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They are bilateral in 12 percent of cases and are the most common ovarian tumor in the second and third decades of life. Pathology — The characteristic macroscopic appearance of benign cystic teratomas is a multicystic mass that contains hair, teeth, or skin mixed into sebaceous, thick, sticky, and often foul-smelling material.

A solid prominence ie, Rokitansky's protuberance is located at the junction between the teratoma and normal ovarian tissue.

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The greatest cellular variety is found in this area, which should therefore be examined carefully by the pathologist to exclude malignant components. Clinical features — If present, symptoms depend upon the size of the mass. Torsion is not uncommon.

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Rupture of dermoid cysts with spillage of sebaceous material into the abdominal cavity can occur, but is uncommon. Shock and hemorrhage are the immediate sequelae of rupture; a marked granulomatous reaction chemical peritonitis subsequently develop and lead to formation of dense adhesions.

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These tumors have a characteristic ultrasound appearance, which allows reasonably accurate noninvasive diagnosis in cases. Treatment — Cystectomy is suggested in order to make a definitive diagnosis, preserve ovarian tissue, and avoid potential problems such as torsion, rupture, or development of malignant components. The latter occur from any of the constituents of the dermoid, and is more common in patients over 40 years of age.

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