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To date, only 21 cases of mature cystic teratoma in Douglas’ pouch that has no connection with adnexa or the alimentary canal have been reported. We report a rare case of extragonadal mature cystic teratoma. A 34-year-old woman, gravida 2 para 1, who had a history of laparoscopic cholecystectomy and cesarean section was referred to our department because of an ovarian cyst. Magnetic resonance imaging (MRI) revealed a 6-cm enhancing right ovarian mature cystic teratoma. We scheduled surgery, but it was delayed because she got pregnant. At 17 weeks of gestation, she was admitted to our hospital because of genital bleeding, high fever, and abdominal pain. Blood examination revealed a marked inflammation. The membranes ruptured right after admission, and the pregnancy resulted in abortion. Two months later, we performed a laparoscopic surgery. A 6-cm tumor was found in Douglas’ pouch and had no connection with right adnexa or the alimentary canal. The tumor had filmy adhesions to the pelvic peritoneum and posterior wall of the uterus. The left adnexa showed normal findings, but the right ovary was small, approximately 1 cm in diameter, and the right fallopian tube was blind-ended. Tumor adhesions were mild and detached from the surroundings, without feeding vessels. The tumor contained hair, adipose tissue, and calcification. Its histological features were consistent with the diagnosis of mature cystic teratoma with degeneration, although no follicles or ovarian interstitial cells were found. Considering that the preoperative MRI findings showed the enhancing cyst wall and laparoscopic findings, the cyst was detached from the right ovary.

A case of mature cystic teratoma in Douglas' pouch suspected to be detached from the right ovary