Design: A retrospective case-control study performed in a tertiary medical center between 1993 and 2023

Setting: N/A

Patients or Participants: The study group comprised of 22 women who underwent surgery for removal of immature ovarian teratoma. A control group of women who underwent surgery for mature ovarian teratoma (dermoid cyst) was established by matching two-to-one according to age and year of surgery.

Interventions: none

Measurements and Main Results: Mean age, menarche status and family history of malignancies were comparable between the groups. Abdominal pain, the most common symptom at presentation, was more common among the malignant group (95.5% vs. 66.7%, p<0.01). Other symptoms such as abdominal pressure or vomiting did not differ between the groups. Ultrasound findings, including tumor size (max diameter, mean (SD) 135 mm (46.9) vs. 73.8 mm (37.9)), presence of ascites (31.8% vs. 2%, p<0.01) and abnormal Doppler flow (36.4% vs. 15.7%, p=0.05) were more common among those with a malignant tumor, whereas presence of septations and a solid ovarian mass did not differ between the groups. Elevated levels of Ca-125 were more common among those with malignancy (50% vs. 11.1%, P<0.01), and the mean levels were higher. Incidence of elevated Ca19-9 and mean ca19-9 levels did not differ between the groups.

In a multivariable analysis, Tumor size >10cm (OR 1.02, CI [1.01-1.04]), ascites (OR 12.5, CI [1.2-123.6]) and elevated Ca-125 (OR 0.12, CI [0.02-0.54]) were the only independent factors associated with malignancy.

Conclusion: Tumor size > 10 CM and presence of ascites were sonographic parameters associated with malignancy among women with a pre-surgical diagnosis of ovarian teratoma. Ca 19-9 levels did not aid in identifying those with malignancy. Those pre-surgical factors might aid planning surgical approach.