Ovarian Dermoid Cyst Research Articles

Ultrasound of ovarian dermoids - sonographic findings of a dermoid cyst in a 41-year-old woman with an elevated serum hCG.

Ovarian dermoid cysts are made up of solid, cystic and fat tissue. These components give rise to characteristic sonographic features such as a fat‐fluid level, dermoid mesh and tip of the iceberg sign. The presence of two or more of these typical features can be used to confidently diagnose a dermoid cyst on ultrasound. This 41‐year‐old woman with a known cystic lesion on her right ovary which, on ultrasound, demonstrated two of these features, had the diagnosis of a dermoid cyst later confirmed on histopathology. She concurrently had an elevated serum human chorionic gonadotrophin (hCG), an unusual, but not unknown, finding in the presence of a dermoid cyst. The hCG resolved after removal of the ovarian cyst.

Tratamiento laparoscópico del quiste dermoide de ovario. Factores asociados a la rotura intraoperatoria, trascendencia clínica y resultados

Objective To analyze the surgical characteristics of laparoscopic treatment of dermoid cyst and the factors associated with intraoperative spillage and its clinical importance. Material and methods A retrospective research was performed of 131 dermoid cysts treated by laparoscopy at the Virgen de las Nieves University Hospital from January 2000 to December 2008. Results The mean age of the patients was 32.4 years. The mean size of the cysts was 63.8 mm. In 62.6% of the patients, conservative surgery (cystectomy) was feasible. Only two patients needed reintervention due to bleeding complications. The mean length of hospital stay was 1.6 days. Intraoperative spillage was more common when cystectomy was performed. There were no cases of peritonitis. Conclusions Laparoscopic surgery is the first treatment option in the management of ovarian dermoid cysts. There are few complications and healing is rapid. Spillage is usually clinically unimportant.

Ultrasound in the diagnosis of ovarian dermoid cysts: a pictorial review of the characteristic sonographic signs

Dermoid cysts (mature cystic teratoma) are the commonest germ cell neoplasm and in some series the most commonly excised ovarian tumour. They are composed of tissue from at least two of the germ cell layers and often contain hair, sebum and teeth. These tumours show a wide range of ultrasonic appearances because of their variable composition. On account of this they may mimic a variety of other pelvic masses. In many cases, however, the ultrasonic appearance can be distinctive, and a number of sonographic signs characteristic of dermoid cysts have been described. Typical appearances include a shadowing echodensity or dermoid plug; diffuse or regional high amplitude echoes; the tip of the iceberg sign; dermoid mesh; fat–fluid levels and intracystic floating balls. When two or more characteristic signs are present, a high positive predictive value and a confident sonographic diagnosis can be achieved. We present a pictorial review of the characteristic sonographic signs helpful in making the diagnosis of ovarian dermoid cyst. We also discuss the pitfalls of making an ultrasound diagnosis, and illustrate some of the conditions that may mimic dermoid cysts. We include correlation with computed tomography and magnetic resonance imaging where appropriate.

A case of carcinoid tumor of the terminal ileum and simultaneous ovarian dermoid cyst

Carcinoid tumors are slow-growing malignant neoplasms associated with an indolent clinical course. About 60% of such tumors are located within the gastrointestinal tract. Here, we describe the first case, to our knowledge, of a carcinoid tumor of the terminal ileum and a simultaneous ovarian dermoid cyst. A 57-year-old woman was presented with abdominal pain, vomiting, and clinical signs of mechanical bowel obstruction. Radiograph and computed tomography scan of the abdomen showed hydroaeric levels. Laparotomy revealed a mass in the terminal ileum and a right ovarian cystic mass. Right hemicolectomy and right oopherectomy were performed. The histopathological workup showed a carcinoid tumor of the terminal ileum and ovarian dermoid cyst. Small intestinal carcinoid tumor, an uncommon disease, has been reported earlier to coincide with various neoplasms. No association between small intestinal carcinoid tumor and ovarian dermoid cyst has been reported earlier in the English literature.

Myxoid malignant fibrous histiocytoma of the ovary: a case report

A 46-year-old woman presented with whole abdominal discomfort, and imaging revealed a 3-cm-sized ill-defined ovarian mass with extensive peritoneal carcinomatosis. Histologic examination showed malignant fibrous histiocytoma of ovary with predominant myxoid stroma. Microscopic examination showed a highly cellular neoplasm composed of fibroblast-like cells with a predominant myxoid stroma and high pleomorphism and mitotic activity. Immunohistochemically, the tumor was negative for smooth muscle actin, desmin, S-100, pancytokeratin, c-kit, epithelial membrane antigen, and calretinin. Malignant fibrous histiocytoma of ovary is extremely rare, with only six previously reported cases. To the best of our knowledge, the myxoid type of malignant fibrous histiocytoma of ovary has not been previously reported in the English literature except for a case arising in a dermoid cyst of ovary. We present the case and briefly discuss the differential diagnosis.

卵巣皮様嚢腫が悪性転化しS状結腸に穿通した1例

卵巣皮様嚢腫が悪性転化しS状結腸に穿通した1例

The assessment of surgical techniques for laparoscopic cystectomy for ovarian dermoid cysts.

The assessment of surgical techniques for laparoscopic cystectomy for ovarian dermoid cysts.

Lipome utérin : à propos d’un cas possiblement lié à un traumatisme chirurgical

Uterine lipomas are uncommon. Several histology hypotheses are described. Ultrasound is firstly performed but diagnosis is sometimes difficult. Magnetic resonance imaging is more specific and helpful to make a differential diagnosis with a dermoid ovarian cyst. Despite those imaging exams we detail a case of a patient where a laparoscopic hysterectomy with bilateral salpingo-oophorectomy and preliminary adhesiolysis has been necessary to establish diagnosis. Among her medical history some previous abdominal surgeries could be the cause of this lesion.

Ovarian Dermoid Cyst Super-infected with Methicillin-sensitive Staphylococcus Aureus Leading to the Misdiagnosis of Appendicitis in an Adolescent

BackgroundMature cystic teratomas (dermoid cysts) are the most common ovarian tumor in adolescents. Super-infection of a dermoid cyst is a rare event usually associated with a concomitant infection. CaseA 14-year-old female was transferred to our institution with five days of fevers and abdominal pain. CT of the abdomen/pelvis was read as acute appendicitis with a 7.6 cm right adnexal dermoid cyst. The patient was treated for appendicitis but later found to have an infected dermoid cyst primarily infected with methicillin-sensitive staphylococcus aureus, which led the misdiagnosis of appendicitis. Summary and ConclusionSuper-infection of an ovarian dermoid cyst is an extremely rare event. We recommend that previously described evaluation, surgical management, and ovarian conservation be employed in all cases of ovarian dermoid cysts.

A Modified Technique to Reduce Spillage and Operative Time: Laparoscopic Ovarian Dermoid Cyst Enucleation ‘in a Bag’

Background: To describe the outcomes of a modified technique for conservative laparoscopic enucleation of ovarian dermoid cyst, placing the ovary in an endobag during enucleation to prevent intraperitoneal spillage. Methods: Laparoscopic dermoid cyst enucleation was performed in 35 cases of premenopausal patients placing the ovary in an endobag at the beginning of the procedure and removing the cyst from the abdominal cavity by the same endobag. Results: Dermoid cysts with a mean diameter of 6.3 ± 2.7 cm were enucleated and removed laparoscopically ‘in a bag’ without intra- or postoperative complications. Cyst rupture occurred in 10 cases (28.5%), but evident peritoneal contamination occurred in only 2 (5.7%; 95% confidence interval: 0.7–19.2%), because in 8 patients spillage was contained by the surrounding bag. The mean operative time was 64.6 ± 27 min. No signs or symptoms of peritonitis were observed. The mean postoperative hospitalization was 1.6 ± 1.4 days. Among the 12 infertile patients, 7 spontaneous pregnancies (58%) occurred. Conclusions: Laparoscopic conservative excision of dermoid cysts placing the ovary in an endobag at the beginning of surgery and removing the cyst by the same bag is a safe and effective approach to reduce intraperitoneal spillage and operative time.

Degenerating Uterine Myomas Mimic Ovarian Dermoid Cysts in a Postmenopausal Woman

Degenerating Uterine Myomas Mimic Ovarian Dermoid Cysts in a Postmenopausal Woman

OVARIAN DERMOID CYST

Objective: Mature teratoma is the most common germ cell tumor(and the most common tumor) of the ovary,composing more than 20% of all ovarian neoplasms. Super infection of dermoid ovarian cyst is very rare. Case report: A 72 years-old woman admitted to the gynecological outpatient clinic because of lower abdominal pain and fever. Gynecological examination and ultrasonography revealed a heterogeneous cystic mass in the right ovary. Abdominopelvic CT scan revealed a Right ovarian mass (15×15 cm) thought to be a dermoid cyst. Right adnexectomy was performed. The pathological evaluation suggested infected benign ovarian dermoid. Conclusion: Infection of a mature teratoma is a relatively uncommon event. However, based on our case and others, superinfection with abscess formation should be considered in the differential diagnosis whenever a patient with a documented pelvic mass and fever.

Does Prevention of Intraperitoneal Spillage When Removing a Dermoid Cyst Prevent Granulomatous Peritonitis?

Dermoid cysts are usually treated by ovarian cystectomy or oophorectomy. Less invasive laparoscopic treatment of dermoid cysts has replaced traditional laparotomy as the preferred surgical approach, but has been associated with a greater likelihood of accidental cyst rupture, intraperitoneal spillage of contents, and subsequent granulomatous (chemical) peritonitis. In the early 1990s, the use of an endoscopic retrieval bag placed under the cyst during surgery was introduced to minimize spillage into the peritoneal cavity. This retrospective study investigated whether use of the endoscopic bag among a population of patients undergoing laparoscopic surgery for ovarian dermoid cysts could prevent intraperitoneal spillage of cyst contents and postoperative granulomatous peritonitis. The study was conducted between 1982 and 2003 in 314 women with ovarian dermatoid cysts confirmed by histology as benign cystic teratomas. Data were analyzed from 2 groups of women: group 1 was comprised of 174 patients in whom endoscopic bags were not used (1983–1992), and group 2 consisted of 140 patients in whom endoscopic bags were used (1992–2003). The primary study endpoints were the incidence of cyst rupture with intraperitoneal spillage of contents and rate of postoperative granulomatous peritonitis in each group. Routine use of the bag during laparoscopy reduced the frequency of accidental cyst rupture compared to a total laparoscopic approach (group 1, no bag: 26/174 or 15% versus group 2, bag: 39/140 or 28%; P = 0.005). In group 1, the incidence of granulomatous peritonitis after intraperitoneal spillage was 8% (2/26). No cases of granulomatous peritonitis were reported in group 2. These findings demonstrate that routine use of an endoscopic retrieval bag during laparoscopic removal of ovarian dermoid cysts can minimize the risk of granulomatous peritonitis.

Expectant management of ultrasonically diagnosed ovarian dermoid cysts: is it possible to predict outcome?

The aim of this study was to assess the natural history of ultrasonically diagnosed ovarian dermoid cysts in a large group of women who were managed expectantly, and to assess the factors that were associated with failure of expectant management. Our database was searched for dermoid cysts diagnosed on ultrasonography by a single expert operator between 2001 and 2007 in this retrospective study. In women who opted for expectant management, demographic data including age, gravidity and parity were recorded. Indications for scan, site of cysts, dimensions and the outcomes of expectant management were also recorded. Two hundred and eighty-nine women were diagnosed with a total of 323 dermoid cysts by a single expert ultrasound operator. 93/289 (32.2%; 95% CI, 26.8-37.6%) women with 105/323 (32.5%; 95% CI, 27.4-37.6%) ovarian dermoid cysts were managed expectantly for longer than 3 months. The mean age at diagnosis was 33.8 (range, 13-79) years and the median duration of follow up was 12.6 (interquartile range, 7.6-29.3) months. The mean growth rate of dermoid cysts during follow up was 1.67 mm/year. There were no demographic or morphological features that could be used to predict the growth rate of dermoid cysts. After a period of expectant management, 24/93 (25.8%; 95% CI, 16.9-34.7%) women had surgical intervention. The risk of surgical intervention was significantly increased in younger women, those of parity > or = 2 and in women with bilateral cysts or larger-diameter cysts, and reduced in women with a past history of ovarian cyst. The success rate of expectant management of dermoid cysts is high and this approach should be considered as a viable alternative to surgical management.

Unreported location and presentation for a parasitic ovarian dermoid cyst: A case report

Dermoid cysts are one of the most common ovarian tumors especially in young patients; however, parasitic dermoid cysts are extremely rare with the most common site being the omentum. This case demonstrates a new site for parasitic dermoid cyst; on the reflection of uterovesical pouch onto the anterior abdominal wall which is known anatomically as the median umbilical fold, as well as previously unreported clinical presentation which is the perception of something moving inside the abdomen, that can be explained by the presence of the parasitic dermoid cyst close to the anterior abdominal wall in this case.

Does prevention of intraperitoneal spillage when removing a dermoid cyst prevent granulomatous peritonitis?

In this retrospective study of 314 patients undergoing surgery for ovarian dermoid cysts, conducted over a 20-year period, we evaluated the impact of the routine use of laparoscopic surgery without recourse to laparotomy to retrieve the specimen, using an endoscopic retrieval bag placed under the cyst to prevent intraperitoneal spillage of cyst contents, and subsequent postoperative granulomatous peritonitis. Accidental cyst rupture was more frequent when a total laparoscopic approach was used (26/174 or 15% versus 39/140 or 28%; P = 0.005), but there were no cases of intraperitoneal spillage when an endoscopic bag was used. Two cases of granulomatous peritonitis developed out of 26 women with intraperitoneal spillage of cyst contents (8%). We conclude that the risk of granulomatous peritonitis can be minimised by undertaking laparoscopic removal of dermoid cysts with the routine intraoperative use of an endoscopic retrieval bag to prevent intraperitoneal spillage of cyst contents.

Mature ovarian dermoid cyst invading the urinary bladder

Mature ovarian dermoid cysts are common lesions, accounting for up to 10-25% of all ovarian neoplasms. Uncomplicated dermoid cysts are often asymptomatic and are relatively easy to diagnose on imaging and to treat. Symptoms develop once complications set in and these may cause diagnostic dilemmas. Torsion (16%) is the most common complication, while rupture, suppuration and malignant transformation are relatively uncommon. Of all these complications, spontaneous rupture into the urinary bladder is least common. The diagnosis of this condition has been through the use of cystoscopy or laparotomy in all cases reported so far. We report a case of a 30-year-old patient with pyuria and dysuria, where ultrasound examination clearly demonstrated an ovarian dermoid cyst invading the urinary bladder. A clear-cut imaging diagnosis helped to allow planning of surgery in advance and a mucosa-sparing partial bladder resection could be performed.

Ovarian Dermoid Cyst Super-Infected With MSSA Leading to the Misdiagnosis of Appendicitis in an Adolescent

Background: Super-infection of a dermoid cyst is an extremely rare event. We report the case of a mature cystic teratoma primarily infected with methicillin-sensitive staphylococcus aureus (MSSA) that led to the misdiagnosis of appendicitis with subsequent appendectomy. The purpose of this report is to present a novel presentation of a super-infected dermoid cyst and review the appropriate pre-operative evaluation and surgical management of newly diagnosed ovarian masses in the adolescent population.

Seven years' experience in laparoscopic dissection of intact ovarian dermoid cysts

A large case series on laparoscopic removal of dermoid cysts with a diameter between 3 and 12 cm, via an endobag, is reported (127 cysts in 121 premenopausal women). The incidence of spillage and recurrence rate of laparoscopic ovarian dermoid cystectomy, the duration of the surgical procedure, the length of hospitalization, the incidence of recurrence and pregnancies was evaluated. In 2.5% of cases, the endobag ruptured during removal, and a total spillage rate of 12% was seen. No signs or symptoms of peritonitis were observed regardless of cystic spillage or not. Laparoscopic cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as an endobag is used and the peritoneal cavity is washed out thoroughly.

Local injection of various drugs for ovarian dermoid cysts at the time of laparoscopic ovarian cystectomy

Recently, surgical treatments for gynecologic benign diseases have become minimally invasive. Thus, in our department, we perform laparoscopic surgery for all cases in which benign tumors are diagnosed, with the exception of cases that are too difficult to treat laparoscopically, such as size or suspected malignancy. We have reported before the efficacy of local infusion of vasopressin for endometrial and dermoid cysts. However, the use of vasopressin for vasocontraction is not indicated and has the possibility for severe complications. Herein we reviewed the cases in which laparoscopic ovarian cystectomies were performed for ovarian dermoid cysts, into non-drug, vasopressin, and epinephrine groups, and examined retrospectively about the age, diameter of tumors, haemorrhage, and operative time. We examined the cases in which laparoscopic ovarian cystectomies were performed for ovarian dermoid cysts in our hospital between January 2005 and March 2009. We performed ovarian cystectomies by using 100X diluted vasopressin or 1,000,000X diluted epinephrine, locally infused into a crevice of walls of ovarian cysts and normal ovarian tissues. There were no significant differences between the three groups in age, diameter of tumors, and operative times. Significant differences were shown with respect to haemorrhage (36.2 ±38.4 ml for the non-drug group, 3.4±6.3 ml for the vasopressin group, and 12.5±23.1 ml for the epinephrine group). More research will be necessary to reduce the haemorrhage equivalent to the use of vasopressin, by modifying the concentration of epinephrine. In the future, we will change the level of epinephrine administration, and it is thought that it is necessary to review whether or not there is an equal reduction in the hemorrhage effect with vasopressin.