Dermoid Research Articles

An infected intracranial dermoid cyst at the region of torcular herophili: A case report

Background: Dermoid cysts result from embryonic fusion anomalies, with intracranial dermoid cysts being rare (0.1–0.7% of intracranial tumors). Often asymptomatic, they can manifest as midline swelling, headaches, seizures, or cerebral ischemia. Recognition and management are crucial for mitigating complications and ensuring favorable patient outcomes. Case Description: A 14-year-old girl presented with swelling at the occiput for 3 months. Initial imaging was suggestive of an extra-dural abscess in the occipital region with surrounding bone erosion. An infectious workup, including tests for tuberculosis, was non-contributory. A suboccipital craniectomy was done. On lifting, the bone flap, thick, purulent, and sebaceous contents with hair were spotted, which was adherent to the inner table of the skull and the dura overlying the torcular herophili, suggesting an infected dermoid cyst. A near-total excision was done, and culture-directed antibiotics were given. Postoperatively, the child made a complete recovery. Conclusion: The diagnosis of a dermoid cyst must be kept in mind, and it should be considered in the differential diagnosis of midline posterior fossa lesions. The risk of postoperative recurrence from incomplete excision should be weighed against the risk of injuring the venous sinuses during the extensive resection of dermoid cysts adherent to the torcular region.

Pediatric Cranial Vault Lesions: A Tailored Approach According to Bony Involvement

Background: Cranial vault lesions are common in children, with dermoid and epidermoid cysts being the most frequent. Management is debated due to their slow growth, but early resection can prevent complications and provide a definitive histological diagnosis, which is sometimes linked to systemic diseases. Methods: A retrospective study of children treated surgically for cranial vault tumors from January 2011 to April 2023 was conducted. The data collected included age, gender, symptoms, comorbidities, lesion location, radiological features, surgical techniques, histopathology, and recurrence rates. Results: Eighty-eight children (mean age: 3.5 years, mean tumor size: 1.21 cm) underwent surgery. The most common locations were the frontal and occipital bones. The main diagnoses were dermoid cysts, myofibroma, and Langerhans cell histiocytosis. Gross total resection was achieved in 64 cases with simple skin incisions. In 13 cases, small cranioplasties with bone cement were used. Craniotomy and cranioplasty with autologous bone grafting were performed for 11 patients with lesions larger than 2 cm and full skull thickness erosion. Conclusions: Early resection is recommended for complete removal with minimally invasive surgery and to ensure histological diagnosis. For lesions larger than 2 cm with full skull erosion, cranioplasty with autologous bone is the preferred technique.

Giant pelvic dermoid cyst in a 17-year-old girl

BACKGROUND: Dermoid cysts in the presacral and retrorectal space in children are relatively rare. However, even more rarely, they have clinical manifestations at patient’s early age and so, can be silent for a long time. CLINICAL CASE DESCRIPTION: The article describes a rare clinical observation — a giant dermoid cyst in the retrorectal space in a 17-year-old girl. The child had a tendency to constipation from her early childhood. Menses started at age 13, painful. During the last year, disorders in her menstrual cycle were noticed. The girl was examined by a gynecologist. Ultrasound examination revealed a cystic formation in the pelvic cavity up to 9 cm in diameter. Non-malignant nature of the process was confirmed by: normal level of cancer markers (α-fetoprotein, β-human chorionic gonadotropin), single node, clearly defined formation capsule, homogeneous nature of its contents, no invasive growth and lesions in the regional lymph nodes. Magnetic resonance imaging with intravenous contrasting defined a true relationship of the cystic formation with other organs and structures of the pelvic cavity. The cystic formation caused deformation of the cervix, vagina, and rectum. The obtained findings allowed to plan surgical intervention correctly. Surgical access-transverse in the coccyx projection up to 10 cm long. The cystic formation was a thin-walled connective tissue capsule with a yellowish content. Due to very large cyst dimensions, first it was opened in a limited area and emptied. Then the capsule was isolated and completely removed. The cyst intimately adhere to rectum, vagina, and cervix walls. Histological conclusion: "Capsule of a dermoid cyst with hemorrhages". The postoperative period was smooth. The patient recovered, all disease manifestations disappeared. She was discharged home in a satisfactory state. Follow-up visits were in 6 and 12 months after surgery. No evidence of possible relapse. CONCLUSION: There are only few descriptions of such cases in the available literature. Ultrasound and MRI examinations allowed to have a full picture of dermoid cyst position and its connection with other pelvic organs due to which surgeons could develop a correct plan for surgical intervention.

A Horseshoe-shaped Dermoid

Dermoid cysts are congenital choristomas. Orbital dermoids are usually encapsulated cystic lesions and are oval, round, or hourglass in shape. Here, we present an unusual case of an external angular dermoid with a unique horseshoe-shaped appearance in a 19-year-old male.

Nasal dermoid sinus cyst with intracranial extension and atretic sinus tract in an adult patient

Nasal dermoid sinus cyst (NDSC) is a rare congenital lesion due to cephalic neural tube defect. It may also have been seen in other parts of the body. NDSC constitutes 1–3% of all dermoid cysts and 11–12% of those in the head and neck. A NDSC is located in the median line of the nasofrontal region from the glabella to the columella. The differential diagnosis based on location includes epidermal inclusion cyst, glioma, meningomyelocele, meningoencephalocele, teratoma, teratoid cyst, thyroglossal duct cyst, branchial cleft cyst, and benign lymphadenopathy. Intracranial extension causes serious complications such as meningitis, osteomyelitis, abscess formation, hydrocephalus, seizures, and personality changes. All patients with NDSC should be considered to have a potential intracranial extension and should, therefore, undergo pre-operative radiological evaluation. Herein, the authors report an unusual adult patient with NDSC with intracranial extension.

Imaging Yield and Surgical Outcomes of Nasal, Medial Brow, Forehead, and Scalp Dermoid Cysts.

Dermoid cyst (DC) is a congenital cyst with the potential to have intracranial extension (ICE). This study aims to evaluate the imaging yield and surgical outcomes of nasal, medial brow, forehead, and scalp DCs. Retrospective review of craniofacial DCs treated at our institution between 1992 and 2024. A total of 117 patients (57 females) were included. The median age at cyst detection and removal were 4.8 months (IQR 3.6-9.6) and 1.8 years (IQR 0.9-5.3), respectively. In 42 patients, parents have noticed the presence of the cyst immediately after birth. Cyst wall rupture during surgical removal was reported in 15.4%. The median follow-up time was 1.3 months (IQR 0.5-12.2). Three patients experienced recurrence. No postoperative complication was reported. The regions with the highest prevalence of ICE were the forehead, frontotemporal scalp, and nasal region. The lateral frontal/temporal scalp had a 33.3% rate of ICE. Midline forehead/scalp lesions demonstrated a higher risk of ICE compared to their lateral equivalents (54.5% vs 17.5%, P = .03). The sensitivity and specificity of magnetic resonance imaging (MRI) were 100% and 95.7%, while for computed tomography (CT scans) were 72.7% and 96.5%. The Area Under the Curve for MRI was 0.978, and for CT was 0.846. The sensitivity and specificity of ultrasound were 50% and 100%. Midline forehead/scalp DCs are more prone to extend intracranially than lateral DCs. MRI had a higher sensitivity and specificity than CT scans in detecting ICE. Routine screening imaging should be considered in midline forehead/scalp, lateral frontal/temporal, and nasal DCs.

Bilateral Dermoid Ovarian Cysts in a Young Woman - A Case Report and Literature Review.

Ovarian tumors are a common type of neoplasm in women, with mature cystic teratomas being the most frequent variant. These tumors occur bilaterally in approximately 10% of cases. However, bilateral and multiple occurrences are rarely reported. A 22-year-old nulliparous woman presented with amenorrhea and sudden, generalized, dull lower abdominal pain. Diagnostic imaging, including ultrasound and computed tomography (CT) scans, revealed large solid-cystic lesions in both ovaries, with internal hyperechoic foci consistent with fat and calcification, along with thin internal septations. A laparoscopic cystectomy was successfully performed, preserving ovarian function. Histopathological examination confirmed the presence of stratified keratinized squamous epithelium, sebaceous glands, hair follicles, mature adipose tissue, blood vessels, and lymphatic vessels within the resected cysts, with no evidence of malignancy. This unique case provides valuable insights into the understanding and management of bilateral dermoid cysts, highlighting the importance of preserving ovarian function in young women.

Monodermal Ovarian Teratoma: A Rare Case Report

Struma ovarii (SO), also known as monodermal ovarian teratoma, is a rare and an uncommon histological diagnosis and a kind of mature dermoid cyst in which thyroid tissue makes up more than 50% of the total component. Boettlin originally reported this tumor in 1889. Although it had been previously documented, Ludwig Pick in 1901 described that this tumor was made up of thyroid tissue. While it is usually benign, its potential to produce thyroid hormones and the rare possibility of malignancy make it an interesting and clinically significant condition. Early diagnosis and appropriate management, often involving surgical removal, are key to ensuring the best outcomes for patients with SO. Definitive diagnosis is based on histopathological examination. This case report is presented due to its rarity and its variable clinical and radiological presentation.

Laparoscopic Treatment of Dermoid Cyst Involving the Bladder

Laparoscopic Treatment of Dermoid Cyst Involving the Bladder

Dermoid Cysts of the Auricle: A Review of the Literature.

Dermoid cysts are congenital anomalies that contain ectodermal elements such as teeth, bone, and nerves. The purpose of this study was to identify trends in the characteristics of dermoid cysts of the auricle and the demographics of the patient population they affect. A PubMed and EMBASE search for English-language publications that included cases of dermoid cyst(s) of the auricle from database inception to October 2022 was performed. A total of 38 cases of dermoid cysts of the auricle were identified from 20 publications. The age, sex, and Fitzpatrick skin type of the patients, locations of the dermoid cysts, associated anomalies, treatment methods, and postoperative outcomes were examined. Patients' ages ranged from 0 to 63 years, with 27.6% (8/29) in the 0-17 age range. 56.8% (21/37) were reported as male. Dermoid cysts were frequently present on the postauricular surface (18/24, 75.0%) and on light skin (Fitzpatrick types I-III; 18/22, 81.8%). Unilateral dermoid cysts were more commonly reported on the right ear (17/22, 77.3%); only one patient had bilateral cysts. Associated anomalies included microtia, prominent ears, foot polysyndactyly, hemifacial microsomia, and cryptotia. All auricular dermoid cysts were managed with complete surgical excision, and no postoperative complications or recurrences were reported. Dermoid cysts of the auricle are reported more frequently in individuals with lighter skin; however, this is likely due to reporting bias. Complete surgical excision can be used to treat patients successfully, with a very low risk of complications and no need for preoperative imaging.

Mature Ovarian Teratoma and Gliomatosis Peritonei: an Uncommon Case Report

Gliomatosis peritonei (GP) is a rare condition characterized by benign glial implants in the peritoneum, omentum, and lymph nodes, typically associated with immature ovarian teratomas and less frequently with mature teratomas. We present a case of a 21-year-old woman with severe abdominal pain and a large abdominal mass. Imaging revealed a large multilocular cystic mass suggestive of a dermoid cyst with torsion. During exploratory laparotomy, a large cystic mass with hair, teeth, and sebaceous material was found in the left ovary, alongside multiple nodules in the omentum. A left salpingo-oophorectomy, omentectomy, and peritoneal biopsies were performed. Histopathology confirmed a mature teratoma with GP. The patient's postoperative period was uneventful, and no adjuvant therapy was required. This case underscores the importance of recognizing GP in patients with ovarian teratomas, highlighting the typically benign nature and favorable prognosis of GP with proper surgical management.

Epidemiological profile and clinical characteristics of ocular and periocular tumors in North and Central India.

To describe the epidemiological profile and clinical characteristics of ocular and periocular tumors in patients presenting to three tertiary care referral centers in North and Central India. Hospital-based consortium study. Retrospective, descriptive, observational study. A total of 3184 patients were diagnosed with 3557 ocular and periocular tumors over 11 years from 2010 to 2021. Of these, 2395 (67.33%) were benign, 84 (2.36%) were premalignant, and 1078 (30.30%) were malignant. The most common location was the ocular surface (n = 1294, 37.09%), followed by the eyelid (n = 1185, 33.97%), intraocular (n = 624, 17.88%), and orbit (n = 454, 13.01%). The most common tumors were retinoblastoma (n = 483, 13.57%), ocular surface squamous neoplasia (OSSN) (n = 301, 8.46%), and dermoid cyst (n = 167, 4.69%). In the pediatric age group, retinoblastoma was the most common tumor (n = 483, 13.57%), while in adults, it was OSSN (n = 301, 8.46%). The stage at presentation for malignant tumors was divided into in-situ (57.14%), local spread (8.16%), and metastasis (32.83%). For specific tumor locations, the stages were 78.83%, 17.51%, and 2.18%, respectively, for eyelid tumors; 51.76%, 27.05%, and 17.64%, respectively, for orbital tumors; 88.37%, 5.81%, and 5.19%, respectively for ocular surface tumors; and 35.71%, 14.15%, and 50.28%, respectively, for intraocular tumors. Identifying the epidemiological characteristics of ocular and periocular tumors will aid in early diagnosis and timely intervention. Intraocular tumors showed delayed diagnosis, advanced stages at presentation, and required patients to travel longer distances for treatment, indicating the need for strengthened diagnostic and treatment facilities to improve access to care.

Lipoleiomyoma of the uterus in a woman of reproductive age (clinical case)

Uterine lipoleiomyoma is one of the variants of uterine leiomyoma, which is histologically represented by the presence of mature fat and smooth muscle cells. The relevance of the coverage of this clinical case is determined by the extreme rarity of the development of uterine lipoleiomyoma in women of reproductive age. The purpose of this work was to record this clinical case in the world statistics of lipoleiomyoma, to evaluate methods of diagnosis and differential diagnosis, to determine the role of early diagnosis of uterine lipoleioma in the subsequent tactics and scope of surgical treatment. Data from the medical records of a 41-year-old inpatient were analyzed. In addition to the generally accepted clinical and biochemical methods of blood and urine examination, electrocardiogram, ultrasound examination of the pelvic organs, the level of ovarian tumor markers in the blood (CA 125, HE4 and the ROMA index) was determined. The diagnosis of the disease was based on the data of pathohistological and immunohistochemical studies. Based on the results of a review of the medical literature, analysis of articles obtained as a result of a search of PubMed, SCOPUS, Web of Science, MedScape databases, the current state of the problem is highlighted, literary data related to the incidence, features of the clinical course, diagnosis and treatment of uterine lipoleiomyoma are summarized. The clinical case presented in the article demonstrates an incidental finding of a uterine lipoleiomyoma in a woman of reproductive age, measuring 30x25x20 cm, originated subserously from the body and cervix of the uterus, in the area of its isthmus. Under this condition, it occupied the entire Douglas space, the area of the sacro-uterine ligaments and the parietal peritoneum, intimately adjacent to the sigmoid and rectum, to the ureters and iliac vessels. The peculiarity of this clinical case is that sonographically uterine lipoleiomyoma was hidden under the "mask" of a dermoid cyst of the right ovary. Macroscopically, it differed from a typical lipoleiomyoma by the purple-bluish color of its outer surface and soot-colored, fine-lobed spongy structure on the section. The diagnosis of uterine lipoleiomyoma was verified only on the basis of pathohistological and immuno­histochemical research. Microscopically, the lipoleiomyoma had a mesenchymal structure with a pronounced vascular component and consisted of mitotically inactive bundles of smooth muscle cells and mature adipocytes. Im­munohistochemically, a positive reaction for caldesmon, desmin, smooth muscle actin alpha of tumor cells and for S.100 (DAKO, polyclonal) fatty cells was detected, which confirmed the hypothesis of direct transformation of smooth muscle cells existing in the leiomyoma of the uterus into fatty cells. This clinical case should complement the global statistical indicators of diagnosis of uterine lipoleiomyoma in women of reproductive age. Lipoleiomyoma should be considered as the primary diagnosis in case of detection of a large uterine tumor in women with excess body weight and be removed immediately after diagnosis, otherwise it is impossible to exclude its malignancy. For the planned diagnosis of neoplasms of the female genital organs, preference should be given to non-invasive research methods: magnetic resonance or computer tomography with contrast enhancement. The problem of these tumors lies in their unpredictable histogenesis, the unexpected presence of fat in the microscopic structure, and in the visual similarity to sarcomas. Verification of the diagnosis is carried out on the basis of pathohistological and immunohistochemical studies of the tumor preparation. Uterine lipoleioma can have a purplie-bluish color and develop by a broad base from the body and cervix of the uterus, as a result of "lipomatous" metaplasia of the uterine leiomyoma existing in a woman. Regular preventive examinations of women of all ages are crucial for timely detection of this rare neoplasm.

Presentation and Management Outcome of Anterior Fontanelle Dermoid Cyst: Report of 6 Cases

Aim: The aim of study is highlight the presentation of anterior fontanelle Dermoid cyst which is relatively uncommon condition, and our ability to excised the cysts in our resource poor environment. Presentation of Cases: A retrospective study of all the consecutive patients managed by pediatric surgery unit over six years was done and the results was analysed and documented. A total of six patients was managed over a period of five years including 4 boys and 2 girls. The age ranges between 6months to five years. Discussion: Dermoid cysts are inclusion cyst mostly seen in the midline. 1, 2 They occur in head and neck or the trunk. It is a benign, slowly growing lesion, dermoid cysts are thought to arise during the third and fifth week of embryogenesis from displacement of germ cells during the formation of the neural tube. All of the patients had excision under general anesthesia. The intra operative finding is a global, cystic swelling containing amber to yellow color jelly fluid. All the patients were operated as day case surgery and were discharged home about four to six hours after recovery from anesthesia. All the patients did well postoperatively, only one patient had surgical site infection which was treated with antibiotics and wound dressing. Conclusion: Dermoid cyst is an uncommon congenital cyst mostly diagnosed during infancy, following excision recurrence is uncommon.

Surgical Management of 2,350 Pediatric Dermoid Cysts.

We examined operative and pathologic findings of a large series of dermoid cysts at a high-volume pediatric hospital over 23 years. A retrospective review was performed of all dermoid cysts excised from 2000 to 2023 at the Children's Hospital of Philadelphia. Lesions were classified by location. Depth was stratified into Type 1, superficial; Type 2, subperiosteal or containing a stalk to a cranial suture; Type 3, intraosseous or intracartilaginous; Type 4, intracranial extradural; and Type 5, intracranial intradural. Of 2,350 lesions, 2,237 (95.2%) were in the head and neck. Most common locations were lateral brow and orbit, 892 (38%); anterior neck, 303 (12.9%); and frontal, 253 (10.8%). Among the series, 67.9% were Type 1, 10.1% were Type 2, 16.5% were Type 3, 2.3% were Type 4, and 3.2% were Type 5. Older age at surgery correlated with depth among locations demonstrating intracranial extension (r=.061, p=.016). Anterior fontanelle (59.1%), nasal (16.2%), occipital (5.6%), and temporal (4.7%) lesions had the highest intracranial extension rates. Temporal (49.4%), frontal (32.8%), nasal (29.9%), and occipital (22.2%) lesions had higher rates of osseous/cartilaginous involvement. On histopathologic examination, 403 (17.1%) were ruptured. Ruptured lesions were associated with giant cell reaction (46.4 versus 5.7%, p<.001). Anterior fontanelle, nasal, occipital, and temporal lesions are at higher risk of intracranial extension and may require preoperative imaging. Frontal and parietal lesions have a lower risk of intracranial involvement. Lateral brow and orbit, periauricular, and anterior neck lesions demonstrate a higher rate of osseous involvement without intracranial tracking.

Suprasellar dermoid cyst masquerading as tumor: A case report

Suprasellar dermoid cyst masquerading as tumor: A case report

7817 A Rare Case of Intrathyroidal Thyroglossal Duct Cyst Presenting as a Rapidly Expanding Left Thyroid Goiter

Abstract Disclosure: C.M. Godar: None. A.J. Spiro: None. K.F. Brown: None. M.K. Shakir: None. T.D. Hoang: None. Introduction: Thyroglossal duct cysts are the most common congenital cyst in the head and neck, found during childhood as a midline neck mass. We present a rare case of a large intrathyroidal thyroglossal duct cyst with left lateral extension in an adult patient. Case Report: A 50-year-old man with family history of familial adenomatous polyposis presented for thyroid nodule evaluation. Thyroid ultrasound for screening of thyroid cancer showed a 4.8 x 4.5 x 2.5cm mixed cystic/solid hyperechoic thyroid nodule with smooth margins in the left lower thyroid lobe. He reported no compressive symptoms. FNA with standard 27G needle was insufficient for evaluation with Bethesda I result. Attempted syringe aspiration did not produce cystic fluid for analysis. The patient returned to clinic 8 weeks later due to visible enlargement of his anterior neck and new neck pressure with swallowing. Physical exam was significant for a new, firm palpable mass over the left thyroid isthmus. Bedside ultrasound noted expansion of the previously visualized mass now extending into the thyroid isthmus. FNA was reattempted with a 25G needle, and cytologic material was again inadequate. He elected to undergo left hemithyroidectomy. Histologic sections demonstrated a 3.4cm simple squamous, non-keratinizing cyst lining overlying a thickened fibrotic wall with mixed acute and chronic inflammation surrounded by benign thyroid tissue, consistent with an intrathyroidal thyroglossal duct cyst. Discussion: The thyroglossal duct derives from epithelial tissue during embryogenesis and atrophies during weeks 8-10 of gestation. A persistent duct may lead to cyst formation in the presence of remnant epithelial tissue secretions and local neck inflammation. A thyroglossal duct cyst is usually located midline in the anterior neck. This stands in comparison to a branchial cleft cyst, which arises due to failure of atrophy of the second branchial groove during embryogenesis and forms a cyst that is usually located in the upper lateral neck compartment. Other common neck masses include lipomas, dermoid cysts, or ectopic thyroid tissue. This case highlights the rarity of intrathyroidal thyroglossal duct cyst in an adult patient and the importance of definitive diagnosis and appropriate management. Presentation: 6/2/2024

Nasal dermoid cyst

Abstract: Congenital midline lesions of the nose include nasal dermoids, encephaloceles, and gliomas. The nasal dermoid is least rare of these and is an uncommon midline developmental anomaly. Unlike encephalocoeles and gliomas ,craniofacial dermoids may present as a cyst, a sinus or a fistula (Setiyawan, 2013). In this patient, it was a cystic nasal swelling obscuring vision without any problem in visual acuity. He had this lesion from childhood but presented to the outpatient department in adolescent age. Diagnostic nasal endoscopy, ultrasonography, fin- needle aspiration cytology, and contrast-enhanced computed tomography of the nose and paranasal sinuses were done reporting it as a nasal dermoid without any bony erosions. All routine investigations were done, and the patient was planned for excision under general anesthesia (GA). Excision of the mass was done under GA and sent for histopathology. Histopathological examination report confirmed it as a dermoid cyst.

Endonasal Endoscopic Resection of a Recurrent Dermoid Cyst With Lateral Transcavernous Sinus Approach: 2-Dimensional Operative Video.

Endonasal Endoscopic Resection of a Recurrent Dermoid Cyst With Lateral Transcavernous Sinus Approach: 2-Dimensional Operative Video.

Role of Laparoscopy in Reproductive Age Group Women with Gynecological Problems in a Tertiary Medical College

Background Laparoscopy has been a revolution in gynecological surgery as it is safe and minimally invasive. It can be used as a diagnostic as well as treatment modality for different gynecological problems like Chronic pelvic pain, adnexal cyst, ectopic pregnancy, Pelvic inflammatory disease and infertility.MethodsThis study was carried out at College of Medical Sciences-Teaching Hospital from April 2022 to March 2023 in 105 women. All the women undergoing laparoscopic surgeries were analyzed for indications, intraoperative findings and interventions.ResultsThe mean±SD of age of women was 30.34±7.73 years, most were in age group 26-35 years. The most common indications for Laparoscopy were for Adnexal cyst (74.28%), Chronic Pelvic Pain (14.28%) and Infertility (11.42%). The most common findings according to site were Ovarian pathology (48.60 %) followed by peritoneal pathology (22.9 %), Tubal pathology (17.14%) and normal findings (10.50%). In ovarian - Dermoid cyst (31.37 %), in tubal - ectopic pregnancy (55.56%), in peritoneal-Adhesions (45.83%) were the most common finding. In laparoscopic interventions, 26.70% had cystectomy, 14.3 % had salpingectomy and 13.3 % had Sterilization. Conclusions Laparoscopy as a modality for diagnosis and treatment of gynecological problems has been well established in recent times. It’s been a choice of surgery because of its reduce postoperative pain, shorter hospital stay, faster recovery and minimal scar. However, adequate advanced training and equipment are needed to perform skillful laparoscopic surgeries.