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Computed tomography and magnetic resonance imaging findings in cases of dermoid cyst coexisting with surface epithelial tumors in the same ovary.

OBJECTIVE: The purpose of this work was to describe the computed tomography (CT) and magnetic resonance imaging (MRI) findings in cases of dermoid cysts coexisting with surface epithelial tumors in the same ovary. METHODS: The pathologic reports of 141 dermoid cysts, 97 mucinous and 35 serous tumors were reviewed. The CT and/or MR images in the cases with a dermoid cyst and a surface epithelial tumor coexisting in the same ovary were analyzed. RESULTS: Eleven cases of mucinous tumors (6 benign, 3 low-grade, and 2 malignant) coexisted with dermoid cysts. Mucinous tumors were found in coexistence with 11.3% of dermoid cysts, and dermoid cysts were found in coexistence with 7.8% of mucinous tumors. In 10 cases, 3 radiologic patterns were observed: small fatty foci in the septa of the cystic tumor, an adjacent fat-containing component and a septated cystic component, and a dermoid cyst with no detectable mucinous tumor component. No histopathologically specific differences were observed between these groups. Small amounts of mucinous components were difficult to detect, but small fatty foci were easily detected. In 1 case, mucinous carcinoma formed a mass lesion in the wall of the dermoid cyst. CONCLUSIONS: The coexistence of these two neoplasms was not rare. If a dermoid cyst accompanies a multiseptated cyst and if the multiseptal cyst contains fatty foci, these two components may be associated. Recognizing the potential for the coexistence of these two neoplasms in the same ovary is essential for making a correct diagnosis.

Adolescent↗

True lateral dermoid cyst of the floor of the mouth.

Congenital dermoid cysts of the floor of the mouth are relatively rare but when they occur, they do so inevitably in the midline. We present a case of a true lateral dermoid cyst of this region without any intra-oral extension. We discuss the anatomical and histological classification of dermoid cysts within the floor of the mouth.

Adult↗

Cerebellar abscesses secondary to occipital dermoid cyst with dermal sinus: case report.

BACKGROUND: Hydrocephalus and cerebellar abscesses as the principal manifestations of posterior fossa dermoid cyst are rare. In addition, extradural dermoid cyst of the posterior fossa has been described in only 9 cases in the literature. We present an unusual case of obstructive hydrocephalus due to cerebellar abscesses induced by an adjacent extradural dermoid cyst with complete occipital dermal sinus. CASE DESCRIPTION: A 14-month-old child presented with acute raised intracranially pressure, seizures, and meningitis. Neuroradiological studies revealed cerebellar cysts with ring enhancement associated with a contiguous occipital cyst, with compression of the adjacent cisterns and the fourth ventricle causing hydrocephalus. The diagnosis of cerebellar abscesses with congenital occipital defect was briefly entertained. The patient was treated by radical excision of the occipital cyst with hair contents, the dermal sinus, and the abscesses through a suboccipital approach, followed by systemic antibiotic therapy with a good outcome. Pathologic examination revealed a dermoid cyst. CONCLUSION: Posterior fossa dermoid cyst should be considered in all children with occipital skin lesions, especially dermal sinus. CT scan and MRI are the methods of choice for further investigation of suspect congenital dermal lesions. Neurosurgical treatment of these malformations should be planned early to prevent the high incidence of infections such as bacterial meningitis and cerebellar abscess. Clinical presentation, diagnostic evaluation, and treatment of these rare lesions are reviewed.

Brain Abscess↗

Pediatric dermoid cysts of the head and neck.

OBJECTIVE: To review the characteristics and determine treatment outcomes of pediatric dermoid cysts. STUDY DESIGN AND SETTING: Retrospective review of the presentation, diagnosis, treatment, and outcomes of all pediatric dermoid cysts of the head and neck examined between 1980 and 2002 at Mayo Clinic. RESULTS: Forty-nine patients (59% girls) had a dermoid cyst of the head and neck. The median age at diagnosis was 22 months. The most common presenting sign was a palpable mass, noted in 100% of patients. During evaluation, approximately 25 patients (51%) had imaging studies. The most common location of the cysts was periorbital (61%), followed by the neck (18%; including 1 submental cyst). Various surgical approaches were chosen. In 2 patients (4%), the dermoid cyst had an intracranial extension. Only 1 patient experienced recurrence. The median pathologic diameter of the cysts was 1.2 cm. CONCLUSIONS: Dermoid cysts are unusual neoplasms that often present in childhood, with the orbit being the area most commonly affected in the head and neck region. Imaging studies help rule out an intracranial or intraorbital extension. With complete excision, recurrence is unusual. Significance Our review will assist both primary care physicians and subspecialists in diagnosing and treating dermoid cysts.

Adolescent↗

The efficiency of ultrasonography in the diagnosis of dermoid cysts.

The aim of the study was to assess the efficiency of sonography in differentiating dermoid cysts of the ovary (mature cystic teratoma) from other adnexal masses. It was carried out prospectively at Dr. Zekai Tahir Burak Women's Hospital of Ankara, Turkey. 943 women with 1035 adnexal masses who had undergone laparotomy and/or laparoscopy between January 1989 and March 1995 were included into the study group. All of these patients had a sonographic preoperatively examination within one week of surgery and the sonographic diagnosis was compared to histopathological findings. The visualization of: 1. echogenic mass with or without acoustic shadowing or enhancement (assumed to represent sebum with lipophilic contaminants or with hair) 2. Dermoid plug; layered lines and dots; fat-fluid level; isolated brigth echogenic foci with acoustic shadowing within the complex mass (assumed to represent Rokitansky protuberance; hair in low viscosity fluid; sebum as a supernatant of serous fluid; teeth or bone fragments respectively) 3. intraovarian echogenic mass with or without acoustic shadowing or enhancement (assumed to represent intraovarian dermoid cyst) were chosen as characteristical sonographic findings of dermoid cysts. Combining these with the subjective visual assessment of the operator, the sensitivity and the specificity were calculated for each visualized adnexal mass to assess the efficiency of sonography in differentiating dermoid cysts from other ovarian masses. All in all 1035 adnexal masses were visualized, 155 were suspected to be dermoid cysts and the diagnosis was confirmed by histopathology in only 147 cases. The sensitivity and specificity of sonography were 94% and 99% respectively. As a conclusion this study demonstrates that ultrasonography has an accuracy of 98% in differentiating dermoid cysts from other adnexal masses with a specificity of 99%.

Adolescent↗

Persisting intraventricular fat-fluid levels following surgery on a ruptured dermoid cyst of the posterior fossa.

Intracranial dermoid cysts occasionally rupture spontaneously into the ventricles or into the subarachnoid space. In such cases, intraventricular fat-fluid levels are invariably evident at computed tomography and may even be visible on a conventional radiograph of the skull. A case is described in which fat was observed to remain in the ventricles long after surgical removal of a dermoid cyst. We think that this fat, by causing obstruction of the cerebrospinal fluid pathways, should be regarded as a potential cause of intermittent elevation of intracranial pressure.

Adult↗

Dermoid cyst mimicking hematoma in the posterior fossa.

Intracranial dermoid cysts are usually reported to be associated with long lasting or waxing-waning symptoms. Computer tomography (CT) scans usually depict such neoplasms as well-defined areas of low density. This report is about a case of a dermoid cyst, the acute clinical features and CT hyperdensity of which mimicked a hematoma in the posterior fossa. The association of acute onset with CT hyperdensity makes this case of dermoid cyst very unusual.

Adult↗

Orbital dermoid cysts: clinicopathologic correlations, classification, and management. The 1997 Josephine E. Schueler Lecture.

The dermoid cyst is one of the most common space-occupying orbital lesions, but there has been no large series that details the clinical, pathologic, and therapeutic aspects of this condition. Furthermore, despite the various presentations and types of dermoid cysts, there is no clinically applicable classification of these lesions. We performed a retrospective histopathologic study of 197 consecutive orbital and periorbital dermoid cysts excised at Wills Eye Hospital during a 32-year period, correlated the histopathologic findings with the recorded clinical and radiographic observations, and devised a clinically applicable classification of orbital dermoid cysts. The mean age at excision was 17 years (range, 5 months to 85 years), and the most frequent clinical finding was a painless subcutaneous mass, present in 89% of cases. In 72% of patients, the mass was located in the superotemporal orbital region and produced no abnormalities of vision or intraocular pressure. Computed tomography and magnetic resonance imaging, performed mainly in the more recent cases, disclosed a characteristic round to ovoid cystic lesion with a well-defined lining. Histopathologically, 165 of the cysts (84%) were lined by keratinizing, stratified squamous epithelium. Ten (5%) were lined by nonkeratinizing epithelium resembling conjunctival epithelium. Hair shafts were present in the wall or lumen of the cyst in 195 (99%) of specimens, sebaceous glands in 148 (75%), and sweat glands in 39 (20%); inflammation was present in 75 cases (38%). Based on these personal observations and a review of the literature, a classification of orbital dermoid cysts is proposed that we believe will provide guidance for the ophthalmologist in the management of these lesions.

Adolescent↗