Finch et al. Journal of Medical Case Reports 2012, 6:148 http://www.jmedicalcasereports.com/content/6/1/148 Page 3 of 5 Figure 1 Imaging studies. (A) Computed tomography scan showing odontogenic keratocyst. (B) Computed tomography scan showing calcification of the falx cerebri. (C) Gross image of odontogenic keratocyst. (D) Photomicrograph of odontogenic keratocyst. (E) Computed tomography scan showing pelvic mass. (F) Ultrasound image showing pelvic mass. showed positivity for vimentin and smooth muscle actin, and negativity for inhibin, calretinin and desmin (Figure 2E,F). Discussion Our case meets two major (odontogenic keratocysts of the jaw, bilamellar calcification of the falx cerebri) and one minor (ovarian fibroma) diagnostic criteria for Gorlin syn- drome. Our patient did not have any basal cell carcinoma skin lesions, which typically develop between puberty and age 35 years and are most commonly located on the face, neck and upper trunk [1]. Our patient developed odonto- genic keratocysts of the jaw from the age of 7 years. These lesions are commonly seen in Gorlin syndrome, develop- ing usually after age 7 years and on average by 15 to 17 years, with 80% of patients typically being affected [1,3,6]. Most patients require more than three operations for removal of the keratocysts [3]. Calcification of the falx cerebri is reported to occur in 65% to 92% of individuals [3,5]. The ovarian fibroma in our case contained calcifications, which is a feature typically found in ovarian fibromas of Gorlin syndrome, but rarely in nonsyndromic cases [1]. Ovarian fibromas are reported in up to 75% of patients with Gorlin syndrome. Syndromic fibromas are also described as usually being multinodular and multifocal [10]. Our patient showed a lobular configuration that was unifocal. Ovarian fibromas associated with Gorlin syn- drome are bilateral in 75% of cases [1], whereas in non- syndromic cases they are bilateral in 8% of cases [10]. Large bilateral fibromas may overlap centrally and be con- fused with a calcified uterine fibroid [1]. In our case, the unilateral fibroma extended beyond our patient’s midline on imaging, which made it difficult to determine whether the lesion was unilateral or bilateral. The lesions are slow- growing tumors and generally are asymptomatic unless they are large enough to cause mass effects within the ab- domen and pelvis, or if they undergo torsion [11]. On microscopy, the tumors are composed of tightly packed spindle cells with round to oval nuclei and have