Ultrasound Diagnosis of a Rare Dermoid Cyst Arising from a Maldescended Ovary in the Upper Abdomen

What is it about?

case report describes a rare case of a mature cystic teratoma (dermoid cyst) arising from a maldescended right ovary located in the subhepatic region of the abdomen. The patient was a 24-year-old woman who presented with right hypochondrial pain and underwent abdominal ultrasound evaluation. Ultrasound examination demonstrated a large complex cystic lesion beneath the liver measuring approximately 9 cm. The lesion showed classic sonographic features of a dermoid cyst, including hyperechoic lines and dots representing dermoid mesh, a dermoid plug with acoustic shadowing, calcification, and fluid–fluid level Subsequent transvaginal ultrasound revealed a normal uterus and left ovary, but the right ovary could not be identified within the pelvic cavity. These findings suggested a dermoid cyst arising from a maldescended right ovary situated in the upper abdomen. Surgery and histopathological examination confirmed the diagnosis of mature cystic teratoma containing tissues derived from all three germ cell layers. The report discusses the embryological basis of ovarian maldescent and reviews its known associations with Müllerian duct anomalies and urinary tract abnormalities. However, the present patient showed no associated uterine or renal anomalies. The case demonstrates that maldescended ovaries should be considered whenever a dermoid cyst or complex adnexal-type lesion is identified in an unusual abdominal location, especially when one ovary is absent from the pelvis on ultrasound examination.

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Photo by Vitolda Klein on Unsplash

Photo by Vitolda Klein on Unsplash

Why is it important?

Maldescended ovaries are rare developmental abnormalities and may be overlooked during routine pelvic ultrasound examinations. When an ovarian dermoid cyst occurs in an abnormal abdominal location, it may mimic diseases of the liver, gallbladder, kidney, appendix, or bowel, leading to diagnostic confusion and delayed treatment. This case highlights the importance of carefully searching for both ovaries whenever a complex abdominal cyst is identified in a female patient. The report also emphasizes the diagnostic value of ultrasound in recognizing characteristic dermoid features and detecting the absence of the ovary from its normal pelvic location. Early recognition of maldescended ovaries may help avoid misdiagnosis and improve surgical planning.

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