Iranian Society of Gynecology Oncology

Document Type : Case Report Article

Authors

1 Department of Obstetrics and Gynecology, School of Medicine, Urmia University of Medical Science. Urmia, Iran

2 Reproductive Health Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran

Abstract

Ovarian mature cystic teratomas (OMCTs) due to their heterogeneous histologic entity, have a wide spectrum of radiologic features. A type of floating spherical globule that has been called “Sack of marble” or "Coins-in-sack,” but without a fat or calcification component that results in misdiagnosis on computed tomography (CT), is a rare finding. The patient was a 35-year-old healthy woman with abdominal pain and sonographic findings based on OMCT with the Coins-in-sack sign, whereas the CT manifestation was a unilocular huge cyst suggesting an adnexal cystadenoma. She had a final diagnosis of the Coins-in-sack variant of OMCT but with keratin balls, not common fat balls. Understanding the unconventional radiologic and histologic manifestations of OMCTs, is necessary to make an accurate diagnosis.

Highlights

 Ovarian mature cystic teratomas (OMCTs) due to their heterogeneous histologic entity, have a wide spectrum of radiologic features. A type of floating spherical globule that has been called “Sack of marble” or "Coins-in-sack,” but without a fat or calcification component that results in misdiagnosis on computed tomography (CT), is a rare finding.

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Main Subjects

1. DiSaia PJ, Creasman WT, Mannell RS, McMeekin S, Mutch DG. Clinical gynecologic oncology e-book: Elsevier Health Sciences; 2017.
2. Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: tumor types and imaging characteristics. Radiographics. 2001;21(2):475-90. [DOI:10.1148/radiographics.21.2.g01mr09475] [PMID]
3. Jagtap SV, Kshirsagar NS, Jagtap SS, Boral S, Nasre N. Ovarian teratomas: clinicopathological study at tertiary care center. Int j Reprod Contracept Obstet Gynecol. 2019;8(8):3318-23. [DOI:10.18203/2320-1770.ijrcog20193558]
4. Sahin H, Abdullazade S, Sanci M. Mature cystic teratoma of the ovary: a cutting edge overview on imaging features. Insights into imaging. 2017;8(2):227-41. [DOI:10.1007/s13244-016-0539-9] [PMID] [PMCID]
5. Saba L, Guerriero S, Sulcis R, Virgilio B, Melis G, Mallarini G. Mature and immature ovarian teratomas: CT, US and MR imaging characteristics. Eur J Radiol. 2009;72(3):454-63. [DOI:10.1016/j.ejrad.2008.07.044] [PMID]
6. Tongsong T, Wanapirak C, Khunamornpong S, Sukpan K. Numerous intracystic floating balls as a sonographic feature of benign cystic teratoma: report of 5 cases. J Ultrasound Med. 2006;25(12):1587-91. [DOI:10.7863/jum.2006.25.12.1587] [PMID]
7. Occhipinti KA, Frankel SD, Hricak H. The ovary. Computed tomography and magnetic resonance imaging. Radiol Clin North Am. 1993;31(5):1115-32. [DOI:10.1016/S0033-8389(22)00359-1] [PMID]
8. DeAngelis CE. An ovarian dermoid cyst with numerous sebum balls. Am J Obstet Gynecol. 1953;66(2):443-5. [DOI:10.1016/0002-9378(53)90587-0] [PMID]
9. Muramatsu Y, Moriyama N, Takayasu K, Nawano S, Yamada T. CT and MR imaging of cystic ovarian teratoma with intracystic fat balls. J Comput Assist Tomogr. 1991;15(3):528-9.
10. Şahin H, Akdoğan AI, Ayaz D, Karadeniz T, Sancı M. Utility of the "floating ball sign" in diagnosis of ovarian cystic teratoma. Turk J Obstet Gynecol. 2019;16(2):118. [DOI:10.4274/tjod.galenos.2019.67209] [PMID] [PMCID]
11. Jantarasaengaram S, Siricharoenthai S, Vairojanavong K. Cystic ovarian teratoma with intracystic fat balls. Ultrasound Obstet Gynecol. 2003;22(1):102-3. [DOI:10.1002/uog.181] [PMID]
12. Gol M, Saygili U, Uslu T, Erten O. Mature cystic teratoma with intracystic fat balls in a postmenopausal woman. Eur J Obst Gyne Reprod Biol. 2005;119(1):125-6. [DOI:10.1016/j.ejogrb.2004.06.003] [PMID]
13. Wang A, Shu Y. Mature ovarian cystic teratoma with "sack of marbles" appearance on magnetic resonance imaging: A case report. Medicine. 2019;98(31):e1669. [DOI:10.1097/MD.0000000000016691] [PMID] [PMCID]