A rare ovarian duo: massive edema and mature cystic teratoma

Massive ovarian edema (MOE) is a rare, benign entity characterized by marked accumulation of stromal fluid resulting in ovarian enlargement, often simulating neoplasia both clinically and radiologically. The simultaneous occurrence of MOE with a mature cystic teratoma (MCT) in the same ovary is exceptionally rare. A 32-year-old female presented with abdominal pain. Ultrasonography revealed a heterogeneous solid-cystic ovarian lesion on the right side. Routine laboratory parameters were within normal limits. A clinical working diagnosis with a differential of torsion or neoplastic mass was considered. Right salpingo-oophorectomy was performed. Grossly, the ovary was enlarged, with a unilocular cyst containing hair and sebaceous material. Microscopy revealed two distinct pathologies: (i) diffuse stromal edema with separation of follicular structures with preserved overall architecture, indicating massive ovarian edema; and (ii) mature cystic teratoma comprising of keratinized squamous epithelium, hair shafts, adipose tissue, and adnexal structures. No immature or malignant elements were identified in the sections studied. This concurrent presentation of both the pathologies in the same ovary highlights the diagnostic challenge due to its clinical and radiological resemblance to ovarian neoplasms. Recognition of MOE is essential to avoid overdiagnosis and unnecessary radical surgery, particularly in young women where fertility preservation is important.