High‐Grade Immature Teratoma in a 20‐Month‐Old Girl: A Rare Case With Cross‐Midline Presentation and Ovarian Torsion

ABSTRACT Background Immature ovarian teratomas are rare malignant germ cell tumours, particularly in children under 2 years old. Ovarian torsion may further obscure diagnosis by altering adnexal anatomy and radiological interpretation. Case Presentation A 20‐month‐old girl presented with persistent vomiting, abdominal distension, and poor oral intake. Imaging suggested a left‐sided mesenteric teratoma. However, exploratory laparotomy revealed a torsed right ovarian mass displaced across the midline. Right salpingo‐oophorectomy was performed. Histopathological examination confirmed a Grade 3 immature teratoma with prominent immature neuroepithelial elements. No metastasis was identified, and the tumour was staged as FIGO Stage IA. Discussion Ovarian torsion in paediatric patients may lead to atypical presentations and mislocalization of adnexal masses. This case underscores the importance of correlating imaging with intraoperative findings. Despite high‐grade histology, early‐stage disease with complete resection is associated with favourable outcomes, though close surveillance is required. Conclusion This case highlights a rare presentation of high‐grade immature teratoma in a toddler, emphasizing diagnostic challenges and the importance of timely surgical and pathological management.