{"paper_id":"b9f7e81c-711a-4411-8b34-34e69de9a021","body_text":"Video Article\nCopyright© 2025 The Author. Published by Galenos Publishing House on behalf of Turkish-German Gynecological Association. \nThis is an open access article under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 (CC BY-NC-ND) International License.\nLaparoscopic management of a mature cystic \nteratoma in the fallopian tube \n Ali Akdemir1,  Cihan Mutu1,  Gürdeniz Serin2,  Necmettin Özdemir2 \nAbstract\n1Department of Obstetrics and Gynecology, Ege University Hospital, İzmir, Türkiye\n2Department of Pathology, Ege University Hospital, İzmir, Türkiye\nOur objective is to present the laparoscopic management of a mature cystic teratoma originating from the fallopian tube and to discuss different \nsurgical approaches. A 28-year-old nulliparous woman presented with right groin pain, and after the diagnostic evaluation, laparoscopic \nexploration was performed for diagnosis and treatment. Intraoperative findings revealed a 4-5 cm cyst protruding from the right tubal fimbrial \nostium was identified, originating from the tubal cavity without ovarian connection. The cyst was successfully extracted through milking \ntechnique, preserving the fallopian tube. Mature cystic teratomas of the fallopian tube are extremely rare, with approximately 75 cases reported \nin the literature. When located near the fimbrial end, direct extraction with tubal preservation is feasible, particularly important for patients \ndesiring future fertility. This case demonstrates successful conservative laparoscopic management preserving tubal function. [J Turk Ger \nGynecol Assoc.  ]\nKeywords: Benign adnexal masses, mature cystic teratoma, teratoma in fallopian tube\nMature cystic teratomas, or dermoid cysts, are cystic structures \nformed in the embryonic period that may originate from all \nthree germ layers and contain different tissues (1).\nMature cystic teratomas are the most common benign ovarian \ntumors in young women. They are found in approximately 10-\n20% of women with ovarian cysts, and 10-15% are bilateral \n(2). Dermoid cysts with a tubal location are very rare in the \nliterature and approximately 75 cases have been reported (3).\nThe patient, a 28-year-old nulligravida, presented with right \ngroin pain. There was no known disease in her history. \nUltrasonography (USG) showed a cystic formation compatible \nwith a dermoid cyst measuring approximately 4-5 cm in \nthe right adnexal area. Pre-operative magnetic resonance \nimaging (MRI) showed a tubular structure, approximately 35 \nmm in diameter, with high T2 signal intensity and no contrast \nenhancement in the vicinity of the right posterior ovary  \n(Figure 1). Laparoscopic cyst extirpation was planned. As \ncan be seen in Video 1, intra-operatively the uterus and both \novaries appeared normal. The left tuba fimbriae was normal \nbut the left ovary was firmly adherent to the surrounding tissue. \nA 4-5 cm cyst was seen in the right tuba, which protruded from \nthe fimbria ostium. The cyst was not connected to the right \novary and originated from the tubal cavity. The cyst was then \nremoved by extraction from the tubal cavity and milking was \nperformed to remove any possible residual cystic parts. Figures \n2a and 2b shows that multiple mature tissues types, including \ncartilage, adipose tissue, nerve, and salivary gland were present \n[Hematoxylin and Eosin (H&E), low power 40x]. Methylene \nblue testing was performed during the surgical procedure to \nassess the functionality and patency of both fallopian tubes, \nReceived: 13 December, 2024  Accepted: 04 July, 2025 Epub: 08.09.2025 \nAddress for Correspondence: Cihan Mutu\ne-mail: cihanmutu05@gmail.com ORCID: orcid.org/0000-0002-0741-1318\nDOI: 10.4274/jtgga.galenos.2025.2024-12-1\nCite this article as: Akdemir A, Mutu C, Serin G, Özdemir N. Laparoscopic management of a mature cystic teratoma in the fallopian tube. J Turk Ger \nGynecol Assoc.  \n\n\nAkdemir et al. \nMature cystic teratoma in fallopian tube\n \nand both were found to be patent. Another advantage of this \ntest is that it can help to expel teratoma tissue remaining in \nthe fallopian tube. Informed consent was obtained from all \npatients.\nThe diagnosis is usually made by USG, computed tomography, \nor MRI. USG is the first-choice imaging modality and dermoid \ncysts appear as heterogeneous cystic structures with variable \nechogenicity (2,3).\nThe differential diagnosis should include hemorrhagic cysts, \nendometrioma, myoma, immature teratoma, and malignant \novarian cysts (3).\nDermoid cysts may often be asymptomatic but can exhibit \nsymptoms, such as abdominal pain, pelvic pain, and a \nsensation of pressure. Rarely, symptoms related to hormone \nsecretion may occur (4). The most common complication is \ntorsion, which occurs in (3-16%), followed by cystic rupture \n(1-4%), malignant transformation (1-2%), and superimposed \ninfection (1%) (5).\nDermoid cysts are most commonly found in the ovary \namong pelvic organs. However, they may rarely originate in \nthe fallopian tubes. The preoperative diagnosis of this rare \noccurrence is challenging and so the physician is mostly \nfaced with tubal dermoid cysts intra-operatively. However, \nthis clinical rarity should be remembered to correctly manage \nthe surgical procedure. Besides, patients should be informed \nrelated to this uncommon pathology. \nTubal dermoid cyst treatment is very similar to dermoid cysts \nof other origins, which is surgical removal. The most difficult \nclinical question is whether to preserve the tube or not. In the \npresented patient, the cyst was located in the tubal ampulla \nand protruded from the fimbrial ostium. Fortunately, we were \nable to preserve the fallopian tube, as direct removal of the \ncyst was possible because it was close to the fimbrial end. \nSurgical treatment options for these patients include \nsalpingectomy, salpingostomy or direct removal of the cyst if it \nis located appropriately. The most critical criteria for choosing \nbetween these surgical options are the patient’s desire for \nfertility and the location of the cyst. If the patient desires fertility, \ndirect extraction may be preferred to increase their chances of \nconceiving naturally. \nDuring the preparation of this work, the authors used sider \nartificial intelligence (AI) for the voice-over of the video. \nThe authors take full responsibility for the content of the \npublication after carefully reviewing the content and editing \nwhere necessary. The use of the AI tool primarily ensured that \nthe video was dubbed by what sounds like a native English \nspeaker. \nFigure 2. (a, b) Multiple mature tissue types, including \ncartilage, adipose tissue, nerve, and salivary gland (H&E, \nlow power 40x). The arrow indicates the tubal epithelium\nH&E: Hematoxylin and Eosin\na\nb\nFigure 1. T2-weighted FS MRI showing a tubular structure in \nthe right adnexal area \n\n\nAkdemir et al. \nMature cystic teratoma in fallopian tube\n  \nVideo 1.\nhttp://dx.doi.org/10.4274/jtgga.galenos.2025.2024-12-1.video1\nInformed Consent:  Informed consent was obtained from all \npatients.\nConflict of Interest:  No conflict of interest is declared by the \nauthors.\nFinancial Disclosure:  The authors declared that this study \nreceived no financial support.\nReferences\n1. Comerci JT Jr, Licciardi F, Bergh PA, Gregori C, Breen JL. Mature \ncystic teratoma: a clinicopathologic evaluation of 517 cases and \nreview of the literature. Obstet Gynecol. 1994; 84: 22-8.\n2. Rha SE, Byun JY, Jung SE, Kim HL, Oh SN, Kim H, et al. Atypical CT \nand MRI manifestations of mature ovarian cystic teratomas. AJR \nAm J Roentgenol. 2004; 183: 743-50.\n3. Sari ME, Ozdemir O, Kadirogullari P , Ertugrul FA, Atalay CR. Mature \ncystic teratoma of the fallopian tube in a postmenopausal woman: \na case report and review of the literature. Case Rep Obstet Gynecol. \n2015; 2015: 583021. \n4. Mazzarella P , Okagaki T, Richart RM.  Teratoma of the uterine tube. \nA case report and review of the literature. Obstet Gynecol. 1972; \n39: 381-8.\n5. Baek J. Synchronous occurrence of mature cystic teratoma of the \nfallopian tube and ovary: a case report. Oncol Lett. 2016; 12: 911-4.","source_license":"CC0","license_restricted":false}