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. (Fertil Steril (R) 2008;90:2008.e17-e19. (C)2008 by American Society for Reproductive Medicine.)