Dermoid Research Articles

The Case Files

A ruptured dermoid can have many presentations, making it hard to diagnoseFigureFigureA 45-year-old man presented after a sudden transient loss of consciousness followed by excessive crying. He was conscious and oriented upon arrival. He had no fever, and his blood pressure was 130/80 mm Hg, heart rate was 90 bpm, respiratory rate was 20 bpm, oxygen saturation level was 100 percent, and blood sugar level was 103 mg/dL. No neurological deficit was found on examination. The patient had a sinus tract on his lower back at L2-L3. The rest of the exam was normal. The patient had no significant medical history and was not taking any medication. Neuroimaging, CT, and a brain MRI revealed disseminated lipid tissue in the frontal horn of the lateral, third, and fourth ventricles. Similar extra-axial fat intensities were also found in the frontal region and left sylvian, interpeduncular, and right CP angle cisterns. Two differential diagnoses were considered: ruptured dermoid tumor and traumatic pelvic or spinal fracture. Spinal MRI suggested an intramedullary mass lesion with lobulated margin (1.6 cm by 1.1 cm by 6.8 cm) in the conus medullaris and cauda equina, extending from the L1 to L3 vertebrae. The lesion appeared hyperintense on T2W and T1W images, which were suppressed on saturated T1 images. Evidence of intramedullary T1 and T2 hyperintense multiple foci adherent to the dorso-lumbar spinal cord suggested a ruptured dermoid. A dorsal dermal sinus tract at L2 to L3 vertebrae was noted. Rupture of a spinal dermoid cyst into the central spinal canal is rare. An intradural dermoid cyst may rupture with subsequent subarachnoid dissemination of lipid droplets. Dermoid cysts are benign tumor-like lesions comprising approximately one percent of intracranial and spinal tumors and occur slightly more often in men. Their high incidence occurs in the lumbosacral region involving the conus and cauda equina. Upper thoracic (10%) and cervical (5%) lesions are rare. Dermoids are associated with a dermal sinus in 20 percent of cases. The rupture of a dermoid cyst is a well-known phenomenon and can be spontaneous, iatrogenic, or traumatic in origin. A ruptured dermoid may have myriad presentations. Chemical and aseptic meningitis are the most common features after a rupture because of the irritating effects of the disseminated cholesterol debris. The patient may be asymptomatic or experience headache, vomiting, seizures, coma, infarct, and rarely death. A headache might occur because of the compression of adjacent structures, chemical meningitis, or hydrocephalus due to obstruction of cerebrospinal fluid pathways by lipid droplet. The mean age at presentation of such lesions is 40.6, and all cases have been reported in men. Treatment includes steroids, analgesics, antibiotics, and surgical resection of the spinal lesion.

Comparative analysis between dermoid and epidermoid cyst

Comparative analysis between dermoid and epidermoid cyst

An unusual sellar dermoid cyst

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Transconjunctival excision of external angular dermoid cyst: A novel approach

To excise external angular dermoid cyst (EADC) by transconjunctival approach and compare the surgical outcomes with the standard transcutaneous approach. This was a prospective, pilot, interventional, comparative study. Patients with EADC with no or minimal fixity to the underlying bone on palpation and limited to eyelid were recruited. Patients were randomized into 2 groups; group 1 included patients with transcutaneous approach, and group 2 included patients with transconjunctival approach. The parameters assessed were intraoperative complications, duration and ease of surgery, postoperative complications, and overall satisfaction. Six children with a painless, round lesion in outer aspect of eyelid were recruited in each group. None of the patients had any intraoperative or postoperative complications, including dysfunction of eyelid contour and fold, persistence or late occurrence of lateral eyelid droop, excessive or recurrence of swelling, and ocular surface problems, especially in group 2, but a skin scar though hidden was inevitable in group 1. The duration of surgery was comparable with better ease of surgery in group 1 and a gradual learning curve in group 2. The overall satisfaction scores were significantly better in group 2 (p<0.0001). In group 1, parents of 5 of 6 patients had to be reassured that the skin scar will fade with time. Transconjunctival excision of EADC is a viable and novel approach in patients with mobile cyst that is limited to the eyelid with no obvious bony fossa. Main limitations of the approach are that it requires surgical expertize, provides less surgical space, and has a gradual learning curve.

Histopathologic profile of cutaneous cystic lesions in teaching hospital, Nnewi, South-east, Nigeria

Background A cyst is an enclosed space or abnormal sac within a tissue, usually containing fluid or semisolid matter and lined by epithelium. Aims and objectives To study all the cutaneous cystic lesions with respect to age, sex, anatomic site, and histologic types in a population of Nnewi, South-East Nigerian. It also aimed at highlighting the importance of histology in evaluating and preventing misdiagnoses encountered in cutaneous cystic lesions. Patients and methods A retrospective review was performed on the histopathology register on all histologically diagnosed cutaneous cysts at the Histopathology Department of Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Nigeria from 2011 to 2019. Results A total of 94 cutaneous cystic lesions, accounting for 1.3% (94/7204) of all surgical biopsy specimens, were included in this study. An overall clinicopathological correlation showed 26.6% (25/94) accuracy, but 73.4% were incorrectly diagnosed, with 7.4% (5/69) of cases misdiagnosed clinically as malignant lesions and one case of malignant cystic lesion diagnosed clinically as benign cyst. There were 49 males and 45 females, giving a slight male predominance, with male to female ratio of 1.1 : 1. The age ranged from 6 weeks to 79 years, with a mean±SD age of 26.5±21.1 years, and a peak age group of 0–10 years, representing 29.8% (28/94). Benign cutaneous cystic lesions were far commoner than malignant ones and included majorly epidermal inclusion cyst [37.2% (35/94)], pilar cyst [17.0% (16/94)], thyroglossal cyst [12.8% (12/94)], and dermoid cyst [8.5% (8/94)]. The only malignant cutaneous cyst was immature cystic teratoma [1.06% (1/94)]. The anatomic site most frequently affected was the head and neck [63.8% (60/94)]. Conclusion Histopathologic evaluation is still the gold standard in eliminating misdiagnosis of these lesions. Epidermal inclusion cysts followed by pilar cysts were commonest cutaneous cystic lesions in our environment and occur more at the third decade and above, whereas cystic hygroma, dermoid cysts, and brachial cyst were predominant at the first decade of life.

Mature Cystic Teratoma at Fallopian Tubes: A Case Series.

case reports; dermoid cyst; fallopian tube; infertility.

Abstract #1412915: Malignant Struma Ovarii - A Rare Disease with Unpredictable Nature and Treatment Option Controversies

Struma ovarii is a rare kind of ovarian teratoma which consists of >50% of thyroid tissue. It contributes to 2-5% of all ovarian teratomas. 5-10% of ovarian teratomas undergo malignant transformation. To date, due to its rarity, unpredictable nature and high recurrence rate no consensus have been reached regarding the optimal treatment strategy. Therefore, it is prudent to highlight this rare disease and its management as sharing experiences will further expand the accruing data and helps in reaching consensus regarding its optimal treatment strategy. 42-year-old lady presented in clinic with missed periods. She had no weight loss and hyper or hypo thyroidism related symptoms. Her ultrasound pelvis revealed left ovarian cyst and MRI showed left ovarian dermoid cyst. She underwent left oophorectomy whose biopsy showed malignant struma ovarii having papillary thyroid carcinoma, FIGO stage 1a and BRAF V600 mutation was present. Her thyroid function test, thyroid scan, CT chest and abdomen were normal. She underwent staging laprotomy, right salphingo-oophorectomy, left salphingectomy and total hystrectomy whose biospy was normal. Subsequently total thyroidectomy was done which showed <1cm low grade papillary thyroid carcinoma involving left lobe of thyroid gland, stage pT1a, Nx, Mx. Her stimulated thyroglobulin and antithyroglobulin antibody were normal. Her 6 weeks postop ultrasound neck was normal. She was kept on replacement thyroxine doses. Malignant struma ovarii presents with abdominal pain, menstrual irregularity, bloating, abdominal mass and ascites. At times it may be asymptomatic. Thyroid symptoms are not frequent. Studies demonstrated good survival with malignant struma ovarii. However, its clinical course remains unpredictable with relatively high frequency of recurrences and metastasis irrespective of its morphology which poses difficulty in optimal treatment selection. Mostly aggressive approach including total hystrectomy, bilateral salphingo-oophorectomy, total thyroidectomy followed by radioactive iodine therapy and thyroxine in TSH suppressive doses have been adapted. Though some prefer less aggressive approach. Due to its uncertain nature and scanty data on its management, its optimal treatment is still a matter of debate. Tumor size, molecular profiling and histopathology have been proposed to consider while stratifying risk and selecting treatment approach. Moreover, vigilant followups should be done to detect early recurrence or metastasis so that timely intervention could be done.

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Revıew

Ovarian lesions in during childhood and adolescence are rare and most of these are benign. Mature teratomas are frequently seen in these cases. The most common of these masses in children are the mature cystic teratoma which are also known as dermoid cysts. The management of children with ovarian dermoids has evolved over recent years in a manner of ovary preservation. In this review article two cases of ovarian dermoids are presented. The tumoral mass was totally excised in both of these cases preserving the effected ovary in an ovary sparing manner. The medical history of the patients, radiological and histopathological findings are also given together with a brief literature review on this issue.

Mature ovarian teratoma in a newborn: A case report

Mature cystic ovarian teratomas, also called dermoid cysts, are one of the most frequent ovarian tumors and are suggested when a fat-containing cystic tumor is identified on imaging. Knowledge of the imaging features of these tumors allows for a confident diagnosis to be made in most cases. Treatment is usually based on surgical resection, which is preferably carried out by laparoscopic way.

Multiple and Bilateral Mature Cystic Teratoma: A Rare Case Report

Mature teratomas, also known as dermoid cysts, are the most commonly occurring benign ovarian tumors in young and middle-aged women. Bilateral occurrence of mature teratomas is observed in 10% of cases. The incidence rate of mature teratomas is equal in both the right and left ovaries, and malignant transformation is observed in 1-3% of cases. At sonographic examination, mature cystic teratomas appear as cystic, solid, or heterogeneous masses containing areas of fat and calcification. Macroscopically, areas of fat are observed in 90% of cases, while areas of calcification are observed in 50% of them. In our presented case, a 28-year-old virgin female patient complained of pain in both adnexal regions, and tumor markers were found to be normal. During imaging, a complex mass measuring 65x47 mm was observed in the adjacent right ovarian parenchyma, and a complex mass measuring 44x41 mm was observed in the adjacent left ovarian parenchyma. However, during surgery, it was discovered that there were two additional teratomas adjacent to the cyst. Given that the presence of both bilateral and multiple mature teratomas is rare, decided to present this case.

A Case Report on the Elusivity of Imaging in Detecting a Ruptured Dermoid Cyst (P8-4.005)

<h3>Objective:</h3> We present a case report on the rare clinical entity of the ruptured intracranial dermoid cyst and the importance of imaging in confirming the diagnosis. <h3>Background:</h3> Intracranial epidermoid and dermoid cysts represent about 1% of intracranial tumors. They can contain lipid, cholesterol crystals, and other ectodermal derivatives. These cysts are considered to be benign tumors, however if they rupture they can cause a significant inflammatory reaction resulting in chemical meningitis with expected symptoms of headache, nuchal rigidity, seizure, hydrocephalus, or even death. We present a case of a ruptured dermoid cyst after a mechanical fall with head trauma in an elderly male with Parkinson’s disease. CT scan was non specific and showed scattered hypoattenuation within the left lateral ventricle with Hounsfield units possibly representing lipid content. MRI was obtained to better characterize interventricular material seen on CT and showed T1 hyperintensity compatible with fat signal within the ventricles and cerebrospinal fluid. This imaging allowed for definitive diagnosis of ruptured dermoid cyst. With this information, the clinical team monitored the patient closely for signs of chemical meningitis in the case that further intervention were needed. Fortunately, the patient did well and was discharged after three days of observation. <h3>Design/Methods:</h3> Not applicable <h3>Results:</h3> Not applicable <h3>Conclusions:</h3> MRI proves to be essential in confirming a diagnosis of ruptured dermoid cyst which can present nonspecifically on CT scan. Once the diagnosis is confirmed, patients must be monitored for chemical meningitis and subsequent sequelae. <b>Disclosure:</b> Dr. Singh has nothing to disclose. Dr. Albadareen has nothing to disclose.

Ruptured intraventricular dermoid cyst in a 33-yearold patient, diagnosis and surgical management. case report and literature review

Ruptured intraventricular dermoid cyst in a 33-yearold patient, diagnosis and surgical management. case report and literature review

A case of adult granulosa cell tumor presenting as thoracic lesions

BackgroundGranulosa cell tumors (GCTs) are uncommon sex cord-stromal ovarian neoplasms. We report a case of GCT presenting in the chest, 18 years after oophorectomy for ovarian cystadenocarcinoma.Case presentationA 63-year-old female was admitted to our hospital for evaluation of a right hilar lesion. Subsequent abdominal and pelvic computed tomography and brain magnetic resonance imaging were unremarkable. Eighteen years earlier, the patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy at another institution for a uterine myoma, with the pathological findings indicating a uterine myoma, dermoid cyst of the right ovary, and serous cystadenocarcinoma and endometrioid adenoacanthofibroma around hemorrhagic cyst of the left ovary. No indication of a granulosa cell tumor (GCT) was present in either ovary. As such, diagnostic video-assisted thoracoscopic surgery was performed, revealing a well encapsulated tumor located next to the inferior pulmonary vein and small, disseminated lesions on the chest wall and diaphragm. Thereafter, we performed resection of the main tumor in its entirety and the disseminated lesions to the extent possible. Pathological examination of the resected specimens revealed a neoplasm characterized by sheets and islands of closely packed tumor cells exhibiting small follicles (Call-Exner bodies) surrounded by cells with pale, uniform nuclei, typically observed in the microfollicular pattern of adult GCT. Although the etiology of occurrence of intrathoracic granulosa cell tumor is unknown, we assumed that the neoplasm oriented from radiologically undetectable peritoneal seeding at the time of her previous surgery, with subsequent migration through the diaphragm. Over the next 10 years, she received chemotherapy with cyclophosphamide, adriamycin, and cisplatin; other combination chemotherapy; single-agent chemotherapy; and palliative radiotherapy. She died from malignant pleuritis and peritonitis 10 years after thoracoscopic surgery.ConclusionsWe have reported a case of a 63-year-old female with a history of ovarian cystadenocarcinoma who underwent resection of a pleural neoplasm, which turned out to be a granulosa cell tumor. This possibility resulted from dissemination of a previous abdominal lesion.

A Survey on Orbital Space-Occupying Lesions during a Twelve-Year Period from a Referral Center in Iran.

In this study, we describe different orbital space-occupying lesions (SOLs) from a referral center in Iran. In this retrospective case series, all records of "orbital tumors" with a definite histopathologic diagnosis at a referral center in Iran were reviewed from April 2008 to May 2020. A total of 375 orbital SOLs were included. The study population consisted of 212 (56.5%) female and 163 (43.5%) male subjects with overall mean age of 31.09 21.80 years. The most common clinical presentation was proptosis and the superotemporal quadrant was the most frequent site of involvement. Extraconal lesions (276 cases, 73.6%) outnumbered intraconal lesions (99 cases 26.4%). The great majority of SOLs (344, 91.7%) were primary, while 24 (6.4%) were secondary and 7 (1.9%) were metastatic. Benign lesions (309, 82.4%) were much more common than malignant SOLs (66, 17.6%). Overall, dermoid cysts and malignant lymphoma were the most prevalent benign and malignant orbital SOLs, respectively. The malignant to benign lesion ratio was 0.46 in children (18 years), 0.81 in middle-aged subjects (19-59 years), and 5.9 in older (60 years) cases. The most common type of malignancy was rhabdomyosarcoma in children, lymphoma in middle-aged subjects, and invasive basal cell carcinoma in older age group. Over the 12-year study period, benign, primary, extraconal orbital SOLs were more frequent than malignant, secondary, and intraconal lesions. The ratio of malignant lesions increased with age in this cohort of patients.

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Review

Ovary-Sparing Surgery for Ovarian Dermoid Cysts in Children: A Report of Two Cases and Literature Review

COMPLICATED INGUINAL HERNIA OR INGUINAL DERMOID: A DIAGNOSTIC DILEMMA

Simple or complicated inguinal hernias are the common inguinal lumps of any surgical emergency or outpatient settings. However, inguinal hematoma, abscess, enlarged inguinal lymph node, undescended testis, lipoma, or encysted hydrocele of the spermatic cord are few relatively less common entities seen in inguinal region whereas inguinal supernumerary pectineus bursa, preperitoneal lipoma, pedunculated uterine fibromyoma, angioma of uterine ligament, inguinal endometriosis, aneurysm of femoral artery, saphena varix, and thrombophlebitis are extremely uncommon entities of the groin region. We present an interesting case in which patient presented with painful firm lump in inguinal region and the history and clinical examination was consistent with the diagnosis of an incarcerated inguinal hernia but intraoperative findings amazed us and subsequently histopathological analysis labeled it a dermoid cyst.

Frontotemporal giant extradural dermoid cyst: illustrative case.

Dermoid cyst is a rare benign tumor exhibiting a typical radiological pattern and most commonly located along the midline. Laboratory examination was always normal. However, the features of some rare cases are atypical that can be easily misdiagnosed as other tumors. A 58-year-old patient presented with tinnitus, dizziness, blurred vision, and gait unsteadiness. Laboratory examination showed the serum levels of carbohydrate antigen 19-9 (CA19-9) were significantly increased (186 U/mL). A computed tomography (CT) scan revealed a predominant hypodense lesion in the left frontotemporal region with a hyperdense mural nodule. The lesion appeared as an intracranial extradural mass with a mural nodule on the sagittal image, displaying mixed signal on T1- and T2-weighted imaging. A left frontotemporal craniotomy was performed for cyst resection. Histological results confirmed a diagnosis of dermoid cyst. No tumor recurrences were observed at the 9-month follow-up. Extradural dermoid cyst with a mural nodule is extremely rare. When a hypodense lesion on CT shows mixed signal on T1- and T2-weighted imaging with a mural nodule, even if it is located in the extradural areas, it is important to consider a dermoid cyst. Serum CA19-9 combined with atypical imaging features may contribute to the diagnosis of dermoid cysts. Only recognition of atypical radiological features can avoid misdiagnosis.

Clinical, pathological, and surgical aspects of ovarian torsion

Abstract Background: Ovarian torsion accounts for 1%–6% of surgical treatment for adnexal masses. Its incidence rises during pregnancy but is rare, and there are varied predisposing factors. However, the etiology remains unknown. Materials and Methods: The cases of ovarian torsion over 2 years (2020–2022) at MGM Women’s Hospital, Kalamboli, Navi Mumbai, India, have been reported duly reviewed retrospectively. Results: Twelve of eighteen adnexal torsions occurred in the right adnexa (67%). Of the four pregnant patients, three had a right-sided adnexal torsion (75%). Right anticlockwise adnexal torsion was the most common entity noted. The most common types of ovarian cysts are dermoid cysts and serous cystadenomas, corresponding to this study, with 77.8% of the cases having either histopathological findings. Conclusion: Ovarian torsion is an urgent gynecological condition that needs prompt intervention. Modalities such as laparotomy, laparoscopy, or conservative management with detorsion can be the treatment of choice. Maximum adnexal torsion occurs on the right side. A large amount of right-sided adnexal torsion has rotation anticlockwise manner, whereas most left-sided adnexal torsion spin clockwise.

A Rare Case of Midline Suprahyoid Dermoid Cyst

Dermoid cysts are congenital tumours which are usually not paid any attention at the time of presentation and later on, they catch the patient’s attention. 40% of dermoid cysts get diagnosed by birth and 60% by five years of age. These are benign in nature. Only 5% have shown malignant transformation which is very rare. These are said to be ectodermal in origin embryologically. These are usually seen in the midline, as these are the site of embryonic fusion. These benign lesions are present as single or multiple throughout the body. For a surgeon, neck swelling is always a diagnostic challenge as it lies in close proximity to very important vital structures. In our case, a 33-year-old female presented to our Chettinad OPD with a painless swelling which turned to painful in due course of time and was located in the suprahyoid region in front of the neck. Our case is unique as the location of this mass was in the suprahyoid region which is usually a very rare location for dermoid cysts. Hence, during differential diagnosis, all surgeons should keep in mind that dermoid cysts have different presentations and locations, one of which happens to be a suprahyoid mass.

Bronchogenic cyst: a diagnostic challenge as cervical swelling

Introduction: Bronchogenic cyst is a developmental anomaly of primitive foregut, usually diagnosed at birth or soon after. Commonly seen as intrapulmonary and mediastinal pathology, it is also reported at other sites, including neck, as a subcutaneous swelling. It seldom produces symptom unless it keeps growing due to persistent secretion and produces compressive symptoms. Abscess formation, discharging sinus or malignant transformation may occur rarely. Case report: A 26 years old male presented with a midline suprasternal swelling. Clinical examination revealed a 6x4cm size soft, mobile, nontender, cystic swelling which did not move upward on deglutition or on protrusion of tongue. Radiological evaluation of neck confirmed a cystic lesion in subcutaneous plane. Differential diagnosis of Thyroglossal cyst, dermoid cyst, branchial cyst, bronchogenic cyst, and Trichilemmal cyst were considered. Histological examination following excision confirmed the diagnosis of Bronchogenic cyst. Discussion: Surgery is the treatment of choice in cases of cervical cystic swellings which merit a wide range of differential diagnosis. Diagnosis of Bronchogenic cyst is confirmed by typical respiratory epithelial lining with interspersed goblet cells and smooth muscle fibres in the cyst lining.