Unusual "floating balls" appearance of an ovarian cystic teratoma: sonographic and CT findings

Mature ovarian cystic teratoma with "sack of marbles" appearance on magnetic resonance imaging: A case report

INTRODUCTION

Mature ovarian cystic teratoma is a cystic fatty tumor. Presence of floating fat balls in an ovarian cystic teratoma looking like a "sack of marbles" on magnetic resonance imaging (MRI) is a rare finding.

PATIENT CONCERNS

Herein, we report a 38-year old woman who was admitted to our hospital presenting with an abdominal mass and abdominal pain.

DIAGNOSIS

Ultrasonography revealed a giant cystic mass in the pelvis; T1-weighted MRI revealed multiple spherical signals in the lesion.

INTERVENTIONS

She underwent exploratory laparotomy and was histopathologically diagnosed with benign cystic teratoma.

OUTCOMES

Finally, the patient recovered after operation. Until December 2018, she had been still healthy without recurrence of tumors.

CONCLUSION

The aim of this case report was to present "sack of marbles" appearance on MRI, which will impress other doctors and improve the diagnosis of such diseases.

Ovarian cystic teratoma with a pathognomonic appearance of multiple floating balls: a case report and investigation of common characteristics of the cases in the literature

OBJECTIVE

To investigate the common characteristics of a rare entity of ovarian cystic teratoma with intracystic floating balls in conjunction with a case.

DESIGN

Case report.

SETTING

University hospital.

PATIENT(S)

A 41-year-old woman with abdominal discomfort and a 2-year obscure history of an ovarian cyst.

INTERVENTION(S)

Right salpingo-oopherectomy by laparotomy.

MAIN OUTCOME MEASURE(S)

Ultrasonography and magnetic resonance imaging (MRI).

RESULT(S)

Ultrasonographic examination revealed a cystic mass (>10 cm) with a unique appearance of multiple floating balls on the lower right quadrant of the abdomen. The MRI showed the same balls with a slightly high fat content. Histopathological diagnosis was mature cystic teratoma and the balls were mostly made of keratin.

CONCLUSION(S)

The appearance of intracystic floating balls is rarely seen but is pathognomonic for mature cystic teratoma. When this typical appearance is found on ultrasonography the value of other diagnostic tests, such as tumor markers, serological tests for echinococcosis, computerized tomography (CT), and MRI, can be considered as limited.

Meat balls: a pathognomonic ultrasound and computed tomography finding in mature cystic teratoma

One of the commonest germ cell tumours are mature cystic ovarian teratomas. Although the imaging features of teratomas are highly variable, the sonographic and CT identification of fatty and calcific components are fairly suggestive. The case presented, however, is of an unusual, yet pathognomonic CT and ultrasound imaging appearance of an ovarian teratoma that was due to floating balls.

A Practical Approach to the Ultrasound Characterization of Adnexal Masses

Because pelvic ultrasound is commonly used to evaluate adnexal masses, it is important to understand the most useful sonographic features for predicting benign and malignant masses. Determining whether an adnexal mass is of ovarian or extraovarian origin is key in arriving at the most likely diagnosis. Most adnexal masses are benign, and each of the most common benign ovarian lesions has a typical sonographic appearance. Additionally, most malignant ovarian neoplasms have a solid component with detectable flow by Doppler ultrasound, allowing one to strongly suggest the diagnosis. We will review an approach to the ultrasound diagnosis of adnexal masses that progresses through a series of 4 questions to help lead one to the most likely diagnosis.

Unusual fast-growing ovarian cystic teratoma during pregnancy presenting with intracystic fat "floating balls" appearance

A large ovarian cyst was diagnosed at 22 weeks' of gestation in a 32-year-old woman. The ultrasonographic appearance of the ovarian cyst was unusual with multiple mobile, spherical echogenic structures floating in the cystic mass, called intracystic "fat balls." Right adnexectomy was performed by laparotomy at 28 weeks' of gestation, because of rapid growth and overall size exceeding 20 cm. Pathological examination confirmed ovarian cystic teratoma. Usually, dermoid cysts are slow-growing, even in premenopausal women. The exact mechanism related to the fast growth during pregnancy is unknown. It could be related to an unusual pattern of estrogen (E)/P receptors expression in the cystic teratoma. This case shows that a fast-growing, mature ovarian cystic teratoma may occur during pregnancy.

Pathogenesis of balls in mature ovarian cystic teratoma. Report of 3 cases and review of literature

Ovarian cystic teratomas with intracystic balls are rare, and only 11 cases have been reported since 1946. We present 2 new cases and review the literature for the clinical presentation and morphological appearances of the cysts and balls. We also present our histology findings on a third case reported in the international literature. The pathogenesis of balls formation is unknown. We put forward a hypothesis based on the forces which control the production and absorption of the intracystic contents and also recommendations for investigators who may encounter this lesion. We believe that predominance of large secretory and absorptive rather than exfoliative surfaces lining the cysts would favor the absorption of most of the contents into the general circulation, leaving the remaining material to solidify and mould into balls. Still, however, there are many unanswered questions.

Cystic ovarian teratoma with intracystic floating globules

Ovarian cystic teratomas are cystic fatty tumors that are often found in patients of reproductive age, and the diagnosis can be easily made radiologically. We present a case of postmenopausal ovarian cystic teratoma with an unusual radiologic appearance of intracystic floating globules.