<h3>Background</h3> Fetus-in-fetu (FIF) is a rare congenital soft tissue mass that resembles a fetus, occurring in approximately one in 500,000 births. It is typically a benign condition, with only one reported case of malignant recurrence in literature. FIF typically occurs in neonates under 18 months of age, and have largely been described as occurring in the retroperitoneum. In this case, we present a 13-year-old female with initial occurrence and subsequent residual re-growth of FIF following resection, within her right ovary. <h3>Case</h3> A 13-year-old female presented with abdominal pain and was found to have a 19-centimeter, complex right adnexal mass. Pre-operative tumor markers were normal and pre-operative risk assessment favored a benign process. She underwent an open, right ovarian cystectomy and was diagnosed with FIF on final pathology. Nine months after her procedure, during post-operative surveillance, she complained of intermittent abdominal pain and was found to have a recurrence of her complex right ovarian mass. Pre-operative tumor markers were normal and again pre-operative risk assessment favored a benign process. Intraoperatively there was no normal appearing ovarian tissue and she therefore underwent a right oophorectomy. Pathology noted tissue similar to her initial mass, indicative of growth of residual FIF tissue. <h3>Comments</h3> In rare cases where FIF is found within the ovary, consider post-operative surveillance, as there is a risk of recurrence or residual disease. Pre-operative assessment using imaging, tumor markers, and a multidisciplinary team is crucial for management of pediatric and adolescent ovarian masses.
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