Mature cystic ovarian teratoma - floating ball appearance
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At the time the case was submitted for publication Ana Paula Bavaresco had no recorded disclosures.View Ana Paula Bavaresco's current disclosures
Diffuse abdominal pain and increased abdominal volume. On physical examination, a palpable mass extending from the right hypochondrium to the ipsilateral iliac fossa.
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Voluminous formation containing numerous echogenic balls floating in an anechoic liquid.
In the posterior region, there are echogenic structures with posterior acoustic shadow probably due to calcifications, hair strands, or foci of fat.
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Macroscopic appearance after surgery and liquid drainage of the ball; bulky saccular formation containing fat balls and hairballs.
1 case question available
Ovarian teratoma is one of the most frequent benign ovarian tumors of reproductive age in women. When mature and cystic, it may also be called a dermoid cyst.
The appearance of cysts containing multiple internal floating balls is a very rare presentation of the dermoid cyst, but is considered pathognomonic for this entity and was first described in 1991 1,2. These internal floating balls may be single or multiple, measuring around 5 to 40 mm, composed of keratin, fibrin, hemosiderin, hair, and fat in different proportions and their mechanism of formation has not been well defined yet.
This imaging aspect is not unique to ovarian teratomas, it can be seen in the rectouterine pouch, mediastinum, and skull teratomas. They are usually asymptomatic and slow-growing but may manifest with discomfort and abdominal bloating, sometimes progressing to rupture, malignant degeneration or causing compressive symptoms due to the expanding size 3-6. Torsion cases are also reported, but mainly in larger than average dermoid cyst (average diameter of 11 cm) 7. Although ultrasound findings have been reported to be sufficient for diagnosis. Complementary examinations such as computed tomography and magnetic resonance imaging are often necessary to define the origin of the lesion.
- 1. Yazici B, Erdoğmuş B. Floating ball appearance in ovarian cystic teratoma. (2006) Diagnostic and interventional radiology (Ankara, Turkey). 12 (3): 136-8. Pubmed
- 2. Muramatsu Y, Moriyama N, Takayasu K, Nawano S, Yamada T. CT and MR imaging of cystic ovarian teratoma with intracystic fat balls. (1991) Journal of computer assisted tomography. 15 (3): 528-9. Pubmed
- 3. Wang B, Zhang H. Dense, Mysterious, Small Balls in the Abdomen. (2018) Gastroenterology. 155 (1): 19-20. doi:10.1053/j.gastro.2017.10.045 - Pubmed
- 4. Gürel H, Gürel SA. 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. (2008) Fertility and sterility. 90 (5): 2008.e17-9. doi:10.1016/j.fertnstert.2008.01.013 - Pubmed
- 5. Espindola APBP, Amorim VB, Koch HA, Bahia PRV, Almeida MVP. Atypical presentation of mature cystic teratoma ("floating balls"). (2017) Radiologia brasileira. 50 (3): 206-207. doi:10.1590/0100-3984.2015.0155 - Pubmed
- 6. Eric K. Outwater, Evan S. Siegelman, Jennifer L. Hunt. Ovarian Teratomas: Tumor Types and Imaging Characteristics1. (2001) RadioGraphics. doi:10.1148/radiographics.21.2.g01mr09475
- 7. Li, Rebecca Yuan, Nikam, Yogesh, Kapurubandara, Supuni. Spontaneously Ruptured Dermoid Cysts and Their Potential Complications: A Review of the Literature with a Case Report. (2020) Case Reports in Obstetrics and Gynecology. doi:https://doi.org/10.1155/2020/6591280
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