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Immature ovarian teratomas are rare ovarian germ cell tumors associated with a variable potential of distant metastasis. The acquisition of mature phenotypes upon post-treatment recurrence of immature teratomas has been previously described. In this study, we report, for the first time, a rare case of a recurrent ovarian immature teratoma with mature deposits in the small bowel. An incidental pelvi-abdominal mass was identified in a 30-year-old pregnant patient during antenatal ultrasonography. The mass, which was resected through salpingo-oopherectomy, was histopathologically characterized as an immature teratoma of grade 2 and treated with 3 cycles of chemotherapy. After 3 years of completing treatment, the patient suffered from severe anemia which was investigated by capsule endoscopy that identified a bleeding source in the ileum. Imaging studies revealed an intrabdominal mass that was resected laparoscopically. The pathological assessment of the mass identified a submucosal/intramuscular teratoma with mature elements indicative of a recurrent metastasis of immature teratoma associated with post-chemotherapy retroconversion. The secondary mass was then managed with adjuvant chemotherapy.

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