Vaginal resection of rectovaginal teratoma: A case series

Abstract

Introduction: Extragonadal teratomas (EGTs) are histologically similar to gonadal teratomas but arise from structures outside of the ovaries, typically along midline structures such as the coccyx, mediastinum, retroperitoneum, and brain. Surgery is curative, but it can be technically challenging. The following cases represent the only published cases of rectovaginal/perirectal location of EGTs and the only cases of successful vaginal resection. Cases: We present three cases of female patients ranging in age from 15 to 17 who presented with rectovaginal mature cystic teratomas. Two cases were found incidentally, one patient reported pelvic pain. The masses ranged in size from 3cm to 6cm. Pelvic MRI provided the best imaging technique for surgical planning. The larger masses (5.1 cms and 6 cms) were exerting significant pressure and mass effect on the rectum and vagina. The 3cm mass was located within 1cm of the ureter and therefore, with growth, could impede normal urologic function. Tumor markers were obtained for each patient prior to surgical resection. Initial surgical approach for the first case was combined vaginal-laparoscopic. However, after vaginal resection was the more successful access point to the first teratoma, subsequent cases were resected vaginally with technique described here. Conclusion: Vaginal surgery offers several benefits including being minimally invasive, providing no visible incisions, utilizing less operating time, and providing rapid recovery. Vaginal resection of the rectovaginal EGTs at our institution proved safe, effective, and minimally invasive. Publication of this approach is important to guide surgical management of these tumors should other clinicians face this rare entity.

Keywords

• Vaginal surgery
• Extragonadal teratoma
• Rectovaginal mass
• Perirectal mass
• Case series