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Pelvis » Female Pelvis (Gynecology)
Cystic Teratoma of the Ovary
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This is a 15-year-old-woman that presented in our unit with abdominal pain.

Caption: Conventional 2D image of the abdomen
Description: A large number of 1-1.5 cm structures with relatively uniform echogenic content and a circular cross section are seen floating within a large fluid-filled structure.
Caption: 3D image of the abdominal mass
Description: 3D imaging of the abdominal fluid filled structure reveals the floating masses to be spherules.
Caption: Image 3
Description: This larger image better demonstrates the variation in the shape and size of the spherules.
Caption: Image 4
Description: This image indicates that the fluid component of the mass has other echo-generating structures within it, appearing as linear streaks within the fluid filled area.
Caption: Image 5
Description: Imaging through a different section of the mass reveals a highly echogenic focal mass that strongly shadows, suggesting a calcified structure.
Differential Diagnosis None.  Finding is pathognomonic for mature cystic teratoma.
Final Diagnosis Mature Cystic Teratoma of the Ovary
Discussion We present a case of mature cystic teratoma of the ovary containing numerous spherules floating in the cyst. Sonographic imaging revealed a large 19 X 14 X 16 cm fluid-filled mass containing multiple floating 1-1.5 cm spherical structures which represented globules of cheese-like sebum.  In one area of the mass there were typical findings of mixed hair and fat and a Rokitansky’s protuberance with a calcified area causing a strong shadow.  The pathology report confirmed mature teratoma of the ovary.  The floating balls of fat-like material are less commonly seen in mature teratomas.  Jantarasaengaram et al (1) reported a similar case in 2003 and provided a review of the history of earlier reports of similar findings.  
Case References 1. Jantarasaengaram, S., Siricharoenthai, S. and Vairojanavong, K. (2003), Cystic ovarian teratoma with intracystic fat balls. Ultrasound Obstet Gynecol, 22: 102–103. doi:10.1002/uog.181

Follow Up Pathology confirmed mature cystic teratoma of the ovary