Dermoid Research Articles

A Case of Dumbbell-shaped Dermoid Cyst Arising Inside and Outside the Orbit

A Case of Dumbbell-shaped Dermoid Cyst Arising Inside and Outside the Orbit

COMPLICAÇÃO DO SEIO DÉRMICO ESPINHALEM CRIANÇAS: SÉRIES DE CASOS E REVISÃO DE LITERATURA

ABSTRACT Introduction: Dermal sinus (DS) is a rare dysraphism. It can be asymptomatic, become infected, and produce severe neurological symptoms. Our objective is to present a series of pediatric cases with spinal DS complicated byinfections (DSCI), describe the findings correlated with the anatomy in a stillbirth, as well as the associated pathologies and their treatment. Method: We analyzeddifferent variables in the clinical histories of 5 children with spinal DSCI. In addition, an anatomical dissection of a stillbirth with lumbar DS was performed. Results: Two males and 3 femaleswith DSCI and a mean age of 2 years and 9 months were included: 2 lumbar (one in the midline and the other in theparamedian region), 1 in the thoracic region, 1 in the upper cervical region,and 1 in the lumbosacral region. The forms of presentation were 3 meningeal profiles (one with pain andlocalized swelling) and 3 neurological deficits (one associated with the meningeal profile and another associated with pain and a tumor). In all cases, the tract of the DS was identified by magnetic resonance imaging (MRI).Associated lesions included 1 dorsal intramedullary dermoid cyst, 1 tethered lumbar spinal cord with syringomyelia, 1 partial cervical medullary disconnection, and 2 spinal dysraphisms. Four were operated on and one died of infectious complications before surgery. In the 12-week-old male fetus with lumbar DS, a permeable tract to the subarachnoid space was verified. Conclusions: DSCIsshould bestudied with MRI to identify their tracts, infectious complications of thecentral nervous system, associated malformations, inclusion tumors, and to enabledifferential diagnosis. Once diagnosed, they should be urgently treated both surgically and with prolonged antibiotictherapy. Level of Evidence IV; Therapeutic Study (Treatment Outcome Investigation)

口腔底に発生した小児舌下型類皮囊胞例

口腔底に発生した小児舌下型類皮囊胞例

A Case of Dermoid Cyst in the Ischiorectal Fossa Resected by the Transperineal Approach

A Case of Dermoid Cyst in the Ischiorectal Fossa Resected by the Transperineal Approach

A Rare Case of Temporal Scalp Dermoid Cyst with No Intracranial Extension

We report a case of 37-year-old female patient presented with a history of a scalp swelling since birth. The swelling increased in size progressively. Magnetic resonance imaging of the brain revealed extracranial cystic lesion over the temporal bone with no intracranial extension. Cyst was excised completely with no postoperative complications. On histopathology it was dermoid cyst.

Pediatric posterior fossa dermoid cyst: Diagnostic dilemma

Abstract Dermoid cysts are rare congenital lesions of the brain. They are commonly located in the supratentorial region. Infratentorial dermoid cysts are uncommon. They can occupy cerebellopontine angle, midline posterior fossa, or brain stem. Midline post fossa dermoid cysts can be confused with another common lesion in this location. We describe a case of midline posterior fossa dermoid cyst in a 6-year-female child who presented with signs and symptoms of raised intracranial pressure. Magnetic resonance imaging showed posterior fossa lesion which was hypointense on T1-weighted images, hyperintense on T2-weighted images, and not enhancing on intravenous contrast administration. The lesion showed restricted diffusion on diffusion-weighted images. Radiological diagnosis was an epidermoid cyst. However, during surgery, we found hair follicles. Histopathological examination revealed dermoid cyst. The child recovered completely following cyst excision. We present a case of a posterior fossa dermoid cyst mimicking epidermoid cyst.

Maximizing surgical resection in revision surgery for an intramedullary spinal cord tumour using DTI/tractography and direct spinal cord stimulation: A technical note

BackgroundIntramedullary spinal cord tumours are formidable lesions in spine surgery due to the high risk of postoperative deficits associated with surgical resection. Traditional MRI imaging fails to provide a 3-D rendering of the relationship between the tumour and spinal cord sensory and motor pathways; in contrast, DTI/tractography can show this relationship with the potential to reduce surgery-related morbidity. The use of intraoperative somatosensory evoked potentials (SSEP) and transcranial motor evoked potentials (MEP) have also been considered a standard of care to minimize neurologic complications of surgery. However, in situations where both baseline SSEPs and MEPs are unobtainable, D-wave and direct cord stimulation can become invaluable intra-operative tools. MethodsA 6 year old child presented with new growth from an incompletely resected thoracic intramedullary dermoid tumour. Pre-operative DTI/tractography images were obtained. During tumour resection, SSEP and MEP signals were unable to be obtained, however intraoperative monitoring of the spinal cord was undertaken with D-wave monitoring and direct cord stimulation. ResultsThis multimodal monitoring technique allowed identification of the corticospinal tracts intra-operatively and allowed safe tumour resection. Post-operative MRI revealed gross total resection and the patient returned to her pre-operative neurological baseline without incurring any further deficits. ConclusionsWe have presented a technical description of the clinical utility of DTI/tractography in surgical planning, and D-wave monitoring with direct cord stimulation as adjuncts in the resection of an intramedullary cord tumour. This is particularly useful in the scenario where TcMEP/SSEP signals cannot be obtained and in revision surgery for intramedullary spinal cord tumours.

Ultrasound Findings and O-RADS Malignancy Risk Stratification of Ovarian Collision Tumors.

To describe the ultrasonographic signs of ovarian collision tumors and evaluate the malignancy risk using the O-RADS system. This was a retrospective analysis of 25 ovarian collision tumors from 8739 patients between May 2010 and January 2020. All clinical characteristics, ultrasound images, and histological findings were collected and analyzed. Using the O-RADS lexicon descriptors, the O-RADS score was determined by two senior doctors. Lesions with O-RADS scores of 1 to 3 were classified as benign tumors, and lesions with O-RADS scores of 4 to 5 were classified as malignant tumors. The mean age of the 25 patients was 30.4 years. Histological findings showed that all tumors were a combination of mature cystic teratomas and cystadenomas/cystadenocarcinomas. There were 11 benign tumors of O-RADS 2 or 3, including 3 uniocular cysts, 3 dermoid cysts, and 5 dermoid cysts with an anechoic fluid cavity. There were 12 benign tumors of O-RADS 4, including 3 uniocular-multilocular cysts with solid components, 2 multilocular cysts with irregular walls, and 8 multilocular cysts with dermoid sacs. One borderline tumor of O-RADS 4 was a multilocular cyst with irregular septation. One malignant tumor of O-RADS 5 was a multilocular cystic tumor with solid components and ascites. The most common ovarian collision tumor was the coexistence of a mature cystic teratoma and a cystadenoma. The O-RADS system was able to sensitively detect malignant tumors in this series. A typical dermoid cyst with an anechoic cavity or a multilocular cyst with a dermoid sac may signify a benign collision tumor.

Congenital Dermoid Cyst in an Atretic Ear.

Jonas, Rachel H.∗; Casazza, Geoffrey C.∗; Dibbern, Megan†; Kesser, Bradley W.∗ Author Information

Surgical treatment strategy in patients suffering from post-traumatic coccygodynia

Clinical effectiveness of coccus removal in post-traumatic coccigodinia is evaluated. The study included 34 patients with diagnosed post-traumatic coccigodinia who underwent surgical treatment in resection or coccyx removal volume. A long history of trauma-related pain syndrome and ineffective conservative treatment were noted in all patients. The exclusion criteria were: inflammatory or oncological process, chronic urogenital diseases, previously undergoing operations on the lumbosacral spine, complicated by the course of the hernia of the intervertebral disc with root syndrome and neurological disorders. Before the operation, patients underwent manual examination, radiography (in direct and lateral projections) and computed tomography of the sacrum and coccyx, examination of the gynecologist (for women) and urologist (for men), examination of the proctologist, according to the indications magnetic resonance imaging of the spine in order to exclude hernia of the intervertebral disc with neural compression and dermoid cysts of the copcystic. Evaluation of treatment results was performed using a visual analogue pain scale and a verbal 5-point operation satisfaction scale. The observation period was from 1 year to 4 years. Cupping of pain syndrome after surgery was noted in 28 (82.4%) cases, in 6 (17.6%) patients there was a decrease in the intensity of pain syndrome with discomfort only after a prolonged sitting position. 5 (14.7%) patients were "satisfied" with surgery, 28 (82.4%) patients were "completely satisfied", in one (2.9%) case there was "doubtful satisfaction" with surgery. Thus, surgical treatment of coccigodinia in the volume of partial or complete coccyx removal is indicated in cases of ineffectiveness of conservative treatment in its post-traumatic instability. Surgical intervention leads to the cessation of pain syndrome and allows patients to return to their previous physical activity.

Laparoscopic Management of Dermoid Cyst of Ovary is a Safe Procedure.

Dermoid cyst, a common benign neoplasm of ovary in women, needs treatment because of the risk of torsion, rupture, and malignant change. Laparoscopic surgery nowadays is the preferred treatment modality, but the only issue is its safety in case of rupture and spillage of its contents with the risk of chemical peritonitis and malignant dissemination. Aim of the study was to find out the safety of laparoscopic surgery for dermoid cyst of ovary. It was a retrospective study done from January 2017 to December 2019. All the women with diagnosis of dermoid cyst of ovary managed laparoscopically either salpingoophorectomy or cystectomy were taken into study. Analysis of size of the cyst operated, the time taken, spillage rate, duration of hospital stay, and post-operative complications especially chemical peritonitis was done. There were 61 women who had undergone laparoscopic surgery. Laparoscopic cystectomy was done in 68.9% (n=42), laparoscopic salpingoophorectomy in 29.5% (n=18). Mean age of the patient was 31.74±8.38 years. Mean size was 6.21±1.99 cm. Rupture and spillage were observed in 21.3% (n=13) that were > 5cm in diameter (X2= 3.62, p=0.05). Larger the size of the cyst, more the surgical time was noted (X2=6.26, p=0.04). Significant difference in mean operating time in case of cyst rupture and spillage (p=0.004) was observed. Mean hospital stay was 53.5±1.3 hours. No case of chemical peritonitis was observed with spillage. All cases had histopathology of mature cystic teratoma. Laparoscopic surgery is safe for dermoid cyst of ovary even with rupture and spillage of its contents.

Internal Angular Dermoid Indenting on the Globe

Angular dermoid cysts are common periorbital tumours in children. They are tumours of embryonic origin that arise along bony sutures as a result of abnormal ectodermal sequestration during development. Angular dermoid cysts usually present in early childhood, are characteristically small benign and slow growing lesion. External angular dermoid present in the superotemporal quadrant is more common compared to internal angular dermoid in the superonasal quadrant. Early surgical excision is recommended and performed in the majority of cases, particularly to restore facial cosmesis.
 Here we report an unusual case of a large internal angular dermoid cyst indenting the globe in a 3-year-old girl presented with left upper eyelid mass at medial angle since one year of age. The cyst was excised completely by anterior orbitotomy through a small superior lid crease incision.

The overlooked value of ultrasound in the perioperative care of ovarian immature teratoma

Ovarian immature teratoma is a rare malignant tumor that appears in young women [1,2]. Diagnosis can be challenging due to the lack of characteristic features in ultrasound or CT/ MRI images, and is usually achieved through the anatomopathological analysis [1]. Treatment normally involves oophorectomy, which may affect fertility in these patients [3]. The clinical image we are presenting belongs to a 28-yearold female patient suffering from abdominal pain. MRI findings suggested a benign dermoid cyst (Figure 1), which was discordant with the ultrasound findings that suspected an immature teratoma.

Conventional and advanced MR imaging findings in a cohort of pathology-proven dermoid cysts of the pediatric scalp and skull.

In the pediatric population, dermoid cysts are among the most frequent lesions of the scalp and skull. Imaging plays a key role in characterizing scalp and skull lesions in order to narrow the differential diagnoses. In general, dermoids are described as heterogeneous T1-/T2-hypo- to hyperintense lesions on magnetic resonance imaging. The goal of this retrospective study is to evaluate the diffusion weighted imaging findings while reviewing the conventional T1-/T2-/T1+C-weighted MR characteristics in a pathology-proven series of 14 dermoids of the pediatric scalp and skull. In our pediatric cohort (eight boys, six girls, age range 3-95 months), half of the dermoids were homogeneous T1-hypointense and homogeneous T2-hyperintense. We found a mixture of restricted (45.5%) and increased diffusion (54.5%) in dermoids. The vast majority of dermoids (91.7%) showed rim enhancement. Most dermoids (57.1%) were located at the midline and adjacent to one of its sutures. This study suggests that dermoids may have more variable imaging appearances than hitherto assumed and are frequently seen in close proximity or adjacent to the anterior fontanelle.

Splenectomy for Aseptic Splenic Abscess

Highlight :A 26-year-old woman have sterile aerobic and anaerobic bacterial cultures.Pus and splenic tissue examination revealed no bacterial proliferation, while the surgery revealed a splenic abscess.Abstract:We presented a rare case, a 26-year-old woman have sterile aerobic and anaerobic bacterial cultures. Clinical examination of the patient showed a dense cystic mass in the left upper abdomen. Ultrasonography examination suspected a dermoid cyst. However, MRI examination of the abdomen showed turbid cystic lesions. The surgery revealed a splenic abscess, while pus and splenic tissue examination revealed no bacterial proliferation. Based on the literature, the patient had a good prognosis.

Ultrasonographic signs of acute ovarian torsion.

Ovarian torsion is defined as partial or complete rotation of the ovarian vascular pedicle and causes obstruction to venous outflow and arterial inflow. Teenage patient was referred to the gynecology ward with pain located in the lower, right abdomen, after an initial misdiagnosis of a dermoid cyst. The patient was diagnosed with a torsion of the right ovarian peduncle. The patient was given diastolic drugs and was discharged in good general condition two days later after the symptoms had resolved. Final USG showed normally vasculated corpus luteum. Among the various treatment options, the wait-and-watch attitude turned out to be the best solution. It is particularly important in the case of young patients, who are planning pregnancy in the future.

Atypical Presentation of a Midline Nasal Dermoid with Intracranial Extension.

Although rarer than their lateral orbital counterparts, dermoid cysts are part of any differential diagnosis of a midline nasal mass in the pediatric population. Here we present a case of a nasal dermoid with intracranial extension that presented as a mass appearing at the nasal-cheek junction. This atypical presentation for a nasal dermoid highlights the need for clinicians to remain vigilant and consider midline dermoid cyst as a diagnosis despite an off-midline position on the face.

Laparoscopic view of endosalpingiosis in a woman with dermoid cyst and endometriosis

Endosalpingiosis is, like endometriosis, the presence of cystic masses outside of the salpinx which contains fallopian tube epithelium. Endosalpingiosis can be seen on the surface of ovaries, tubal serosa, uterine serosa, myometrium, and also in the bladder. The main clinical features of endosalpingiosis are pelvic pain, adnexal mass which mimics cancer, and urinary symptoms. Herein, we present a surgical video of endosalpingiosis in a woman with endometriosis and a dermoid cyst.

P145 DERMOID CYST MASQUERADING AS INCARCERATED INGUINAL HERNIA

Abstract Aim “For pre operative optimization and educational purposes, rare possibilities should be included in the differential diagnosis”” Material and Methods “CASE REPORT. Inguinal hernia is one of the common operations done by surgeons, often diagnosed clinically. Here we present a case of 29 year old male patient presented with inguinal swelling for 3 years. He was admitted for the surgical ward as a case of incarcerated inguinal hernia for elective repair under GA. Intra op the mass was not consistent with inguinal hernia, two other possibilities were a concern that can cause the swelling; 1) testes, which was excluded by examining the scrotum, 2) Dermoid/Epidermoid cyst which was checked by the mass content of hair and pasty fluid” Results “DERMOID CYST” Conclusions “Most surgeons depend on clinical picture in diagnosing inguinal hernia, thus even other rare possibilities should be included in the differential diagnosis. Unusual presentations of inguinal hernia should be having radiological evaluated.”

Drain or no drain in Rhomboid excision and Limberg rotational flap for pilonidal sinus

Background: Healing in Rhomboid flap for pilonidal sinus is always a problem. Different measures are applied to reduce the rate of wound infection with variable results. Objectives: To determine the effect of routine use of drain on the rate of early wound complications and additional interventions after Rhomboid flap. Methods: A retrospective chart review of all cases that underwent Rhomboid flap in five years in two tertiary care centres was done. Complication rates such as wound infection, wound disruption, and flap necrosis were evaluated. Results: A total of 38 cases of Rhomboid flap are included for analysis. Out of all cases 37 cases were done for Pilonidal sinus and one case for presacral dermoid cyst. In the first eight cases, flap was made without drain and subsequent 30 cases were done with two suction drains for five days. The rate of superficial wound infection in the group without drain was found to be significantly higher compared with flap with drain 5 (in 8) versus 2 (in 30) (62.5% versus 6.66%, p <0.5). Conclusion: Drain placement after Rhomboid flap is a good intervention to reduce wound infection.