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PubMedDate not supplied

Laparoscopic management of ovarian dermoid cysts: a review of 47 cases.

BACKGROUND: Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary. In the recent years, transvaginal sonographic diagnosis of ovarian dermoid cysts together with laparoscopic approach have greatly improved the treatment of this benign lesion. We retrospectively reviewed the outcome of laparoscopic surgery for suspected ovarian dermoid cysts. PATIENTS AND METHODS: The preoperative findings, operative techniques and postoperative complications were retrospectively reviewed in women who underwent laparoscopic surgery for dermoid cysts, between January 2000 and May 2003. RESULTS: In 47 women aged 21 to 53 years (median, 38.8 years), 93.6% had a unilateral cyst with a diameter of 17 to 108 mm (median, 51 mm). Clinical presentations were pain (62%), abnormal vaginal bleeding (21%) and ovarian torsion (2%), whilst 17% were diagnosed incidentally during routine examination. Surgery included cystectomy (57%), total (36%) or partial oophorectomy (6.4%) and laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy (2%). During the cyst extraction, minimal spillage occurred in 42.5% of the cases and none developed chemical peritonitis. In 2 patients, conversion to laparotomy (4.3%) was required, one for sigmoid colon injury and one for malignant ovarian tumor detected via frozen section. The median operating time was 80 minutes (range, 35-180 minutes). CONCLUSION: Using strict adherence to guidelines for preoperative clinical assessment and intra-operative management, laparoscopic treatment of dermoid cysts appears to be a safe procedure.

Adult↗
PubMed1997

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women.

OBJECTIVE: To evaluate prospectively the evolution of ovarian dermoid cysts and the safety of nonsurgical management in premenopausal women. DESIGN: A prospective study. SETTING: Tertiary hospital-based ultrasonographic unit. PATIENT(S): Between 1985 and 1994, 72 premenopausal and 14 postmenopausal women had ovarian dermoid cysts < 6 cm in diameter diagnosed by ultrasound and were followed up at Kaplan Medical Center in Israel. INTERVENTION(S): Ultrasound examination was scheduled at 3 and 9 months after the initial diagnosis and then annually. Every cyst was measured in three planes. The growth rate of the cysts was calculated from the data gathered. MAIN OUTCOME MEASURE(S): Prospective evaluation of the evolution of dermoid cysts and the safety of nonsurgical management in premenopausal women by an ultrasonographic follow-up. RESULT(S): For the premenopausal and postmenopausal women, the mean age (+/-SD) at diagnosis was 32.3 +/- 8.2 and 61.1 +/- 6.9 years, the mean duration of follow-up was 34.5 +/- 21.6 and 35.3 +/- 26.8 months, the mean cyst size at diagnosis was 3.7 +/- 1.2 and 4.1 +/- 1.5 cm, and the calculated mean growth rate was 1.77 +/- 3.86 and -1.59 +/- 2.48 mm/y, respectively. The difference in the mean growth rate of the cysts between the two groups was statistically significant. The mean growth rate was significantly different from zero in the premenopausal group but not in the postmenopausal group. Twenty-eight women were delivered of 35 healthy infants without complications attributable to the dermoid cysts. The cysts were removed surgically in 24 of the 86 women (27.9%), and benign cystic teratomas were confirmed by histologic examination in all cases. CONCLUSION(S): Premenopausal women with ovarian dermoid cysts of < 6 cm in diameter can be safely managed expectantly, especially if pregnancy is desired. The mean growth rate of dermoid cysts in premenopausal women is 1.8 mm/y.

Adolescent↗
PubMed2006

Inguinal dermoid cyst of the round ligament. A case report and review of the literature.

INTRODUCTION: Dermoid cysts are rarely located in extraovarian sites, representing an extremely uncommon lesion of the round ligament. The differential diagnosis of an inguinal lesion that proved to be a dermoid cyst deriving from the round ligament is presented with a review of the literature. CASE REPORT: A case of a 27-year-old female with a dermoid cyst arising from the round ligament and lying inside the inguinal canal, which was tender and palpable, is reported. DISCUSSION: Underlining their origin, clinical manifestation, gross appearance and pathology, we differentiate dermoid cysts mainly from epidermoid cysts and mature cystic teratomas, analyzing the importance of such a distinction to the possibility of malignant degeneration and recurrence of a dermoid cyst in the round ligament.

Abdominal Neoplasms↗
PubMed1994

Dermoid cyst in the floor of the mouth. Review of the literature and case reports.

Dermoid cyst, frequently used to describe three closely related histologic cysts, the dermoid, epidermoid, and teratoma, is commonly considered a rare finding in the floor of the mouth. This review, which identifies 195 case reports of dermoid cysts in the floor of the mouth, has unveiled some findings that do not support conclusions expressed in previous articles. Examination of the literature includes muscle influence on clinical presentation and surgical approaches, locations, age distribution, histologic distribution, infection rate, incidence of multiple cysts, fibrous attachments, airway problems, anesthesia administration, surgical difficulties, and diagnostic aids. Brief suggestions in treatment are made in light of the clinical, radiographic, and historic findings. Three clinical cases are also included.

Adolescent↗
PubMed2001

Dermoid cyst of the caecum: case report.

Benign dermoid cysts of the caecum are rare. We present a case of benign dermoid cyst of the caecum and discuss the various explanations of pathogenesis. Various possible explanations exist, including embryological sequestration, implantation following surgery, squamous metaplasia of enterogenous cysts and teratoma. In this case there was also a finding of intratubular germ cell neoplasia of one testis, detected on follow-up studies on the patient. The significance of this is discussed.

Adult↗
PubMed2004

Case report of a dermoid cyst at the floor of the mouth.

The growth of dermoid cysts at the floor of the mouth is considered a rare condition. Typically, intra-oral dermoid cysts present as non-tender, slow growing masses at the sublingual, submental and submandibular region. We report a case of a young adult male who presented at our hospital with a sublingual cyst superimposed with acute infection and failed antibiotic treatment. The cyst was excised and confirmed histopathologically as a dermoid cyst with overlying acute inflammation. Clinical progress was uneventful and postoperative recovery excellent with no recurrence.

Adult↗
PubMedDate not supplied

[Malignant transformation of thyroid tissue in an ovarian dermoid cyst: case report].

INTRODUCTION: Mature cystic teratoma is the most common type of ovarian teratomas and also the most frequent tumor originating from germ cells. Usually unilateral, it is, by definition, composed of well-differentiated derivates which originate from all three layers. It is most frequently diagnosed in the female reproductive period; in its pure form, it is generally benign, but occasionally it may undergo malignant transformation in one of its elements. CASE HISTORY: The authors report a case of a 43-year-old woman who underwent a thyroid regulation substitutive therapy 12 years after thyroidectomy which had been performed because of Basedow's disease. On the occasion of her fourth delivery by cesarean section, bilateral cystical formations in both ovaries were found. Upon ending the delivery, the right ovary with the cyst was surgically removed, as well as part of the cystically changed left ovary. The pathohistological analysis of the samples taken from the left ovary cyst pointed to the following diagnosis: dermoid cyst of the ovary a mature cystic teratoma, whereas the samples from the cystic tumor of the right ovary were diagnosed as: ovarian teratoma malignant a papillary carcinoma of the thyroid tissue and cystadenoma papillare serosum ovarii. The histological type of the malignant thyroid tissue neoplasm in the teratoma was a papillary carcinoma consisting of papillary proliferations lined by cuboidal, cylindrical and pseudostratified epithelium with charasteristic "ground glass" nuclei, but without invasion into the blood vessels. DISCUSSION: Malignant transformation of the ectopic thyroid tissue, which is one of the elements of the ovarian cystic teratoma, is extremely rare: it is diagnosed on basis of the histological picture and criteria which are the same as for the tumor of the thyroid gland. One should not exclude a pssibility that the identical or different pathological alterations characteristic of the thyroid gland may also be detected in the ectopic thyroid tissue of a dermoid cyst. CONCLUSION: The reported case was chosen due to its complex and rich clinical and pathohistological picture characterized by the occurrence of a bilateral dermoid cyst with the malignant transformation of the thyroid tissue. The malignant neoplasm in the mature ovarian cystic teratoma was papillary carcinoma of the thyroid tissue with all histological properties typical for the thyroid gland carcinoma. The possibility of the malignant transformation of the endodermal thyroid tissue in the mature ovarian cystic teratoma and changes in the thyroid gland of the Basedow's disease type diagnosed before are without clear causation.

Adult↗
PubMed2003

Lateral distribution of ovarian dermoid cyst.

STUDY OBJECTIVE: To determine the distribution of ovarian dermoid cysts in a large series of women. DESIGN: Observational study (Canadian Task Force classification II-3). SETTING: University teaching hospitals. PATIENTS: Three hundred thirty-six women. INTERVENTION: Evaluation of operative reports. MEASUREMENTS AND MAIN RESULTS: Dermoid cysts had a mean diameter of 5.6 cm. They were present in the right ovary (48.8 %), left ovary (37.8%), and bilaterally (13.4%). Unilateral cysts were more frequent in the right ovary (56.4%) than in the left (p = 0.002, odds ratio 1.7, confidence interval 1.2-2.3). This was significantly different from the expected 50% (4.45, chi2). A similar predisposition was found when we included women with bilateral cysts (p < 0.01, OR 1.5, CI 1.1-1.9). Patient age and size of cyst did not differ between those with left and right lesions. CONCLUSION: In this large cohort of women, ovarian dermoid cysts had a predisposition to a right lateral location.

Adult↗
PubMed1998

Laparoscopic conservative excision of ovarian dermoid cysts with and without an endobag.

STUDY OBJECTIVE: To compare outcomes of conservative laparoscopic treatment of dermoid cysts removed from the abdominal cavity without (group A) and with an endobag (group B). DESIGN: Prospective, randomized, 4-year (June 1992-June 1996) study (Canadian Task Force classification I). SETTING: Department of Obstetrics and Gynecology of the Catholic University of the Sacred Heart in Rome. PATIENTS: Fifty-five premenopausal women with dermoid cysts. Intervention. Patients were randomly assigned to removal of dermoid cysts from the abdominal cavity with or without an endobag through a 10- to 12-mm cannula sleeve. MEASUREMENTS AND MAIN RESULTS: We assessed surgical time, spillage, complications, length of hospitalization, recurrences, and pregnancies. In the 55 women, 58 dermoid cysts (mean diameter 5.6 +/- 2.03 cm) were enucleated and removed at operative laparoscopy through a 10- to 12-mm cannula sleeve without intraoperative or postoperative complications. Mean operating time was 73 minutes. When cysts were removed with an endobag, operating time was significantly reduced over removal without the endobag (63 vs 81 min, p <0.05). Obvious spillage of endocystic contents occurred in 13 (43.3%) patients in group A but in only 1 patient in group B because the bag ruptured (p <0.05). No signs or symptoms of peritonitis were observed in women with evident cystic spillage or in those in group A in whom spillage was possible. Average postoperative hospital stay was 1.7 days and did not differ between groups. Among 20 infertile women, 9 (45%) experienced spontaneous pregnancy within a year, with no differences between groups. Echographic follow-up did not reveal cyst recurrence. CONCLUSIONS: Laparoscopic conservative cystectomy of dermoid cysts in premenopausal women is safe and effective and appears to be a valuable alternative to laparotomy. Removing cysts in an endobag significantly reduced both operating time and spillage. However, controlled intraperitoneal spillage of cyst contents does not increase postoperative morbidity as long as the peritoneal cavity is thoroughly washed.

Adolescent↗
PubMedDate not supplied

Laparoscopic management of ovarian dermoid cysts: ten years' experience.

OBJECTIVE: To determine the safety and efficacy of laparoscopic management of ovarian dermoid cysts based upon our ten years' experience. METHODS: Charts of 81 patients who underwent laparoscopic removal of dermoid cysts since March 1988 at Stanford University Medical Center or the Center for Special Pelvic Surgery in Atlanta were reviewed retrospectively. RESULTS: Ninety-three dermoid cysts with a mean diameter of 4.5 cm were removed in 81 patients. Operative techniques used were cystectomy for 70 cysts, salpingooophorectomy for 14, and 9 salpingo-oophorectomy with hysterectomy. Fifty-three cysts were treated via enucleation followed by cystectomy or salpingo-oophorectomy and removal through a trocar sleeve. Twenty-two were treated via enucleation and removal within an impermeable sack. Nine were treated via enucleation and removal by posterior colpotomy. Nine were removed via colpotomy following hysterectomy. We had a total of 39 spillages. Spillage rates varied with removal method: 32 (62%) for trocar removal without an endobag, 3 (13.6%) for removal within an endobag, and 4 (40%) with colpotomy removal. No spillage occurred for the nine patients who had a colpotomy done for hysterectomy. Mean hospital stay after surgery was 0.98 days, and there were no intraoperative complications. In one case, there was a postoperative complication of an incisional infection in the umbilicus. CONCLUSION: Including this and 13 other studies, review of the literature reveals a 0.2% incidence of chemical peritonitis following laparoscopic removal of dermoid cysts. Thus, we conclude that laparoscopic management of dermoid cysts is a safe and beneficial method in selected patients when performed by an experienced laparoscopic surgeon.

Adolescent↗
PubMed2003

Clinicopathological and immunohistochemical features of a sebaceous carcinoma arising within a benign dermoid cyst of the ovary.

Pure sebaceous neoplasms arising in dermoid cysts of the ovary are exceedingly rare. A 63-year-old female with abdominal swelling and pain underwent a right salpingo-oophorectomy that showed a unilocular cyst weighing 830 g and measuring 15x12x10 cm, filled with sebaceous material containing a few hair shafts. The cyst wall exhibited plaques protruding into the cavity of the cyst. Microscopy revealed a dermoid cyst with nests and lobules of atypical and infiltrating sebaceous cells surrounded by basaloid cells. The tumor cells stained diffusely for high-molecular-weight cytokeratins and focally for cytokeratin 7, cytokeratin 19, epithelial membrane antigen and carcinoembryonic antigen in the immunohistochemistry study. Low-molecular-weight cytokeratins, cytokeratin 20, vimentin, S100, p63, estrogen receptor, progesterone receptor, p53 and c-erbB-2 were negative in tumoral cells. The proliferative labeling index (Ki67 and proliferating cell nuclear antigen) was low. Basal cell carcinoma with sebaceous differentiation and sebaceoma must be considered in the differential diagnosis. However, the presence of obvious malignant sebaceous differentiation in nearly every tumor nest and lack of peripheral palisading and peri-tumoral myxoid stroma excluded these diagnoses. Some histogenetic concepts relevant to this case are discussed along with a brief review of this neoplasm. To our knowledge, this is the sixth case report of a sebaceous carcinoma arising in a mature cystic teratoma of the ovary.

Adenocarcinoma, Sebaceous↗
PubMed1998

Pineal dermoid cyst developing 18 years after gross total removal of a pineal mature teratoma.

A 21-year-old male presented with a pineal dermoid cyst manifesting as headache and diplopia. He had undergone gross total removal of a pineal mature teratoma 18 years before and had done well until recently. Diffusion-weighted magnetic resonance imaging showed a region of high signal intensity due to a round mass in the pineal region and extending into the trigone of the right lateral ventricle. Subtotal excision of the tumor was achieved. Histological examination showed an epidermoid cyst consisting of keratinized stratified squamous epithelium and connective tissue. Intraoperative observation had detected black hairs, so the diagnosis was dermoid cyst. The dermoid cyst may have arisen from a microscopic remnant of the cyst wall of the original pineal mature teratoma. The regrowth of a dermoid cyst 18 years after gross total removal of a mature cystic teratoma in the pineal region is exceptional. However, careful follow-up of patients who undergo gross total removal of a pineal teratoma is recommended for a period more than that of the patient's age at surgery plus 9 months.

Adolescent↗
PubMed1994

A new laparoscopic aspiration technique for ovarian dermoid cysts.

A new method for aspirating benign dermoid cysts enables removal of the collapsed cyst wall without the need for extending laparoscopic incisions or opening the pouch of Douglas. The technique has been used by one of the authors in 10 patients with good effect and minimal or no spillage of dermoid cyst contents into the peritoneal cavity.

Anti-Infective Agents, Local↗
PubMedDate not supplied

Dermoid cysts in camels.

In our experience the camel (Camelus dromedarius) seems to be affected more commonly by dermoid cysts as compared to other cutaneous cysts. However, apart from one reference (Monteverde, 1935), the dermoid cyst has not been reported in the camel. This report documents dermoid cysts in identical locations in 11 camels with two camels having bilateral dermoid cysts at the similar site.

Animals↗
PubMed2003

A case of large dermoid cyst in the floor of the mouth.

Dermoid cysts in the floor of the mouth are rarely observed. When they develop, they do not appear until they grow large enough or appear through infection. Some operative approaches and management have been performed to large dermoid cysts in the floor of the mouth with some variations. Intra-oral approach is the most useful for cosmetic appearance. We presented a 24-year-old female who underwent expedient surgical excision using finger end serviceable enucleation through the intra-oral approach.

Adult↗
PubMedDate not supplied

Dermoid cysts of the tongue: report of five cases and review of the literature.

Dermoid cysts of the tongue are uncommon. To date, there have been nine reported cases in the English language literature. In this article, we describe five cases accessioned at our institution over a 12-year period, two of which have previously been reported. The prevalence of dermoid cysts at our institution over this period was quite low. Of 324,042 surgical cases, 0.24% (765 cases) were dermoid cysts. Of these, five were from the tongue, representing only 0.7% of the dermoid cysts accessioned and 0.0015% of the total surgical specimens. The literature is reviewed and the possible origin of these lesions is discussed.

Adolescent↗
PubMed2004

[Case of presacral dermoid cyst].

A case report of a presacral dermoid cyst in an adult. A 39-year-old man visited our hospital because of lower abdominal pain. A soft mass was palpable on the right side wall of rectum. Computed tomographic (CT) scan, transrectal ultrasonography and MR imaging showed presacral cystic tumor with a diameter of 10 cm. The tumor was resected by using a sacral approach. It contained muddy substance and hairs. Histopathological examination showed that the tumor wall was made of stratified squamous epithelium with skin appendage. Hence, it was diagnosed as a dermoid cyst. After operation, wound infection and dehiscence occurred, but it healed after conservative treatment. Complete excision of developmental cysts is advised because of possibility of malignancy and infection.

Abdominal Neoplasms↗
PubMedDate not supplied

Intracerebral extension of nasal dermoid cyst: CT appearance.

We report on a 46-year-old man with a congenital nasal dermoid cyst that extended intracranially to form large bifrontal intraaxial dermoid cysts, which became secondarily infected through a nasal dermal sinus tract. Computed tomography demonstrated bilateral frontal lobe ring enhancing cystic masses containing fat-fluid levels consistent with dermoid cyst abscesses. Axial and coronal CT of the skull base and nose demonstrated a midline bony canal extending from two dimples on the dorsum of the patient's nose to the base of the anterior cranial fossa. The clinical, CT, and surgical findings are reviewed as well as the embryogenesis of congenital nasal dermoid cysts.

Brain Neoplasms↗