Bilateral Multifocal Ovarian Teratomas and Ovarian Torsion in a Young Woman With Polycystic Ovarian Syndrome: A Case Report.

Background: Ovarian dermoid cysts are common benign neoplasms that typically manifest as a solitary lesion. Bilateral multifocal presentations, particularly in the context of polycystic ovarian syndrome (PCOS), are exceptionally rare and pose significant diagnostic challenges. Case Presentation: A 22-year-old nulligravid Caucasian woman with a history of PCOS presented with acute, severe lower abdominal pain accompanied by nausea and vomiting. Initial imaging revealed large bilateral ovarian masses with features consistent with dermoid cysts and clinical findings suggestive of a right ovarian torsion. Despite a prior computed tomography (CT) scan indicating bilateral ovarian cysts, the patient attributed her symptoms to PCOS-related changes, delaying timely evaluation. Intraoperative findings during an exploratory laparotomy confirmed the presence of more than five distinct dermoid teratomas on each ovary. Bilateral ovarian cystectomies were performed with careful preservation of ovarian stromal tissue, and histopathological analysis verified the diagnosis of mature cystic teratomas. Conclusion: This case underscores the critical need for early differentiation between PCOS-related cysts and ovarian dermoid cysts to avert complications such as ovarian torsion and to preserve fertility. It also highlights the essential role of clear and effective communication between healthcare providers and patients in ensuring timely diagnosis and intervention. Misinterpretation of clinical symptoms can lead to delayed presentation with potentially deleterious effects on future fertility. Teaching Point: A CT scan obtained during the patient's initial evaluation revealed ovarian teratomas; however, the patient mistakenly believed these masses represented her typical PCOS-associated cysts rather than pathology of a different etiology. This misconception delayed recognition of the severity of her condition and underscores the importance of clear physician-patient communication to ensure patients understand the significance of their diagnoses, particularly when fertility and overall well-being may be affected.