Presentation
Abdominal pain and vomiting for two weeks
Patient Data
A large abdominopelvic cyst with numerous intracystic nondependent globules in the cystic fluid. They are hyperechoic compared to the fluid and appear to be floating like balls in the fluid, moving with change in the patient's position.
Microscopic examination of a section from the cyst wall showed stratified squamous epithelium with lamellated keratin suggestive of dermoid.
Case Discussion
Mature cystic teratomas may have a variety of appearances characterized by iso- to hyperechoic sebaceous material and calcification. The most common appearance consists of a cystic lesion with a very hyperechoic mural nodule with calcification (Rokitansky nodule/dermoid plug). Another appearance is that of a cystic lesion with diffuse internal echos with sound attenuation due to sebaceous material and hair with or without a fluid-fluid level. Yet another manifestation comprises a cyst with multiple small echogenic lines or bands caused by hair within the cyst (dot-dash pattern/dermoid mesh). Sometimes, as in this case, a striking appearance is created by non-dependent intracystic globules in the cystic fluid that look like floating balls. It is uncommon but almost pathognomonic of ovarian mature cystic teratoma.
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