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Mandible-like structure with teeth in an ovarian cystic teratoma
Mandible-like structure with teeth in an ovarian cystic teratoma J. Perry McGinnis, Jr., D.D.S., MS., * and David M. Parham, M.D., ** Tulsa, Okla., and Memphis, Tenn. UNIVERSITY
OF TENNESSEE CENTER FOR THE HEALTH
SCIENCES
The finding of a tooth-hearing mandible-like structure within a large ovarian dermoid cyst is reported. Although the presence of assorted teeth and bone is not uncommon in teratomatous lesions, the formation of an apparent alveolar structure possessing multiple teeth is found less often.
T
he origin of benign cystic teratomas (dermoid cysts) which contain various body tissuesremains an enigma. Ashley’ proposedtwo groups of teratomas:(1) those occurring in the gonadsand derived from germ cells by the processof parthenogenesisand (2) those
Fig. 1. Radiograph of lower abdominal region showing calcific density in vicinity of right ovary. Fig. 2. Surgical specimens consisting of large right ovarian mass and four separate cystic structures dissected from left ovary. *Associate Professor, Department of Oral Medicine, School of Dentistry, Oral Roberts University **Resident, Department of Pathology, University of Tennessee Center for the Health Sciences. 104
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Fig. 3. Tooth-bearing mandible-like specimen removed from wall of ovarian cyst. Five teeth and an apparrnt follicular cyst (arrow) may be seen. The surface covered with skinlike tissue represented the luminal aspecI !,f the dermoid cyst. One tooth remained within the bone. Fig. 4. Radiograph of tooth-bearing specimen after removal from wall of dermoid cyst.
arising in the sacrococcygeal region, head, and chest which are related to sequestration of blastula cells and representing the derivative of an incomplete conjoined twin. In at le,ast seventeen reported cases, the level of organization and differentiation of the growi w tissues has been such that a fetus-like structure or homunculus has developed.* CASE REPORT
A 29-year-old black woman (gravida 0) was seen in the City of Memphis Hospital following an automobile accident. Abdominal distention was noted, but, according to the patient’s history, the enlargement had begun approximately 8 months earlier. The menses had occurred regularly duning the preceding year but had been heavier than normal and had continued for 9 to 11 days. Pelvic 2tnd
106
McGinnis and Parham
Oral Surg. January, 1978
x-ray examinations indicated the presence of a right ovarian mass which contained apparent bone and toothlike structures (Fig. 1). A right salpingo-oophorectomy and cystectomy were performed and four smaller cystic structures were dissected from the left ovary (Fig. 2). The smaller specimens weighed a total of 50 grams and ranged in size to 3 by 2.5 by 2 cm. The mass from the right ovary weighed 2,820 grams, measured 25 by 19 by 10 cm., and was filled with sebum, hair, and a mucoid fluid. The calcified mass was embedded in the cyst wall, and each of the protuding teeth was covered with an intact fibrous follicle 5 to 10 mm. thick. The bone was covered with a skinlike outer surface (Fig. 3). A microscopic diagnosis of multiple dermoid cysts was made. The calcified tissue removed from the wall of the dermoid cyst consisted of bone which, when located adjacent to the teeth, roentgenographically resembled well-developed alveolar bone (Fig. 4). Each tooth had a definite periodontal ligament space, and appeared morphologically to represent either a premolar or a molar. One 10 mm. cystic follicle-like structure was found situated adjacent to the teeth but contained no calcified tissue. Location of the teeth in relation to the bone structure would suggest some attempt at a bilateral, symmetrical development with three teeth on either side of a centrally located, albeit somewhat vague, symphysis or suture line. REFERENCES
1. Ashley, D. J. B.: Origin of Teratomas, Cancer 32: 390-394, 1973. 2. Azoury, R. S., Juhayh, N. W., and Barakat, B. Y.: Dermoid Cyst ofOvary Containing Fetus-like Structure, Obstet. Gynecol. 42: 887-891, 1973. Reprint requeststo: Dr. Perry McGinnis School of Dentistry Oral Robetts University 7777 S. Lewis Tulsa. Okla. 74171
OF TENNESSEE CENTER FOR THE HEALTH
SCIENCES
The finding of a tooth-hearing mandible-like structure within a large ovarian dermoid cyst is reported. Although the presence of assorted teeth and bone is not uncommon in teratomatous lesions, the formation of an apparent alveolar structure possessing multiple teeth is found less often.
T
he origin of benign cystic teratomas (dermoid cysts) which contain various body tissuesremains an enigma. Ashley’ proposedtwo groups of teratomas:(1) those occurring in the gonadsand derived from germ cells by the processof parthenogenesisand (2) those
Fig. 1. Radiograph of lower abdominal region showing calcific density in vicinity of right ovary. Fig. 2. Surgical specimens consisting of large right ovarian mass and four separate cystic structures dissected from left ovary. *Associate Professor, Department of Oral Medicine, School of Dentistry, Oral Roberts University **Resident, Department of Pathology, University of Tennessee Center for the Health Sciences. 104
Volume 45 Number 1
Mandible-like
structure in ovarian cystic teratoma
105
Fig. 3. Tooth-bearing mandible-like specimen removed from wall of ovarian cyst. Five teeth and an apparrnt follicular cyst (arrow) may be seen. The surface covered with skinlike tissue represented the luminal aspecI !,f the dermoid cyst. One tooth remained within the bone. Fig. 4. Radiograph of tooth-bearing specimen after removal from wall of dermoid cyst.
arising in the sacrococcygeal region, head, and chest which are related to sequestration of blastula cells and representing the derivative of an incomplete conjoined twin. In at le,ast seventeen reported cases, the level of organization and differentiation of the growi w tissues has been such that a fetus-like structure or homunculus has developed.* CASE REPORT
A 29-year-old black woman (gravida 0) was seen in the City of Memphis Hospital following an automobile accident. Abdominal distention was noted, but, according to the patient’s history, the enlargement had begun approximately 8 months earlier. The menses had occurred regularly duning the preceding year but had been heavier than normal and had continued for 9 to 11 days. Pelvic 2tnd
106
McGinnis and Parham
Oral Surg. January, 1978
x-ray examinations indicated the presence of a right ovarian mass which contained apparent bone and toothlike structures (Fig. 1). A right salpingo-oophorectomy and cystectomy were performed and four smaller cystic structures were dissected from the left ovary (Fig. 2). The smaller specimens weighed a total of 50 grams and ranged in size to 3 by 2.5 by 2 cm. The mass from the right ovary weighed 2,820 grams, measured 25 by 19 by 10 cm., and was filled with sebum, hair, and a mucoid fluid. The calcified mass was embedded in the cyst wall, and each of the protuding teeth was covered with an intact fibrous follicle 5 to 10 mm. thick. The bone was covered with a skinlike outer surface (Fig. 3). A microscopic diagnosis of multiple dermoid cysts was made. The calcified tissue removed from the wall of the dermoid cyst consisted of bone which, when located adjacent to the teeth, roentgenographically resembled well-developed alveolar bone (Fig. 4). Each tooth had a definite periodontal ligament space, and appeared morphologically to represent either a premolar or a molar. One 10 mm. cystic follicle-like structure was found situated adjacent to the teeth but contained no calcified tissue. Location of the teeth in relation to the bone structure would suggest some attempt at a bilateral, symmetrical development with three teeth on either side of a centrally located, albeit somewhat vague, symphysis or suture line. REFERENCES
1. Ashley, D. J. B.: Origin of Teratomas, Cancer 32: 390-394, 1973. 2. Azoury, R. S., Juhayh, N. W., and Barakat, B. Y.: Dermoid Cyst ofOvary Containing Fetus-like Structure, Obstet. Gynecol. 42: 887-891, 1973. Reprint requeststo: Dr. Perry McGinnis School of Dentistry Oral Robetts University 7777 S. Lewis Tulsa. Okla. 74171