Mature cystic teratomas are benign germ cell tumors most commonly found in the ovaries, while extragonadal teratomas, particularly in the mediastinum, are rare. Concurrent ovarian and mediastinal teratomas pose a diagnostic challenge, often mimicking malignancy.

A 21-year-old woman presented with menorrhagia and respiratory symptoms, initially suggestive of a pulmonary pathology. Imaging revealed masses in the ovary and anterior mediastinum, raising suspicion of a malignant ovarian germ cell tumor with mediastinal metastasis.

This case highlights the diagnostic dilemma and precision decision-making involved in the management of concurrent teratomas and emphasizes the need for a multidisciplinary approach to ensure accurate diagnosis and optimal management.