# Bilateral Giant Ovarian Masses in a Pre-pubertal Girl: A Case of Mature Teratoma and Torsion Presenting With Acute Urinary Retention

## TL;DR

A pre-pubertal girl with rare bilateral giant ovarian teratomas and torsion presented with acute urinary retention and was successfully treated with surgery and hormone therapy.

## Contribution

This case highlights the rare presentation of bilateral mature teratomas in a prepubertal girl and emphasizes fertility-preserving surgical strategies.

## Key findings

- Bilateral mature cystic teratomas with torsion were diagnosed in an 8-year-old girl.
- Surgical cystectomy preserved ovarian tissue and ruled out malignancy.
- Long-term hormone replacement was initiated due to compromised ovarian reserve.

## Abstract

Mature cystic teratoma (MCT) is a common benign ovarian neoplasm, but its presentation as bilateral, giant masses in a prepubertal child is rare. Complications like torsion and acute urinary retention pose significant diagnostic and management challenges, where fertility preservation is a primary concern.

An 8-year-old premenarchal girl presented with a four-day history of abdominal pain, fever, and acute urinary retention. Examination revealed a large, firm abdominal mass. Imaging suggested bilateral immature teratoma. Emergency laparotomy revealed two massive ovarian masses, with the left torsed, ischemic, and a rudimentary uterus. Bilateral ovarian cystectomy was successfully performed. Histopathology confirmed a right-sided mature cystic teratoma and left-sided hemorrhagic necrosis from torsion, ruling out malignancy. The patient had an uneventful recovery and was commenced on hormone replacement therapy due to compromised ovarian reserve. At two-year follow-up, she remains stable with no complaints.

This case underscores that giant ovarian teratomas, though rare in children, can present dramatically. It highlights the critical importance of a fertility-preserving surgical approach even in complex cases and the necessity of long-term, multidisciplinary follow-up to manage subsequent endocrine sequelae.