Solid mature ovarian teratoma with intrarectal protusion: case report.

BACKGROUND: Primary rectal teratoma is a very rare entity. It has been suggested that these tumors grow from aberrant germinal cells of the embryonic digestive tract. Ovarian tumor can also erode the rectal wall, allowing the formation of a fistula localized inside the rectum, becoming an extremely rare complication. CLINICAL CASE: We report the first case of a 54-year old woman with transanal bleeding whose endoscopic investigation showed a hairy-covered tumor in its surface localized 15 cm from the anal margin. Scanning detected its exact location and the presence of bony tissue within. By means of a laparotomy, we identified the left ovary fusioned to the anterior face of the rectum where a 5 x 4 cm tumor was originally protruding towards its lumen. Left oophorectomy was performed and through a peri-tumoral section of the intestinal wall we extracted the tumor from the inner rectum and closed the defect with simple sutures. Histological report demonstrated a conglomerate of tissues that corresponded to the three germinal layers. CONCLUSIONS: Although rare, diagnosis of intrarectal ovarian teratoma must be considered as a differential diagnosis in patients with rectal tumors. Diagnosis is relatively easy in the presence of a tumor with a hairy surface that is evaluated endoscopically. For treatment we suggest a simple procedure with adequate results.

Teratoma sólido maduro de ovario con protrusión intrarrectal: informe de un caso / Solid mature ovarian teratoma with intrarectal protusion: case report

Introducción: El teratoma primario de recto es una entidad extremadamente rara; se ha sugerido que deriva de células germinales aberrantes del tracto digestivo embrionario. Una complicación inusitada es que el tumor ovárico erosione la pared rectal y permita la formación de una fístula para así alojarse en el interior del recto. Caso clínico: Mujer de 54 años de edad con sangrado transanal. Por endoscopia se observó tumor cubierto de pelos en su superficie, localizado a 15 cm del margen anal. Una tomografía computarizada identificó la localización exacta y la presencia de tejido óseo en su interior. Mediante laparotomía se apreció el ovario izquierdo fusionado a la cara anterior del recto, de donde se originaba un tumor de 5 × 4 cm que protruía hacia su luz. Se realizó ooforectomía izquierda y mediante sección peritumoral de la pared intestinal se extrajo el tumor del interior del recto y se cerró el defecto con suturas simples. El estudio histológico demostró conglomeración de tejidos correspondiente a los tres estratos germinales. Conclusiones: Aunque es raro, el diagnóstico de teratoma de ovario intrarrectal debe ser considerado en pacientes con tumores del recto. El diagnóstico es relativamente fácil ante la presencia de pelos en la superficie tumoral, que se evalúa mediante endoscopia.

BACKGROUND: Primary rectal teratoma is a very rare entity. It has been suggested that these tumors grow from aberrant germinal cells of the embryonic digestive tract. Ovarian tumor can also erode the rectal wall, allowing the formation of a fistula localized inside the rectum, becoming an extremely rare complication. CLINICAL CASE: We report the first case of a 54-year old woman with transanal bleeding whose endoscopic investigation showed a hairy-covered tumor in its surface localized 15 cm from the anal margin. Scanning detected its exact location and the presence of bony tissue within. By means of a laparotomy, we identified the left ovary fusioned to the anterior face of the rectum where a 5 x 4 cm tumor was originally protruding towards its lumen. Left oophorectomy was performed and through a peri-tumoral section of the intestinal wall we extracted the tumor from the inner rectum and closed the defect with simple sutures. Histological report demonstrated a conglomerate of tissues that corresponded to the three germinal layers. CONCLUSIONS: Although rare, diagnosis of intrarectal ovarian teratoma must be considered as a differential diagnosis in patients with rectal tumors. Diagnosis is relatively easy in the presence of a tumor with a hairy surface that is evaluated endoscopically. For treatment we suggest a simple procedure with adequate results.