PMC5047864_01
Transvaginal ultrasound image. A pelvic mass is seen of approximately 11 cm in diameter and is suspected to contain hair because of the presence of hyperechoic lines
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Fig1
Transvaginal ultrasound examination revealed an 11 cm pelvic mass (Fig. 1).
Magnetic resonance images. a A T1-weighted image shows a cystic tumor containing a fat-fluid level. b A fat-suppression image reveals fat suppression on the abdominal side of the niveau
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Fig2
The fat-fluid level inside the tumor was also observed on pelvic contrast-enhanced magnetic resonance imaging (MRI), with high signal intensity on the abdominal side in both T1- and T2-weighted images and low signal intensity on fat-suppression images, suggesting ovarian mature cystic teratoma (Fig. 2a, b).
Lower gastrointestinal tract endoscopy image. Hair and a submucosal tumor-like protrusion with redness at its apex are seen
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Fig3
Endoscopic examination of the lower gastrointestinal tract revealed hair and a submucosal tumor-like protrusion with redness at its apex, situated approximately 12 cm adoral to the anal orifice (Fig. 3).
Surgical images. a An ovarian tumor with a smooth surface occupies the pelvic cavity. b After left salpingo-oophorectomy, a fistula of approximately 1 cm in diameter is seen on the surface of the rectum at the site of adhesion
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Fig4
The ovarian tumor had a smooth surface, and part of the dorsal side was closely adhered to the rectum (Fig. 4a). In addition, a fistula of approximately 1 cm in diameter was observed in the anterior rectal wall at the site of separation from the tumor (Fig. 4b).
Histopathological images. a A histological section of the mature cystic teratoma reveals abundant inflammatory cell invasion (circled section) and hair-shaft tissue (arrows). b A section of the rectal-fistula site shows hair-shaft tissue in the serous membrane of the rectum (arrow)
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Fig5
Findings of abundant inflammatory cell invasion in the cyst wall and hair-shaft tissue were consistent with a mature cystic teratoma (Fig. 5a). Further, although inflammatory cell invasion and hair-shaft tissue were observed in the rectal serosa, no structural disorders such as diverticulitis of the colon or signs of malignancy were observed (Fig. 5b).