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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 595-596
Mandible like structure with fourteen teeth in a benign cystic teratoma


1 Department of Pathology, Karnataka Institute of Medical Sciences, HUBLI-580 022, Karnataka, India
2 Hubli Diagnostics, Medicare & Research Centre Pvt Ltd, HUBLI-580 029, Karnataka, India

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Date of Web Publication1-Oct-2009
 

How to cite this article:
Chavan SS, Yenni V V. Mandible like structure with fourteen teeth in a benign cystic teratoma. Indian J Pathol Microbiol 2009;52:595-6

How to cite this URL:
Chavan SS, Yenni V V. Mandible like structure with fourteen teeth in a benign cystic teratoma. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Nov 24];52:595-6. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/595/56145


Sir,

We are reporting a case of benign cystic teratoma with mandible like structure and fourteen teeth as reported by McGinnis et al. [1] and Devoize et al. [2]

A 28-year-old lady came with history of pelvic mass on left side, associated with burning micturition. General physical examination was unremarkable except for conjunctival pallor. Per abdominal and per vaginal examination revealed a mass in left pelvic region measuring approximately 16 Χ 16 cms, mobile, non tender, and soft to firm in consistency without any adhesions. On ultrasonography, the mass was cystic with mixed echogenicity. She was diagnosed as having left ovarian tumor. The mass was resected.

On gross examination, the ovarian mass measuring 18 Χ 16 Χ 15 cms, soft in consistency, surface was variably gray white, dull and lusterless, and weighed 1.8 kg. Cut section of the mass showed yellow pultaceous material with matted hair. On evacuation of pultaceous material two hard bony protuberances were observed facing opposite to each other [Figure 1]. There were firm to hard septations seem to arise from these protuberances, dividing the cystic mass into two to three compartments. From one protuberance, there were grossly visible six teeth with well-formed gingival tissue. On examination, four of them appeared to be canine type and other two of incisor type. There were two horn like structures [Figure 2] projecting from one protuberance and measured 4 to 5 cms in length. The other protuberance was bony hard, showed grossly visible five teeth, two of them looked like molars with well-formed gingival tissue, two canines and one incisor. Radiograph of the lateral view of the specimen looked like mandible with alveoli and showed seven teeth on each protuberance [Figure 3] and [Figure 4].

The usual contents of benign cystic teratomas are ectodermal derivatives such as sebum with hairs, and if present, one or two teeth and single bony protuberance called 'Dermoid' protuberance or 'Rokitansky' protuberance. [3] The present case showed two protuberances with seven teeth embedded in each, with well-formed gingival tissue. It is unusual to see more than 2 to 3 teeth in benign cystic teratomas. But Devoize et al. [2] and Zakin et al. [4] recorded as many as 300 and 28 teeth, respectively. Similarly, it is unusual to see mandible like structure in benign cystic teratomas. Very few cases of benign cystic teratomas with mandible like structure were reported including the one by McGinnis et al. [1] In the present case, radiograph of the specimen revealed mandible like structure [Figure 3] with alveolar sacs and teeth.

The teeth found in benign cystic teratoma varied from incisor to canine to molars and are usually incompletely organized and asymmetrical. In the present case, the presence of mandible like structure with teeth and gingival tissue indicate that there is some attempt at bilateral symmetrical development.

It is unusual to see completely organized structures such as horns, nails, mandible, and vertebral bodies in benign cystic teratomas. The present case showed two horns arising from one protuberance [Figure 2].

In conclusion, though the presence of mandible like structure and more number of teeth does not indicate any clinical significance such as malignant transformation occurring in a benign cystic teratoma, it is worth to document the case for academic reasons.


   Acknowledgement Top


We thank Dr G. C. Patil, Consulting Radiologist and Dr Shanthala K. S., Dental Surgeon for their valuable opinion in characterizing the teeth and radiological opinion.

 
   References Top

1.McGinnis JP Jr, Parkham DM. Mandible like structure with teeth in an Ovarian cystic teratoma. Oral Surg Oral Med Oral Pathol 1978;45:104-6.   Back to cited text no. 1      
2.Devoize L, Collangettes D, Le Bouedec G, Mishellany F, Orliaguet T, Dallel R, et al. Giant mature ovarian cystic teratoma including more than 300 teeth. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;105:e76-9.   Back to cited text no. 2      
3.Nogales FF. Germ cell tumors of the ovary. In: Fox H, Wells M, editors. Haines and Taylor Obstetrical and Gynaecological pathology 4 th ed. Edinburgh: Churchil Livingstone; 1995. p. 847-87.  Back to cited text no. 3      
4.Zakin D. Radiologic diagnosis of Dermoid cysts of the ovary. Obstet Gynecol Surv 1976;31:165-84.  Back to cited text no. 4      

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Correspondence Address:
Sateesh S Chavan
Department of Pathology, Karnataka Institute of Medical Sciences, HUBLI-580 022, Karnataka
India
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DOI: 10.4103/0377-4929.56145

PMID: 19805995

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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