Dermoid Research Articles

Testicular tumor in a9-year-old boy

A9-year-old boy presented to the emergency department after noticing apainless mass on the right testicle during self-examination in the shower. On physical examination, both testes were mobile and painless, with the right testis twice as big as the left and exhibiting palpable resistance. Sonographic examination revealed auniformly demarcated mass with aventral protrusion on the right testis. Tumor markers and blood tests were normal. The testis was exposed inguinally and the tumor was enucleated, which revealed adermoid cyst. The testicle could thus be preserved. Final histology confirmed complete excision of the benign dermoid cyst (mature teratoma). As testicular tumors in prepubertal boys are rare and usually benign, an organ-preserving procedure with perioperative biopsy should be aimed for. Due to the rarity of studies on recurrence after organ-preserving testicular surgery, we recommended regular ultrasound examinations during the first year after surgery, followed by annual examinations for aperiod of 5years.

A Rare Presentation of Occipital Dermoid Cyst with Intracranial Extension and Secondary Infection: Case Report and Follow-Up

AbstractCraniofacial dermoid cysts are congenital anomalies that rarely have intracranial extension and can be associated with other anomalies. Common sites of these lesions are the lateral brow and parietal scalp. Presentation of the dermoid cyst in the occipital region with intracranial extension is extremely rare. We report a 2-year-old female with a presentation of an occipital dermoid cyst with intracranial extension and secondary cerebellar abscess. This case highlights the rarity of the presentation of an occipital dermoid cyst with intracranial extension and secondary infection and the importance of early imaging for suspected dermoid cysts in the occipital region for identification of intracranial extension.

Kimura's Disease Finding on Ocular Adnexal Mass

Introduction: Kimura's disease is an unknown chronic lymphoproliferative inflammatory disease affecting the skin, soft tissues, and lymph nodes. Until September 2020, only 200 cases of Kimura's disease were reported worldwide, however, their exact incidence is unknown. Here, we are interested in reporting a patient with Kimura's disease of the ocular adnexa due to its rarity and to enhance the knowledge of ophthalmologists about confirming the diagnosis of Kimura's disease. Case Presentation: A 40-year-old female presented with a chief complaint of a mass on her left nasal orbit for the last year. The mass gradually increased for six months, and it was painless. The systemic laboratory workup revealed eosinophilia and increased serum IgE. Contrast CT-Scan revealed a benign tumor, suspect dermoid cyst. She underwent surgery, and the histopathologic showed Kimura's disease. The patient was followed up on a scheduled basis, and there was no recurrence during four months of monitoring. Conclusions: A clinical, systemic laboratory, and histopathological examination is required to confirm the diagnosis of Kimura's ocular adnexa disease and determine the best therapy for the patient due to the high recurrence rate. Combining surgical excision with postoperative radiation is recommended as the most effective treatment in terms of controlling the residual lesion and minimizing the recurrence rate while causing the fewest side effects. Eosinophil screening regularly is advised to evaluate the recurrence rate.

Traumatic Rupture of Dermoid Cyst in Early Pregnancy: Diagnosis and Management in Peki Government Hospital Resulting in a Successful Delivery at Term

Introduction: Dermoid cyst is the commonest germ cell tumour, constituting about 20% of adult ovarian tumours. They are mostly asymptomatic, but complications such as torsion, rupture, and malignant transformation have been reported. Only a few cases of ruptured mature cystic teratoma in early pregnancy have been described and even fewer are those in early pregnancy with the pregnancy successfully carried to term with successful delivery. Case Presentation: We present a case of a grand multiparous woman who presented to Peki Government Hospital at 11 weeks gestation with an acute abdomen following a fall. She had been diagnosed with a dermoid cyst a week with dimensions of 20cm x15 cm before the presentation. Ultrasound diagnosis of a possible rupture of the cyst was made on admission. Right oophorectomy was done at laparotomy. She had progesterone support for the succeeding 4 weeks and the pregnancy was successfully carried to term with good outcomes at delivery for both mother and baby. The APGAR score for the baby at 1minute and 5minute after birth were 7/10 and 8/10 respectively. Conclusion: Traumatic rupture of dermoid cyst should be considered as a differential diagnosis in women presenting with acute abdomen in early pregnancy. Laparotomy with abdominal lavage is a viable management option in a low-resource setting.

Schwannoma of Facial Region: A Pathology Often Missed in the Initial Diagnostic Hypothesis: A Case Report

Schwannoma, also known as neurilemmoma, is a benign tumor originating from Schwann cells and may involve any nerve in the body but its most common occurrence is in the head and neck region. When it involves a nerve of face, it is often confused with dermoid cyst. We present the case of a 23-year-old male patient with Schwannoma arising from the area just below the lateral canthus of the left eye where the initial diagnostic hypothesis was dermoid cyst but later confirmed as Schwannoma on histopathological analysis.

A giant dermoid cyst in the floor of the mouth: a case report

Dermoid cysts are slow-growing cystic masses that are lined by stratified squamous epithelium and contain skin appendages. Dermoid cysts in the floor of the mouth account for less than 0.01% of all neck and oral cavity cysts. They can be either congenital or acquired. We report a case of a 25-year-old male, a final-year engineering student, who came to our outpatient department with complaints of swelling in the mouth and weight loss for 4 years. On examination, a large cystic swelling in the floor of the mouth, approx. 5x6 cm, obscuring the oropharynx, was seen. USG and CECT of the neck suggested ranula and plunging ranula in the right submandibular space, respectively. He underwent a combined (debulking and enucleation) submandibular cystic swelling excision through a transoral approach under general anesthesia guided by awake fiber optic nasal intubation. The intraoperative and postoperative periods were uneventful. Histopathologic examination of the resected tissue specimen suggested a dermoid cyst. The patient recovered well during the 1-month follow-up, and he gained weight up to 2.5 kg in a month of treatment. Dermoid cysts are very rare cystic lesions on the floor of the mouth. Surgery is the most curable method of treatment. A proper clinical examination with imaging guidance is necessary for accurate delineation of the cyst. Large submandibular cystic lesions can be excised by combining debulking and enucleation through a transoral approach, with a good cosmetic and functional outcome.

Ovarian dermoid cyst in a buffalo

AbstractOvarian dermoid cyst is characterised by the presence of hair follicles, sebaceous glands grossly observed as clusters of matted hair in greyish cheesy material in the vicinity of ovaries. Upon examination of 235 buffalo genitalia, five were found to have abnormal ovarian texture and were relatively large in size. Further investigation revealed presence of dermoid cyst in these ovaries. Histopathological analysis showed degenerated primary, secondary and tertiary/Graafian follicles in the ovarian parenchyma, with patches of neuro‐ectodermal rosette‐like structures composed of glial cells. Other extra‐gonadal tissues often less organised were also observed like cartilage, fibrous connective tissue and glandular structures. In two of the specimens, corpus luteum with degenerated luteal cells was also present in the parenchyma of the ovary. These detailed investigations pointed to the infertility problems in buffaloes associated with this condition and often dictated in slaughterhouse‐derived ovaries. It has clinical significance as these structures are often confused with cystic ovarian disease upon rectal palpation, and treatment is unsuccessful in reducing the size of the ovary at the field level.

Growing Pains: A Rare Case of a Temporal Dermoid Cyst in an Adult and Review of the Literature

Dermoid cysts are common cutaneous developmental anomalies that occur due to the entrapment of ectodermal elements during embryonic closure. While the exact origin of dermoid cysts is unknown, they are theorized to originate from multipotent embryonic stem cells or translocated epithelial cells. Dermoid cysts are typically congenital but are sometimes diagnosed later in childhood and rarely in adulthood. They are reported as the most common pediatric skull tumors. Surgical excision is recommended to prevent enlargement, invasion, rupture, or infection. Temporal dermoid cysts, specifically, are extremely rare, with only a few cases having been reported in adulthood. We present a case of a 51-year old female with an enlarging left temporal mass found to be a dermoid cyst. The mass was excised, resulting in complete resolution of symptoms. This case highlights the importance of early excision, radiologic studies, and a tailored management approach based on cyst location. Our proposed treatment algorithm provides guidance for clinicians in identification and management of adult dermoid cysts.

Prevalence of surgical affections of sheep in Mymensingh division of Bangladesh

Background: This study aimed to investigate the occurrence of surgical conditions in sheep and analyze their distribution based on age, sex, sheep, and seasonal variation. Methods: Retrospective data on surgical conditions in sheep were compiled from Upazila Livestock Offices and Veterinary Hospitals within Mymensingh division between January 2021 and December 2021. Simple descriptive statistics were used for data analysis. Results: A total of 788 surgical cases in sheep were documented. The predominant surgical conditions observed in sheep included wounds (29.18%), myiasis (15.10%), bloat (14.08%), subcutaneous cysts (12.56%), and foot rot (8.24%). In addition, there were instances of abscesses (6.47%), horn fractures (4.56%), atresia ani (3.93%), dermoid cysts (1.64%), dog bites (1.90%), overgrown hooves (1.52%), and gangrenous mastitis (0.63%). Surgical affections were more prevalent in adult sheep (73.35%) compared to young ones (26.64%). Among adult sheep, myiasis, bloat, subcutaneous cysts, and foot rot showed higher prevalences. In females, myiasis, subcutaneous cysts, bloat, and abscesses occurred more frequently than in male sheep. The occurrence of surgical affections was relatively higher in adult sheep during the rainy season, followed by summer, autumn, and winter during the rainy season followed by summer, autumn, and winter. Conclusion: The findings of this study highlight the variable demographic distribution of surgical affections in sheep. The observed patterns suggest that the surgical disorders pose a substantial threat to sheep rearing in the study areas.

Ultrasound radiomics-based artificial intelligence model to assist in the differential diagnosis of ovarian endometrioma and ovarian dermoid cyst.

Accurately differentiating between ovarian endometrioma and ovarian dermoid cyst is of clinical significance. However, the ultrasound appearance of these two diseases is variable, occasionally causing confusion and overlap with each other. This study aimed to develop a diagnostic classification model based on ultrasound radiomics to intelligently distinguish and diagnose the two diseases. We collected ovarian ultrasound images from participants diagnosed as patients with ovarian endometrioma or ovarian dermoid cyst. Feature extraction and selection were performed using the Mann-Whitney U-test, Spearman correlation analysis, and the least absolute shrinkage and selection operator (LASSO) regression. We then input the final features into the machine learning classifiers for model construction. A nomogram was established by combining the radiomic signature and clinical signature. A total of 407 participants with 407 lesions were included and categorized into the ovarian endometriomas group (n = 200) and the dermoid cyst group (n = 207). In the test cohort, Logistic Regression (LR) achieved the highest area under curve (AUC) value (0.981, 95% CI: 0.963-1.000), the highest accuracy (94.8%), and the highest sensitivity (95.5%), while LightGBM achieved the highest specificity (97.1%). A nomogram incorporating both clinical features and radiomic features achieved the highest level of performance (AUC: 0.987, 95% CI: 0.967-1.000, accuracy: 95.1%, sensitivity: 88.0%, specificity: 100.0%, PPV: 100.0%, NPV: 88.0%, precision: 93.6%). No statistical difference in diagnostic performance was observed between the radiomic model and the nomogram (P > 0.05). The diagnostic indexes of radiomic model were comparable to that of senior radiologists and superior to that of junior radiologist. The diagnostic performance of junior radiologists significantly improved with the assistance of the model. This ultrasound radiomics-based model demonstrated superior diagnostic performance compared to those of junior radiologists and comparable diagnostic performance to those of senior radiologists, and it has the potential to enhance the diagnostic performance of junior radiologists.

Presentation and treatment of two cases of malignant struma ovarii

BackgroundMalignant Struma Ovarii (MSO) is a rare type of germ cell tumour which is diagnosed postoperatively on surgical pathology specimens by the presence of differentiated thyroid cancer in mature cystic teratomas in the ovaries. Treatment and follow-up procedures are not clearly established due to the paucity of MSO cases.Case 1A 44-year-old multiparous female presented with an irregular period. Ultrasound showed a left ovarian lesion mostly a dermoid cyst, however, CT showed a 3.8 × 2.7 × 4 cm complex cystic lesion with thick septation and enhancing soft tissue component. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed a follicular variant of papillary thyroid carcinoma arising in a mature cystic teratoma. Peritoneal cytology was positive for malignancy. A thyroid function test was normal before surgery. Total thyroidectomy was performed followed by radioactive (RAI) iodine therapy. Later, a total laparoscopic hysterectomy and right salpingo-oophorectomy were performed. There is no evidence of recurrent disease during the 26-months follow-up.Case 2A 46-year-old single female presented with left lower abdominal pain that had persisted for 2 months. Imaging revealed an 8 × 9 × 9.5 cm left ovarian mass. Laparoscopic left salpingo-oophorectomy was performed and histopathology showed mature cystic teratoma with small papillary thyroid cancer. CT showed no evidence of metastatic disease. Later, the patient had a total thyroidectomy followed by radioactive (RAI) iodine therapy. She was started on thyroxine and later had total abdominal hysterectomy and right salpingo-oophorectomy.ConclusionMSO is a very rare tumour. Preoperative diagnosis is very difficult because of the nonspecific symptoms and the lack of specific features in imaging studies. Also, there is no consensus on the optimal treatment of women with MSO. Our two cases add to the limited number of MSO cases.

Pediatric orbital lesions: non-neoplastic extraocular soft-tissue lesions.

Orbital pathologies can be broadly classified as ocular, extraocular soft-tissue (non-neoplastic and neoplastic), osseous, and traumatic. In this paper, we discuss the key imaging features and differential diagnoses of congenital and developmental lesions (dermoid cyst, dermolipoma), infective and inflammatory pathologies (pre-septal cellulitis, orbital cellulitis, optic neuritis, chalazion, thyroid ophthalmopathy, orbital pseudotumor), and non-neoplastic vascular anomalies (venous malformation, lymphatic malformation, carotid-cavernous fistula), emphasizing the key role of CT and MRI in the imaging work-up. In addition, we highlight the adjunctive role of ocular ultrasound in the diagnosis of dermoid cyst and chalazion, and discuss the primary role of ultrasound in the diagnosis of vascular malformations.

A rare case in emergency department: intracranial dermoid cyst rupture

Intracranial dermoid cysts (IDC) are rare cystic lesions that are present from birth. After rupture of these cysts, patients may present to the hospital with ischemic cerebral symptoms, headaches, seizures, syncope, and meningitis. Brain magnetic resonance imaging (MRI) is the most sensitive radiologic method in the diagnosis of IDC rupture, which has a high mortality rate. Patients should be rapidly evaluated for surgery if a symptomatic and ruptured cyst is detected. In this presentation, we aimed to describe the diagnosis and treatment of IDC in a 23-year-old male patient brought to the emergency department after syncope.

Eyelid Tumors at Razi and Farabi Hospitals, Tehran, Iran

Background: Eyelid tumors are common in the daily practice of skin tumors and are composed of benign and malignant lesions. Methods: This retrospective case series study collected histopathologic reports of eyelid tumors of patients treated between 2022 and 2023 in Razi and Farabi hospitals (Tehran, Iran). Patient data, including patient age, sex, location of the lesion, and recurrence, were collected. Descriptive and inferential statistics were used to characterize the subgroups. Results: The sample was composed of 154 eyelid tumor specimens, including 72 (47%) malignant cases, 80 (52%) benign cases, and 2 (1%) premalignant cases. Malignant tumors included 81.9% basal cell carcinomas (BCC), 15.3% basosquamous cell carcinomas (BSC), and 1.4% squamous cell carcinoma (SCC). The benign eyelid lesions were comprised of 20% intradermal melanocytic nevus, 11.3% epidermal cyst, 7.6% dermoid cyst, 10% seborrheic keratosis, 6.3% xanthelasma, 2.5% wart, 3.8% compound nevus, 5% fibroconnective tissue, 3.8% squamous papilloma, 3.8% neurofibroma, 2.5% comedone,2.5% apocrine hidrocystoma, 2.5% foreign body type granuloma, and 1.3% of others (arteriovenous hemangioma, cavernous hemangioma, cutaneous horn, etc.) The premalignant lesions were 2 cases of actinic keratosis. Benign lesions had an equal frequency of occurrence in the upper and lower lids. Malignant lesions were seen more in the lower lid. Premalignant lesions were seen in the lower lid. The mean age at diagnosis was 45.8 ± 23.06 years for patients with benign lesions and 63.5 ± 16.7 years for patients with malignant lesions. The mean age for patients with premalignant lesions was 81.5 ± 9.19 years (P < 0.001). Conclusions: In our study, benign lesions were seen predominantly in young persons and malignant lesions were mostly seen in elderly persons. There is an equal occurrence of malignant lesions in males and females, and recurrence after excision was infrequent.

Malignant melanoma arising in mature teratoma with pugnacious spread: A case report

Of all ovarian neoplasms, mature cystic teratomas make up between 10–20%. Malignant transformation accounts for just 0.1-2 percent of cases of adult teratoma. Malignant melanoma is one of the rarest metamorphoses. Here, we describe a postmenopausal woman who complained of abdominal pain. Upon examination, it was discovered that she had an abdominally metastasized mature dermoid cyst that had ruptured. Following an exploratory laparotomy and staging procedures, she had a total abdominal hysterectomy and bilateral salpingo-oophorectomy with removal of melanotic deposits from the pouch of doughlas, bladder peritoneum, mesentric, and omentum, as well as the small and large bowel serosa. Only roughly 45 cases of malignant melanoma originating in mature cystic teratomas in the ovary have been documented since 1901.

CK7+/CK20+/CDX2+ mucinous carcinoma, arising in a mature cystic teratoma of ovary, presenting with disseminated metastasis and pseudomyxoma peritonei.

Mucinous carcinomas arising within an ovarian dermoid tumor are rare. Most of the cases reported in the literature show morphological features resembling an appendiceal mucinous neoplasm. They exhibit CK7-/CK20+ immunophenotype similar to carcinomas of the lower gastrointestinal tract. In this report, we have described a case of a well-differentiated mucinous carcinoma arising within a mature cystic teratoma. The mucinous carcinoma showed a spectrum of morphological patterns, including cystadenoma-like areas, proliferative/borderline areas, villous adenoma-like areas, and areas of invasive carcinoma. In addition, our case showed some unusual findings, namely, diffuse CK7 positivity, associated pseudomyxoma peritonei, and metastasis to lungs. These features were not demonstrated in any of the previously reported cases. Our case shows that the teratomatous mucinous neoplasm of the ovary may show CK7+/CK20+/CDX2 + immunoprofile making it immunohistochemically indistinguishable from a primary ovarian mucinous neoplasm or a metastatic mucinous carcinoma of the lower gastrointestinal tract.

Pseudopterygium After Limbal Dermoid Cyst Excision in a Child with Goldenhar Syndrome

Introduction : Goldenhar syndrome is a rare congenital disorder also known as oculoauricularvertebral dysplasia. Limbal dermoid associated with this syndrome. This case report aims to present an reccurent pseudopterygium after three times limbal dermoid cyst excision in patient with Goldenhar syndrome.
 Case Illustration : Patient 13 years old male with pseudopterygium in right eye. Visual acuity both eyes 6/6 snellen chart. Fibrovascular tissue from tarsal conjunctival inferotemporal to 2 mm limbal cornea in right eye. Patient had limbal dermoid cyst in right eye since birth and underwent limbal dermoid cyst excision for three times. First time surgery used amniotic membrane transplantation, then second and third surgery used conjunctival limbal graft. Goldenhar syndrome have been diagnosed since the age of 2 years old. External examination noticed asymmetrical hemifacial microsmia, grade III microtia right ear, conduction deafness, and laryngomalacia.
 Discussion : Limbal dermoid cyst is one of characteristic of Goldenhar syndrome. In this case pseudopterygium grade II in right eye developed after limbal dermoid cyst excision for three times. Limbal dermoid simple excision may lead to corneal vascularization persistent epithelial defect, scar, and pseudopterygium. Various surgical include superficial keratectomy, amniotic membrane transplantation and lamellar or penetrating keratoplasty. Pseudopterygium still occurs in this case, even though recurrence has been prevented by administration of amniotic membrane transplantation and conjunctival limbal graft.
 Conclusion : We should be concerned about management of limbal dermoid cyst with Goldenhar syndrome to prevent recurrent pseudopterygium.

Primary Retroperitoneal Mature Cystic Teratoma (Dermoid Cyst) in Pelvic Musculature

Dermoid cysts, or mature cystic teratomas containing ectoderm-derived skin adnexa, rarely occur intramuscularly, especially within the male pelvic musculature. We present a male patient with a dermoid cyst within the obturator internus spreading into the adductor compartment and the pelvic cavity. In contrast to dermoid cysts in previous reports, the cyst appeared centered in muscle rather than simply perforating muscle via an extension. The case is also notable for the rapid recurrence of the cyst after incomplete resection and intraoperative rupture

Endoscopy-assisted excision of nasoglabellar dermoid cyst.

To assess the endoscopic assisted excision of the nasoorbital dermaoid cyst. Case series. Zagazig univesity hospitals. The study included patients with nasal dermoid who were operated using a local vertical incision with endoscopic assisted dissection and excision. Complete removal, complication, recurrence. In all patients, complete excision of the cyst was achieved with negligable blood loss. No recurrence was detected throughout the follow up. Endoscopic-assisted resection of the nasal dermoid cyst appears a safe and effective approach with small incision, precise dissection and satisfactory apparent scar with with low incidence of recurrence.

Ocular and orbital tumors in childhood

Pediatric tumors of the eye and orbit can be benign or malignant as well as congenital or acquired and are usually distinctively different than those seen in adults. Although most of these neoplasms are benign (eg, dermoid cyst, chalazion, molluscum), their location near and within a vital organ can result in serious dermatologic and ophthalmologic sequelae. Lesions discussed include vascular lesions, retinoblastomas (the most common primary pediatric intraocular malignancy), rhabdomyosarcoma (the most common primary pediatric orbital malignancy), Langerhans cell histiocytosis, and metastatic lesions to the orbit (neuroblastoma, Ewing sarcoma). Although cysts and ocular melanoma can occur within the pediatric population, these conditions are covered in other contributions in this issue of Clinics in Dermatology.