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mature cystic teratomas ( mct ; also called dermoid cysts ) account for about 30 - 45% of all ovarian neoplasms and around 60% of all benign tumors arising in the ovary with a 0.17 - 1.4% reported incidence of malignant transformation . squamous cell carcinoma in mcts is most commonly seen in postmenopausal women .
there are no definitive clinical features , tumor markers are not often raised and imaging methods are many times not helpful . hence , most cases are diagnosed postoperatively .
tumors confined to the ovary usually have a better prognosis and patients with stage iii or iv disease rarely survive five years . here , we are presenting a case of squamous cell carcinoma of the ovary which was diagnosed at an early stage and was managed appropriately keeping in mind the poor prognosis of the condition .
a 53-year - old postmenopausal lady , gravida3para2 with 1 abortion , presented in the outpatient wing of gynecologic oncology department of bhagwan mahaveer cancer hospital & research centre , jaipur , rajasthan with the complaint of pain in right lower abdomen since one month .
there was no visible or palpable evidence of any neck swelling , breast abnormality or lymphadenopathy .
her per abdominal examination showed a large firm to hard , non - tender , well - defined , mobile mass in right iliac and hypogastric region arising out of pelvis .
usg whole abdomen suggested the possibility of a dermoid cyst of the ovary ( side not specified ) .
mri of the abdomen reported a large complex multicystic abdomino - pelvic mass with fat fluid levels .
a large solid component along right side of lesion was seen extending in right iliac fossa .
tumor markers were carried out and values were reported as follows : 
 ca 125 : 143 u / ml.cea : 13.1ng / ml.ca 19.9 : 2350 u / ml . 
 
adhesions were dissected and the mass along with appendix and part of the adherent omentum were sent for frozen section .
frozen section reported possibility of squamous cell carcinoma arising in a dermoid cyst and no malignancy in appendix .
final histopathology was reported as squamous cell carcinoma of left ovary arising from dermoid cyst and a benign dermoid cyst in the right ovary [ figure 1 ] .
both fallopian tubes , parametrial tissues , peritoneal biopsies , uterus , cervix , omentum and pelvic lymph nodes were unremarkable .
peritoneal fluid was negative for malignant cells . a dermoid cyst showing area of squamous cell carcinoma for management , the patient was assigned to squamous cell carcinoma of the ovary arising in anmct , surgical stage ic2 .
squamous cell carcinoma of the ovary is quite rare and usually arises in mct of the ovary ( up to 2% ) .
takagi et al have found cea to be more useful than ca 125 and ca 19 - 9 in malignant transformation of mct .
suspicious features ( clinical and on mri ) include : 
 postmenopausal women ( mean age-55years vs. 37.5 years for benign dermoid cysts).larger size of tumor ( mean- 152 mm vs. 88 mm for benign).solid areas within the cyst.invasion of adjacent organs / capsule . 
 
postmenopausal women ( mean age-55years vs. 37.5 years for benign dermoid cysts ) . larger size of tumor ( mean- 152 mm vs. 88 mm for benign ) . solid areas within the cyst .
sixty - four suitable studies provided information on 277 patients . it was observed that squamous cell carcinoma in mct was mainly found in women above 50 years of age , having a high concentration of ca 125 and ovarian tumors more than 10 cm in size .
they also found that figo stage ia had better survival than those with advanced disease .
complete resection with advanced disease followed by adjuvant chemotherapy was seen to be associated with higher survival . according to them adjuvant radiotherapy
a case series and review of literature was published in european oncology and hematology , 2013 . in this retrospective review
conducted over 24 years between 1986 and 2010 , they found six women treated for squamous cell carcinoma in mct , all stage iii/ iv .
they found that durable responses were difficult to achieve but best treatment response was seen in a woman who had partial response to chemo - radiotherapy ( survival 19 months ) . according to them ,
however , khajuria et al and santwani et al have reported squamous cell carcinoma in dermoid cyst at younger ages i.e. , 37 years and 40 years , respectively .
keeping in view the rarity and poor prognosis of squamous cell carcinoma of the ovary arising in a mature cystic teratoma , it is very essential for a gynecologic oncologist to be aware of this condition and be equipped to deal with it .
squamous cell carcinoma of the ovary is a rare condition and usually arises in mature cystic teratoma ( mct ) or dermoid cyst of the ovary . 
 the reported incidence of malignant transformation in mct is approximately 2% . 
 a case of squamous cell carcinoma arising in a dermoid cyst of the ovary presenting at an early stage is presented here . a 53-year - old postmenopausal lady , presented with the complaint of pain in right lower abdomen since one month and a large complex abdomino - pelvic mass on examination and investigations . 
 final histopathology was reported as squamous cell carcinoma of left ovary arising from dermoid cyst and a benign dermoid cyst in the right ovary . 
 the patient was assigned to squamous cell carcinoma of the ovary arising in a mature cystic teratoma , surgical stage ic2 . in view of the poor prognosis , 
 adjuvant chemotherapy was started .