Mature cystic ovarian teratoma

Case contributed by Dr Antoni Boscà

Presentation

Acute severe pelvic pain and swollen abdomen. The patient also has nausea and vomiting.

Patient Data

Age: 50 years
Gender: Female
CT

Left ovarian mass, located anterior to the uterus. Note the fat-fluid level with a central single large ball floating at the interface, tufts of hair and calcification. Distended, swirling left ovarian vascular pedicle consistent with ipsilateral ovarian torsion being the cause for acute presentation.

Annotated image

Left ovarian mass more than 5 cm in diameter with a liquid-fatty level, a central Rokitansky nodule (arrow), hyperdense linear images that were shown to correspond to tufts of hair (empty arrow), and tooth-like calcifications (arrowhead).

Coiled and distended left ovarian vascular pedicle in relation to left ovarian torsion (asterisk).

Edited images showing the striking similarity between the ovarian cystic teratoma and a "Poké Ball".

Authors of this case are Drs Antoni Boscà Ramon, Marcelo Rengel, Ana Julve Parreño.

Case Discussion

The displayed ovarian mass was removed and the anatomopathological study confirmed the existence of a mature ovarian teratoma with areas of hemorrhage, along with an abundant pilous component. The patient presented with elevation of CA 125 and CA 15-3 tumor markers.

This case contains a striking example of pareidolia; a psychological phenomenon wherein a stimulus (an image in this case) is perceived to contain a familiar pattern of something (in this case a Poké Ball) where none actually exists. This phenomenon is encountered not infrequently in radiology, and in fact Radiopaedia has an article entitled Rorschach radiology which is dedicated to it!

As far as we know, this case is the first one to ever describe the similarity between a mature cystic ovarian teratoma with floating central ball and a Poké Ball.

Aside from the pareidolia, this case is an excellent example of a mature cystic teratoma appearance on CT, and in particular it highlights how large ovarian masses can cause ovarian torsion which is a surgical emergency. 

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Case information

rID: 46899
Published: 26th Jul 2016
Last edited: 5th Apr 2020
System: Gynaecology
Inclusion in quiz mode: Included

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