Mobile globules in benign cystic teratoma of the ovary

Abstract

Case reportA 39 year old nulliparous woman was referred to the outpatient department by her general practitioner following the detection of an abdominal swelling, found incidentally during a routine visit to obtain a cervical smear for cytology. She had no other medical complaints and had not noted any pressure symptoms or systemic disturbance in association with the mass. The previous cervical smears had been normal.She had regular menstrual periods, bleeding for five days in a 28 day cycle. There had been no associated bleeding irregularity, pain or significant weight loss. She was not sexually active and therefore did not use any contraceptives, although she had had an intrauterine contraceptive device inserted for one year, 12 years previously.This was removed following an episode of severe pelvic pain. A left ovarian cyst had also been diagnosed 18 years prior to this referral. The cyst appeared to have resolved spontaneously and no further treatment had been required. She smoked about 20 cigarettes per day and suffered from mild chronic bronchitis. In addition, she was receiving treatment for left lower limb sciatica.General physical findings were normal at presentation. There was no sign of pallor, lymphadenopathy, respiratory or cardiovascular disease. Further examination revealed a nontender, smooth, cystic mass arising from the pelvis which was consistent in size with an 18-week pregnancy. There was no other palpably enlarged organ, no clinical evidence of ascites, and no bruit were heard over the mass. Pelvic examination revealed a mobile, normal sized uterus, separate from, and anterior to the mass.Laboratory investigations performed subsequently were all reported normal. These included estimation of the serum CA125, alpha fetoprotein, carcinoembryonic antigen, human chorionic gonadotrophin and serum carbohydrate antigen C19-9. A full blood count, kidney

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

“…We found 18 cases of ovarian cystic teratoma with multiple floating balls from 14 studies in the review of the literature (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). We investigated common features in these 18 cases from the literature and our present case, such as the age of the women, the size of the tumor, and the side of the body in which the tumor located.…”

“…We do not yet have an answer. Venous stasis has been blamed for pathogenesis of the ovarian torsion that is most frequently seen in the right ovary in cases of teratoma (11). Similarly, it has been reported that hypovascularity may have played a role in such cases, especially those in which the masses are seen in the Douglas pouch with no attachment to the ovary or any other vascular organ (4).…”

MR and Ultrasound Imaging of Floating Globules in Mature Ovarian Cystic Teratoma

“…Though the mechanisms forming the globules were unclear, in all reported cases [2,5,6] the fat globules have occurred in rather large cysts, so it might be that the fat balls require space to be remodeled; in our case, the size of the lesion was 112 cm. Each globule, therefore, may be formed by aggregating sebaceous matter around a nidus while moving around the cystic cavity.…”

“…In 2000, Otigbah et al [2] reported ultrasound imaging of mobile globules in an ovarian cystic teratoma. Recently, 3-D imaging has become available commercially and definitely has useful clinical applications in obstetrics, although the usefulness of 3-D images in gynecological diagnosis is still somewhat controversial.…”

Pathognomonic Landmark of Mature Cystic Ovarian Teratomas in HDlive Ultrasound

“…This type of growth could be related to an unusual pattern of estrogen and progesterone receptor expression in the cystic teratoma, 27 although consensus has not been reached. 18,21,24 With magnetic resonance imaging (MRI), the sebaceous component is specifically identified with fat-saturation techniques. With computer tomography (CT), fat attenuation and a calcification inside a cyst are diagnostic.…”