Two rare cases of squamous cell carcinoma in a mature cystic teratoma of the ovary

Mature cystic teratoma (dermoid cyst) is the commonest ovarian neoplasm in reproductive age. They are arising from all three germ cell lines and commonly have a benign behavior. However, rarely; in about 1-2% of the cases, mature cystic teratomas transform into malignancy where the squamous cell carcinoma transformation (80%) is the commonest. In addition, squamous cell carcinoma of the ovary is also extremely rare. We report two patients who were operated on first for a benign ovarian tumor and secondarily required re-staging laparotomies as the histology revealed malignant transformation. The first patient was a 35-year-old female who had an ovarian cystectomy for presumed ovarian torsion and the next patient was a 64-year-old female who had a hysterectomy for a dermoid cyst. Fortunately, in both cases, completion staging surgery has not revealed residual tumor or spread. The pre-operative diagnosis and planning the management could be challenging since there are no definite features to confirm malignant transformation, however, the presence of lymphadenopathy may raise the suspicion. No proper staging done at primary surgery will require a patient to undergo repeat surgery. In addition, since laparoscopic cystectomies are often carried out for dermoid cysts, the tumor spillage causing up-stage and subsequent need for chemotherapy is a concern.