Triple Twist in a Cystic Tale: Diagnostic Dilemma in Adnexal Masses

Adnexal masses represent a frequent clinical problem in gynecological practice and often pose diagnostic challenges due to overlapping clinical, biochemical, and radiological features. Mature cystic teratoma (MCT), mucinous cystadenoma, and ovarian hydatid cyst are pathologically distinct entities with differing etiologies, management strategies, and prognostic implications. Ovarian hydatid disease is exceptionally rare and is typically secondary to disseminated echinococcosis. We report a diagnostically challenging case of a 44-year-old woman who was incidentally detected with a complex adnexal mass where ultrasonography and magnetic resonance imaging suggested mucinous cystadenoma or ovarian hydatid cyst. Definitive diagnosis of mature cystic teratoma was established only after surgical excision and histopathological examination. This case highlights the limitations of imaging in complex ovarian cysts and underscores the indispensable role of histopathology in achieving diagnostic certainty.