From the Guidelines
A dermoid, also known as a mature teratoma, is a type of benign tumor that typically presents as a cystic lesion containing skin, hair, and other tissue elements.
Key Characteristics
- Typically benign, with a low risk of malignancy 1
- May contain a variety of tissue elements, including skin, hair, and teeth 1
- Usually presents as a cystic lesion, which can be diagnosed using ultrasound 1
Management
- Treatment for dermoids usually involves surgical excision, with the goal of completely removing the tumor and its capsule to prevent recurrence 1
- In some cases, preoperative administration of anti-inflammatory medications such as prednisone (20-30 mg orally for 3-5 days) may be considered to reduce inflammation and facilitate surgical removal
- Postoperative management may include antibiotics such as cefazolin (1g intravenously every 8 hours for 24 hours) to prevent infection
Follow-up
- If not excised, dermoids can be safely followed with yearly ultrasound 1
- The risk of missing malignant degeneration is quite low, with a risk of malignancy in benign-appearing lesions on US managed conservatively with 2-year follow-up of 0.3% to 0.4% for malignancy and 0.2% to 0.4% for acute complications such as torsion or cyst rupture 1
From the Research
Definition and Composition of Dermoid Cysts
- A dermoid cyst, also known as a mature cystic teratoma, is a type of ovarian germ cell tumor that is composed of skin, hair, teeth, and sebum covered by thick fibrous tissue 2.
- These cysts contain tissue from three germ cell layers: ectoderm (skin, hair, brain), mesoderm (muscle, fat, teeth, bone, and cartilage), and endoderm (mucous and ciliated epithelium) 3.
- They are the most common type of ovarian germ cell tumor, usually occurring in the reproductive age group, and are commonly unilateral, but 10-12% can be bilateral 3.
Clinical Presentations and Complications
- Dermoid cysts can present with complications like torsion, rupture, infection, and autoimmune hemolytic anemia 2.
- Rupture of a dermoid cyst is a rare complication, and patients may present with peritonitis, which can be acute or chronic 2.
- Chronic peritonitis may not show any clinically distinguishable features, making the clinical diagnosis of a ruptured dermoid cyst difficult to make, and radiological assessment is crucial for accurate diagnosis and management 2.
- Malignant transformation in dermoid cysts is rare, and Squamous Cell Carcinoma (SCC) is the most common form, often occurring in large tumors and middle-aged women 4.
Diagnosis and Treatment
- Dermoid cysts are often evaluated using imaging techniques such as computed tomography, magnetic resonance imaging, pelvic ultrasonography, or transvaginal ultrasound 5.
- Laparoscopy and laparotomy are the two surgical procedures typically used to remove persistent or exceptionally large cysts 5.
- Leakage of cyst contents during surgery is a common postoperative complication that can seldom result in chemical peritonitis 5.
- Accurate diagnosis and extensive follow-up care are essential to reduce the risk of morbidity in patients with dermoid cysts 5.