, Llompart M, Rossello J, Rifá J, Más J, Anglada P, et al. Immature teratoma primary of the uterine cervix. First case report. Eur J Gynaecol Oncol. 1989;11(1):37–42.Google Scholar
- Ben Ameur El Youbi M, Mohtaram A, Kharmoum J, Aaribi I, Kharmoum S, Bouzoubaa A, et al. Primary immature teratoma of the uterus relapsing as malignant neuroepithelioma: case report and review of the literature. Case Rep Oncol Med. 2013;2013:971803.PubMedPubMed CentralGoogle Scholar
- Hamilton CA, Ellison M. Cystic teratoma. Emedicine (http://emedicine.medscape.com.article/281850-overview). 2006.
- Cappello F, Barbato F, Tomasino RM. Mature teratoma of the uterine corpus with thyroid differentiation. Pathol Int. 2000;50(7):546–8.View ArticlePubMedGoogle Scholar
- Newsom-Davis T, Poulter D, Gray R, Ameen M, Lindsay I, Papanikolaou K, et al. Case report: Malignant teratoma of the uterine corpus. BMC Cancer. 2009;9(1):195.View ArticlePubMedPubMed CentralGoogle Scholar
- Sc L, Ys K, Lee Y, Lee M, Jy L. Mature teratoma of the uterine cervix with lymphoid hyperplasia. Pathol Int. 2003;53(5):327–31.View ArticleGoogle Scholar
- Wang W-C, Lee M-S, Ko J-L, Lai Y-C. Origin of uterine teratoma differs from that of ovarian teratoma: a case of uterine mature cystic teratoma. Int J Gynecol Pathol. 2011;30(6):544–8.View ArticlePubMedGoogle Scholar
- Papadia A, Rutigliani M, Gerbaldo D, Fulcheri E, Ragni N. Mature cystic teratoma of the uterus presenting as an endometrial polyp. Ultrasound Obstet Gynecol. 2007;29(4):477–8.View ArticlePubMedGoogle Scholar
- NEWTON CW, ABELL MR. Iatrogenic fetal implants. Obstet Gynecol. 1972;40(5):686–91.PubMedGoogle Scholar
- Tyagi S, Saxena K, Rizvi R, Langley F. Foetal remnants in the uterus and their relation to other uterine heterotopia. Histopathology. 1979;3(4):339–45.View ArticlePubMedGoogle Scholar
- Graham L. ACOG releases guidelines on management of adnexal masses. Am Fam Physician. 2008;77(9):1320–3.PubMedGoogle Scholar