Topical Hemostatic Agent May Be Mistaken for Ovarian Teratoma

  • Katherine G. Hayes
    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts
    Search for articles by this author
  • Amanda V. French
    Address correspondence to: Amanda V. French, Tufts Medical Center, Department of Obstetrics and Gynecology, 800 Washington Street, Boston, MA 02110; Phone (617) 636-2229.
    Division of Gynecology, Department of Surgery, Boston Children's Hospital, Boston, Massachusetts

    Department of Obstetrics, Gynecology and Reproductive Biology, Brigham and Women's Hospital, Boston, Massachusetts
    Search for articles by this author
Published:December 03, 2021DOI:



      Ovarian teratomas are common, as is use of topical hemostatic agents in ovarian surgery.


      Following laparoscopic right ovarian cystectomy, a flowable hemostatic agent was placed in the ovarian bed. Postoperative ultrasound demonstrated an enlarged heterogeneous right ovary with solid and cystic components interpreted as residual or recurrent teratoma. Visual inspection during repeat laparoscopy revealed an irregularly shaped, enlarged right ovary with a smooth cortex. A cavity inside the ovary contained brown, shaggy material. Pathological evaluation demonstrated normal ovary and fibrin.

      Summary and Conclusion

      We report the first case of a hemostatic agent routinely used in ovarian cystectomy postoperatively, mimicking a teratoma. Consideration of this finding is important when planning surgery in adolescent patients to optimize fertility preservation and minimize ovarian follicle damage.


      To read this article in full you will need to make a payment


      Subscribe to Journal of Pediatric and Adolescent Gynecology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Henkel A
        • Cooper RA
        • Ward KA
        • et al.
        Malignant-appearing microcalcifications at the lumpectomy site with the use of FloSeal hemostatic sealant.
        Am J Roentgenol. 2008; 191: 1371-1373
        • Chung JPW
        • Law TSM
        • Chung CHS
        • et al.
        Impact of haemostatic sealant versus electrocoagulation on ovarian reserve after laparoscopic ovarian cystectomy of ovarian endometriomas: a randomised controlled trial.
        BJOG. 2019; 126: 1267-1275
        • Kang JH
        • Kim YS
        • Lee SH
        • et al.
        Comparison of hemostatic sealants on ovarian reserve during laparoscopic ovarian cystectomy.
        Eur J Obstet Gynecol Reprod Biol. 2015; 194: 64-67
        • Rogers EM
        • Allen L
        • Kives S:
        The recurrence rate of ovarian dermoid cysts in pediatric and adolescent girls.
        J Pediatr Adolesc Gynecol. 2014; 27: 222-226
        • Angioli R
        • Muzii L
        • Montera R
        • et al.
        Feasibility of the use of novel matrix hemostatic sealant (Floseal) to achieve hemostasis during laparoscopic excision of endometrioma.
        J Minim Invasive Gynecol. 2009; 16: 153-156
        • Stachowicz AM
        • Whiteside JL:
        Topical hemostatic agents in gynecologic surgery for benign indications.
        Obstet Gynecol. 2020; 135: 463-468
        • Zhang F
        • Bonidie MJ
        • Ventrelli SM
        • et al.
        Intraovarian oxidized cellulose (Surgicel) mimicking acute ovarian pathology after recent pelvic surgery.
        Radiol Case Reports. 2015; 10: 39
        • Cormio L
        • Cormio G
        • Di Fino G
        • et al.
        Surgicel® granuloma mimicking ovarian cancer: a case report.
        Oncol Lett. 2016; 12: 1083
      1. Ethicon. Surgicel Original, Surgicel Nu-knit and Surgicel Fibrillar (Instructions for use, package insert). Neuchatel, Switzerland, 2020.

        • Gupta B
        • Guleria K
        • Suneja A
        • et al.
        Adolescent ovarian masses: a retrospective analysis.
        J Obstet Gynaecol (Lahore). 2016; 36: 515-517
        • Havrilesky LJ
        • Peterson BL
        • Dryden DK
        • et al.
        Predictors of clinical outcomes in the laparoscopic management of adnexal masses.
        Obstet Gynecol. 2003; 102: 243-251