Ovarian Dermoid Research Articles

Surgical Management of an Ovarian Bilateral Multiple Dermoid Cyst During Pregnancy: A Case Report Study

Introduction: Most ovarian dermoid cysts occur during the reproductive age and therefore could occur during pregnancy. They are present in 0.03% of pregnancies and the risk of torsion during pregnancy is approximately 8%. They are bilateral in approximately 10% of cases. Diagnosis is usually made by ultrasound imaging. An ovarian cystectomy is almost always possible, even if it appears that only a small amount of ovarian tissue remains. Intraoperative spill of tumor contents may be a cause of complications. Case Presentation: A 28-year-old, pregnant, primipara female with gestational age 20 weeks + four days where referred to with complaint of pelvic mass that was incidentally reported in sonography where referred to the hospital. She had undergone intact removal (without spillage) of cysts during pregnancy by laporotomy and histopathologic report confirmed bilateral, multiple, benign and dermoid cyst. She was discharged without any complication on the second day after operation. She had an uneventful pregnancy and a cesarean delivery with alive, normal, female fetus at 38 weeks of gestation because of breech presentation. Conclusions: It seems that early diagnosis and intact surgery of multiple ovarian dermoid cysts during the second trimester of pregnancy could prevent complication of cysts and probably guarantee the prevention of adverse pregnancy outcome.

Effect of ovarian dermoid cyst excision on ovarian reserve and response: Insights from in vitro fertilization

Abstract Study objective To investigate the impact of an ovarian dermoid cyst or dermoid cyst surgery on ovarian reserve in patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Design We performed a retrospective cohort study by using the records of patients with a history of ovarian dermoid cyst who underwent IVF/ICSI between 2009 and 2013. The antral follicle count (AFC) obtained by transvaginal ultrasound during controlled ovarian hyperstimulation of IVF/ICSI, total number of basal follicles [i.e., basal antral follicle count (B-AFC)], and dominant follicles greater than 1.4 cm [i.e., dominant antral follicle count (D-AFC)] were calculated between the different groups. Patients We included 260 patients with a history of dermoid cyst excision and 23 patients with a dermoid cyst who underwent IVF/ICSI. Two hundred and eighty-three matched patients without a dermoid cyst and ovarian surgery history were included. Intervention None. Measurements and main results The B-AFC was significantly smaller in the dermoid cyst group than in the matched control group ( p = 0.030). The B-AFC and D-AFC were both significantly smaller for the previously operated ovary than for the contralateral nonoperated ovary ( p = p = 0.018 and p = 0.004, respectively). The B-AFC and D-AFC were significantly fewer in ovaries treated by open surgery than in ovaries treated laparoscopically ( p = 0.031 and p = 0.028, respectively). There was no significant difference in the main IVF outcomes between the two groups or the subgroups. Conclusion Our results suggest that ovarian dermoid cyst excision could significantly reduce ovarian reserve to a similar extent as the cyst itself. The presence or resection of dermoid cysts will not affect the main IVF outcomes.

Outcomes After Intraoperative Rupture of Ovarian Dermoid Cysts in the Pediatric and Adolescent Population

Outcomes After Intraoperative Rupture of Ovarian Dermoid Cysts in the Pediatric and Adolescent Population

HDLive ultrasound images of ovarian dermoid cysts: diagnostic accuracy

Objective: To demonstrate that the use of 3D/4D HDLive increases the image quality in the diagnosis of benign cystic ovarian teratomas. Materials and Methods: 3D/HDLive ultrasound (US) was used in 31 cases of suspected ovarian cystic teratoma using vaginal 2D US. The following pathognomonic images of mature cystic teratomas were considered for diagnosis: 1) a cystic, unilocular lesion with a densely echogenic tubercle (Rokitansky nodule); 2) a diffuse or partially echogenic mass usually demonstrating sound attenuation; 3) fluid-fluid/fat-fluid levels; 4) dermoid mesh with hyperechogenic calcifications indicating the presence of bone, teeth, or other ectodermally-derived structure; 5) multiple mobile spherical structures (fat globules). Results: Dermoids present a wide spectrum of images depending on the predominant tissue type. In the vast majority of cases there are dense echogenic structures that correspond to complex masses of fatty tissue, sebum, hair, epithelial remnants, along with cartilage or bone. If we catalogue all the images together, the pathognomonic of dermoid are: 1) cystic or solid cystic lesions with a Rokitansky nodule, with bone, teeth or cartilage (six cases, 22.2%); 2) a solid mass with or without attenuation that corresponds with pure sebum (five cases, 18.5%); 3) a diffuse mass with fine bands that correspond with hair inside sebum (four cases, 12.9%) and that may form meshes or plugs corresponding with a mixture of fat, sebum, and hair (three cases, 11.5%). Conclusions: HDLive U.S. provides some images of exceptional quality that enhance the definition of the structures of these tumors (fat, hair, cartilage, bone, etc.) compared to 2D/3D/4D.

Laparoendoscopic single-site surgical cystectomy of a twisted ovarian dermoid cyst during early pregnancy: A case report and literature review

Abstract In pregnancy, the most frequently discovered ovarian tumor is mature cystic teratomas. Acute ovarian torsion in a pregnant patient is rare and is difficult to diagnose. Recent studies have demonstrated that laparoscopy during pregnancy is safe and confers many advantages over laparotomy. We report a patient with acute ovarian teratoma torsion treated with ovarian cystectomy via a single-port laparoscopy and review of the literature. A 17-year-old woman, gravida 1, in her 12 th week of pregnancy, came to our emergency room with severe abdominal pain and nausea. Torsion of ovarian teratoma (5 cm in diameter) was suspected. The patient underwent emergent laparoendoscopic single-site surgery (LESS) under general anesthesia, and the detorsed cyst was successfully excised and removed intact through the single port. This was enabled by the endobag technique, thus preventing spillage of the cyst content into the abdominal cavity. The fetus tolerated surgery well without complications and was term delivered uneventfully. The literature review revealed that the advantages of using LESS in pregnant patients are that this technology is safe for both the mother and the fetus, and it allows easy removal of specimen. However, it also has several drawbacks: technically challenging and limitation of working space. In conclusion, LESS seems to be a viable alternative to multiport laparoscopic surgery for the treatment of adnexal masses in pregnancy.

Ovarian Mature Cystic Teratoma: Challenges of Surgical Management.

Although ovarian mature cystic teratomas are the commonest adnexal masses occurring in premenopausal women, there are many challenges faced by gynecologists on deciding upon the best surgical management. There is uncertainty, lack of consensus, and variation in surgical practices. This paper critically analyzes various surgical approaches and techniques used to treat these cysts in an attempt to outline a unified guidance. MEDLINE and EMBASE databases were searched in January 2015 with no date limit using the key words “ovarian teratoma” and “ovarian dermoid.” The search was limited to articles in English language, humans, and female. The two authors conducted the search independently. The laparoscopic approach is generally considered to be the gold standard for the management. Oophorectomy should be the standard operation except in younger women with a single small cyst. The risk of chemical peritonitis after contents spillage is extremely rare and can certainly be overcome with thorough peritoneal lavage using warmed fluid. There is a place for surveillance in some selected cases.

当院における臍部からの卵巣皮様嚢腫搬出に対する工夫

腹腔鏡下での卵巣嚢腫の摘出は比較的手技が容易であるにもかかわらず，腹腔外への搬出が困難となる場合が多く，特に卵巣皮様嚢腫に関しては苦慮することが多い印象が見受けられる。当院では，7～10cm程度の卵巣嚢腫に対して，腹腔内で回収後に臍部12mmトロッカーからの搬出法に関して検討したので報告する。

Mature cystic teratoma of both the fallopian tube and contralateral ovary: a case report

Intratubal teratoma is a very rare condition. The authors believe to present the first case of a completely intratubal mature cystic teratoma with a contralateral intraovarian teratoma. Preoperative ultrasound examination allowed the intraoperative diagnosis of this rare condition, hence allowing appropriate surgical management. Materials and Methods: A 19-year-old woman presented with a history of pelvic pain and severe dysmenorrhea. Ultrasound examination initially suggested bilateral ovarian dermoids. Upon laparoscopy, the distal left fallopian tube was obstructed and contained an inflammatory mass adhered to the rectosigmoid. The left ovary was entirely normal. A contralateral intraovarian dermoid was also identified. Conclusion: Although rare, when an intratubal mass is identified, consideration of intratubal dermoid should be given. Preoperative ultrasound can be of critical importance to the intraoperative diagnosis.

Pale-Staining Anucleate Squames in Ovarian Dermoid Cyst Contents

Pale-Staining Anucleate Squames in Ovarian Dermoid Cyst Contents

Rapid acquisition axial and coronal T2 HASTE MR in the evaluation of acute abdominal pain

PurposeTo assess T2 HASTE MR in acute abdominal imaging and ascertain if it is a reliable alternative to CT in patients under 60. Method and materialsIn a prospective diagnostic performance study from January 2009 to December 2013, patients under 60 presenting with acute abdominal pain, that required imaging following surgical review, were imaged with T2 HASTE MR. Rapid acquisition HASTE (Half Fourier Acquisition Single Shot Turbo Spin Echo) coronal and axial sequences were obtained, without intravenous contrast. Patients were followed up clinically for a minimum of 3 months. Results468 cases included in the study. 349 were negative for acute abdominal pathology, 116 positive for acute abdominal pathology and 3 were indeterminate.In the MR positive group (n=116), 64 had surgery confirming findings (34 appendicitis, 14 SBO, 3 ovarian torsion, 3 LBO, intussusception, ovarian carcinoma, ovarian dermoid, 2 pelvic inflammatory disease, diverticular abscess, crohns, 4 endoscopy for acute bowel pathology) while 51 were managed conservatively with concordant follow up (4 SBO, 11 diverticulitis, 6 pelvic inflammatory disease, 7 inflammatory bowel disease, 7 colitis, 6 pyelonephritis, 2 cholecystitis, renal abscess, pseudomembranous colitis, splenic haematoma, mesenteric adenitis, 2 pancreatitis, lymphoma, epiploic appendagitis). 1 patient had an MR diagnosis of appendicitis but at laparoscopy a sigmoid diverticular perforation was diagnosed and the appendix was normal.In the MR negative group (n=349), 324 had uneventful follow-up, 22 had negative laparoscopies, while 3 had subsequent appendectomies, with appendicitis on histology (3 days, 10 days and 2 months post scan).In the MR indeterminate group (n=3), one was treated conservatively with uneventful follow up, one had laparoscopic appendectomy with normal appendix on histology, one had laparoscopic appendectomy with acute appendicitis on histology.When MR correlated with clinical follow up (n=468), overall diagnostic accuracy is 99% (463/468). When MR findings correlated with direct visualisation at surgery/endoscopy (n=90), sensitivity is 98% (95% CI) and specificity is 92% (95% CI). ConclusionThis study demonstrates that rapid acquisition axial and coronal T2 HASTE MR is a practical, safe and effective method in the diagnosis of acute abdominal pain.MR is the preferred option to CT in patients of an age prone to radiation with a potential surgical diagnosis. Clinical relevance/applicationMRI in acute abdominal imaging is both effective and practical and is the preferred imaging option in patients of an age prone to radiation with a potential surgical diagnosis.

OP03.01: Elastographic features of ovarian dermoid cysts

OP03.01: Elastographic features of ovarian dermoid cysts

A Rare Case of Huge Unilocular Autoamputated Extra-ovarian Dermoid Cyst

Ovarian dermoid cysts are one of the commonest benign, pelvic tumours. However, presence of dermoid cysts at extra-ovarian locations is very rare. The extra-ovarian dermoid cysts can be of ovarian origin or may also originate from non-ovarian sites like omentum, retroperitoneum, mediastinum, etc. We report one such rare case of extra-ovarian dermoid cyst observed in a 70-year-old postmenopausal woman at department of Gynaecology of our hospital. Her ultrasonographic observations showed a large well defined cystic lesion predominantly in the left adnexa extending into the midline with internal echoes within, which was later confirmed with MRI. Following this, she underwent a total abdominal hysterectomy with vertical midline incision. Intraoperatively, she was found to have a large tumour of 3.25kg (28cm x 26cm x 11cm) with adhesion to the omentum on its anterior upper and posterior aspects. The surface of the oval mass was smooth with few adherent lobules of fat in some areas. Its gross cut section showed a thick walled uniloculated cyst with yellow areas and thick creamy white fluid. Cyst wall had a bony hard area and two balls of hair were also noted in side. The pedicle of the tumour seen to arise from the left side broad ligament close to left ovary. Uterus was atretic with an intramural fibroid. The dermoid appears to be derived from its autoamputation from one of the pelvic organs; probably ovary. It is unique in its size and vastness occupying the major part of the lower half of the abdominal cavity.

Subtle Presentation of Bilateral Ovarian Dermoid Cysts With Unilateral Torsion: A Case Report

Majority of non-physiological tumors seen in pregnancy are mature cystic teratomas, also known as dermoid cysts. Their discovery in pregnant women poses a vexing problem as there are no established guidelines for their management and multiple factors need to be considered to decide the appropriate strategy. We are reporting a case of bilateral ovarian dermoid cysts in a pregnant woman who presented towards the end of her third trimester and was managed by careful observation until the day of elective cesarean section and bilateral cystectomy. During surgery the team was surprised to discover a torsed dermoid cyst. The striking features of this case were the subtlety of clinical presentation and the absence of typical signs associated with ovarian torsion. J Clin Gynecol Obstet. 2015;4(2):232-234 doi: http://dx.doi.org/10.14740/jcgo334w

Historical Concepts of Ovarian Dermoid Cysts

Documentation by of the Italian anatomist and pathologist, Giovanni Battista Morgagni [2], professor at Padua, led to the original publication of “The Seats and Causes of Disease” in 1761. To that authority, we go for the report on an old woman who had died in the Hospital in the year 1755. Her body, having been brought into the College, he dissected it personally. Now, as he carefully noted, “let us attend to the appearances which were seen in one of the ovaria”. Therefore, it is pertinent that he wrote thus: “The ovary was equal in size to a very large walnut, and was made up of white and thick membrane, including water”. Assuredly, this description fits the now well known simple ovarian cyst rather than the distinguishingly named “dermoid”.

Hip Pain - High School Track Athlete

HISTORY: 17 year old female track and cheer athlete presents to our sports medicine clinic with lateral and anterior left hip pain with snapping which had been present for 6 months. The lateral hip pain was worse with activity and associated with snapping. Anterior hip pain was deep and present even while at rest. No numbness or tingling. No fever or chills. She recalled no mechanism of injury or prior symptoms. She had been seen 4 weeks prior, diagnosed with trochanteric bursitis for her lateral pain, and treated with oral prednisone after declining an injection. She then attended formal physical therapy for pelvic stabilization, ASTYM and eccentric strengthening for her hip abductor /flexors. Despite these efforts, she had seen little improvement. PHYSICAL EXAMINATION: Tender to palpation on left greater trochanteric bursa and on the left hip flexor tendons. Decreased hip abduction strength on left with medial collapse on single leg squat. Tight IT band on the left compared to right. Full IR/ER ROM of the hip with no pain and negative impingement tests. No snapping palpated with ROM. Normal femoral pulses. No adenopathy. DIFFERENTIAL DIAGNOSIS: 1. Greater trochanteric bursitis/Gluteus medius tendinosis 2. Iliopsoas bursitis/Hip flexor tendinosis 3. Acetabular labral tear 4. Hip impingement 5. Femoral stress fracture 6. Ovarian dermoid cyst 7. Fecalith 8. Phebolith TEST AND RESULTS: AP pelvis with cross-table lateral of left hip -No significant hip abnormality is identified. -Triangular 1.1cm pelvic calcification of undetermined exact location and etiology. 45° and 90° Dunn views of pelvis -Normal Dunn views, opaque foreign body Repeat AP pelvis - 1 month -Similar to prior imaging, 1.1cm triangular calcification CT of pelvis with and without contrast -8.8x6.2x8.3cm mixed density mass arising from right ovary consistent with ovarian dermoid cyst FINAL WORKING DIAGNOSIS: 1. Ovarian dermoid cyst 2. Left hip pain secondary to ovarian dermoid cyst versus hip flexor tendinosis versus acetabular labral tear TREATMENT AND OUTCOMES: 1. Referral to OB/GYN for surgical consultation 2. Continue home exercise program of eccentric strengthening of hip flexors and abductors 3. Possible MRA of hip if hip pain not improved with surgical removal of dermoid cyst and proceed as clinically indicated after MRA

Ovarian Dermoid Cyst Causing Distal Ureteral Obstruction.

A case of a 45-year old woman with an ovarian dermoid cyst causing ureteric colic secondary to distal ureteral obstruction is reported. The dermoid cyst was observed on computed tomography to be adjacent to and compressing the distal left ureter and this was confirmed at surgical exploration. Following oophorectomy, the patient's symptoms completely resolved and the excised ovarian cyst was confirmed on pathological evaluation to be a dermoid cyst. This appears to be the first reported case of ureteral obstruction caused by an ovarian dermoid cyst in the English medical literature.

Removal of Ovarian Dermoid Cyst via Posterior Cul-de-Sac

Background: Most women who develop dermoid cysts are of reproductive age and require conservative fertility-sparing surgery. The surgical approach to a dermoid cyst was cystectomy via laparotomy until the laparoscopic surgery was developed. However, this approach may induce spillage of cyst contents into the peritoneal cavity, although risk of this complication has been reduced with technical advances. The vagina offers direct access to the peritoneal cavity and to any existing ovarian cyst. One vaginal approach is via the posterior cul-de-sac. Objective: The aim of this retrospective study was to investigate surgical management of ovarian dermoid cysts via the posterior cul-de-sac. Materials and Methods: This study was conducted in a gynecologist's private clinic. Thirty women with dermoid cysts were operated on vaginally via the posterior cul-de-sac without laparoscopic assistance. Preoperatively, the patients were counseled and written content was obtained for the surgery to be performed vaginally unless required otherwise, with preparations made to utilize laparoscopic assistance or, if necessary, even open the abdomen. After careful clinical examination and assessment under anesthesia, each patient's dermoid cyst was accessed via the posterior cul-de-sac and excised. Results: The vaginal route without laparoscopic assistance was successful in 29 women; 1 woman required laparoscopic assistance through a single port to push her dermoid cyst into the pouch of Douglas to make it accessible. To conserve the women's fertility, ovarian cystectomies were performed and healthy ovarian tissue was preserved. The postoperative hospital stay was 24 hours. No disposable equipment or instruments were used in the surgery. Conclusions: The vaginal route offers an excellent alternative to laparoscopic surgery and eliminates, in most cases, the need for invasive laparotomy. The vaginal route has the advantages of minimal invasion, shorter hospital stay, rapid recovery, and being the most economical option. (J GYNECOL SURG 31:8)

Dermoid Teratoma in a Fallopian Tube

Abstract Background: Dermoid teratomas are commonly found in the ovaries. On rare occasions a dermoid teratoma may develop in a Fallopian tube. Case: A 30-year-old woman was diagnosed to have a left ovarian dermoid teratoma, based on the findings of clinical and radiological examinations. On laparoscopy she was found to have a dermoid cyst arising from the fimbrial end of left Fallopian tube. Results: The patient recovered well postoperatively and is asymptomatic to date. On histopathology, she was found to have a mature teratoma. Conclusions: Mature cystic teratomas may arise from the Fallopian tube and are usually diagnosed intraoperatively. (J GYNECOL SURG 31:35)

Ovarian dermoid presenting as acute intestinal obstruction: a rare case report and review of literature

Teratomas are germ cell tumors mainly composed of multiple cell types derived from one or more of the 3 germ layers and they range from benign, well-differentiated (mature) cystic lesions to those that are solid and malignant (immature). Dermoid cysts of the ovary represent the most common form of benign ovarian tumor. Benign cystic teratomas of the ovary have been reported in wide age groups ranging from 1 to 91 years. Although ovarian dermoids remains asymptomatic for quite long time yet rarely, serious complications occur that result in life-threatening events such as bowel perforation. The most common complication associated with dermoid cysts is torsion. In contrast, rupture, infection and secondary malignant change are uncommon complications and dermoid cysts only very rarely present with bowel involvement. The case under report is that of 25 years old lactating female who delivered a full term baby 12 weeks back and presented to hospital with features of acute intestinal obstruction. The case is being reported due to rarity of its presentation.

Subtle Presentation of Bilateral Ovarian Dermoid Cysts With Unilateral Torsion: A Case Report

Subtle Presentation of Bilateral Ovarian Dermoid Cysts With Unilateral Torsion: A Case Report