••• Chapter 26^ Benign Disorders of the Upper Genital Tract^261
❍ What is Halban syndrome?
A persistent corpus luteum cyst that, prior to sensitive pregnancy tests, simulated an ectopic gestation because of
pelvic pain, amenorrhea, and an adnexal mass.
❍ What functional ovarian cyst is most commonly associated with a hydatidiform mole?
The theca lutein cyst is associated with up to 50% of molar gestations and 10% of choriocarcinomas. They are usually
bilateral and produce moderate to massive enlargement of the ovaries. Theca lutein cysts may also be associated with
ovulation induction or pregnancies where large placentas are produced (diabetes, twins, and Rh sensitization).
❍ What is the luteoma of pregnancy?
A benign hyperplastic reaction of ovarian theca lutein cells that may cause virilization in the mother or female
fetus, although most cases are asymptomatic.
❍ A 10-year-old girl presents with an adnexal mass. What is the most common etiology?
Mature cystic teratomas (also known as dermoid cysts) develop from totipotential cells and are composed of
well-differentiated ectodermal, endodermal, and mesodermal elements. They account for >50% of adnexal masses
in the prepubertal period.
❍ A 6-year-old girl presents for evaluation of premature thelarche. Her workup reveals Tanner stage 4 breast
development, numerous café au lait spots, and ovarian cysts. What is her most likely diagnosis?
McCune-Albright syndrome is associated with an ovarian etiology of excess hormone production and is
characterized by polyostotic fibrous dysplasia and café au lait spots. Patients have a genetic mutation in the G
protein that results in polyglandular lesions involving the thyroid, pituitary, and gonads.
❍ What percentage of teratomas are bilateral?
Fifteen to twenty percent of mature teratomas are bilateral whereas immature teratomas are almost always
unilateral; however, there may be contralateral metastasis of an immature teratoma. The contralateral ovary should
be inspected carefully at the time of surgery by visualization and palpation. The presence of a mature unilateral
teratoma does not necessitate a wedge resection or bivalving of the contralateral ovary.
❍ What is the karyotype of a mature teratoma?
The karyotype is 46 XX and arises from a single germ cell after the fist meiotic division.
❍ What are the most common complications of teratomas?
Torsion occurs in nearly 15% of cases and is more common in younger women. Other complications include
rupture, infection, hemorrhage, and malignant degeneration.
❍ What is the risk of malignant transformation in a mature teratoma?
Malignant transformation occurs in <2% of mature teratomas, and >75% of the time this is in patients older than
40 years. Squamous cell carcinoma arising in ectodermal layers accounts for 80% of malignant transformations.
❍ What is struma ovarii?
An ovarian mass (usually a teratoma) in which thyroid tissue is a major component. Thyroid tissue occurs in
approximately 10% of teratomas. Patients usually present with a pelvic mass, and <5% of women with struma
ovarii develop thyrotoxicosis. Struma ovarii occurs most often in women ages 40 to 60.