Unusual Feature of Mature Cystic Teratoma: Multiple Intra-cystic Spherical Structures: A Case report

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.