Case 8/Picture 10 (23.11.2013.) Could you identify the picture?Answer
This is a picture of Dermoid cyst. Dermoid Cyst (Benign germ cell ovarian cyst)
* Occurs due to differentiation (change) of totipotent (that could form any tissue) germ cells into embryonic tissues.
* Most common in young women with a median age at presentation of 30 years.
* Commonest neoplastic ovarian cyst during pregnancy (90% of cysts in pregnancy is corpus luteal cyst that is not meoplastic).
* Bilateral in about 11%.
* Contents – Yellowish or brownish-grey greasy sebaceous material, hair, teeth and nervous tissue (ectodermal); thyroid (5-20%), intestinal and bronchial tissues (endodermal); osseus tissue and smooth muscle (mesodermal).
* Symptoms – Asymptomatic (60%, majority), abdominal swelling, pain, dyspareunia (painful sex), backache, urinary symptoms etc.
* Diagnosis is usually suggested by ultrasound. * Complications – Torsion (3.5-10%), rupture (1-4%; hair coming with urine if rupture occurs into the bladder), chemical peritonitis and chronic granulomatous peritonitis (in case of rupture – spontaneous or peroperative), infection, impaction in the pelvis causing obstructed labour in pregnancy, malignant (cancerous) change etc. Rupture is more common during pregnancy due to pressure from the enlarging uterus or trauma during delivery.
* Malignant (cancerous) change in 1-2%.
* Treatment – Removal of the cyst by open surgery. The place of laparoscopy is debatable as it would be difficult to remove the cyst intact, but it is not absolutely contraindicated. There is no medicine to treat it.
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