Are they Spherules of Ovarian Cystic Teratoma or Daughter Cysts of Echinococcosis?

Abstract

Teratoma is a germ cell tumour which accounts for approximately 15-20 % of all ovarian cancers. The tumour is possibly derived from ectodermal differentiation of totipotent cells or mitotic germ cells. We present a case of a 37-year-old female patient with multiple spherical structures floating in a large pelvic-abdominal cystic mass seen on sonographic images. A giant echinococcal cyst gravid with its daughters was the presumed preoperative sonographic diagnosis. The patient underwent excision of the lesion, and the pathological diagnosis was teratoma. The striking feature of multiple spherical structures in the cyst was caused by multiple spherules of a mature ovarian cystic teratoma which were representing numerous mobile sebaceous cysts and desquamative keratin formations.

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.…”

“…In some studies (6,10,13,16,18), serological tests were done for a differential diagnosis of echinococcus, rarely found in the pelvis. We do not believe that they are necessary, because usually it is not difficult to differentiate with a careful ultrasonographic examination hyperechoic globules floating in a hypoechoic fluid from hypoechoic daughter cysts of echinococcus.…”

Dense, Mysterious, Small Balls in the Abdomen

“…Mature cystic teratoma is among the most common germ cell tumors of the ovary and accounts for approximately 15% to 20% of all ovarian neoplasms. 1 However, an ovarian mature cystic teratoma having so many intracystic floating balls of similar size is extremely rare. Moreover, these spherical entities were often misdiagnosed as daughter cysts of cystic hydatid disease.…”

“…Moreover, these spherical entities were often misdiagnosed as daughter cysts of cystic hydatid disease. 1 The mechanism of formation of the spherules is mysterious. Histologically, these spheres are composed of keratin, fibrin, hemosiderin, sebaceous debris, hair, and fat, in variable proportions.…”

Computed Tomographic and Magnetic Resonance Features of Gynecologic Abnormalities in Women Presenting With Acute or Chronic Abdominal Pain

“…A far less common appearance is that of multiple spherical structures in the cyst caused by multiple spherules that represent numerous mobile sebaceous cysts and desquamative keratin formations within the mass. 22,23 On CT, the presences of calcium or fat within a pelvic mass is diagnostic (Fig. 6B).…”