What are the symptoms of a dermoid cyst?

Symptoms of Dermoid Cyst

Dermoid cysts typically present as a pelvic mass in younger women, often with minimal or no symptoms until they reach a significant size or develop complications.

Common Presentations

Dermoid cysts (mature cystic teratomas) can present with various symptoms depending on their location, size, and whether complications have occurred:

Primary Symptoms

• Pelvic mass (most common presentation) 1
• Abdominal pain (often intermittent) 2
• Palpable abdominal mass 2
• Usually asymptomatic until they grow larger or develop complications 2

Symptoms Based on Location

• Ovarian dermoid cysts (most common location):

  • Often asymptomatic and incidentally detected
  • May cause pressure symptoms when large
  • Can present with acute pain if torsion occurs

• Other locations (less common):

  • Skin/subcutaneous: Visible swelling, sometimes with a sinus tract that may discharge white tofu-like material 3
  • Head and neck region: Visible swelling or mass 4
  • Sublingual: Difficulty swallowing or mild respiratory problems when large 5
  • Lower limb: Visible mass or swelling 6

Complications

• Torsion (twisting of the cyst)
• Rupture (causing inflammatory response)
• Hemorrhage (bleeding into the cyst)
• Infection 2

Diagnostic Features

Dermoid cysts have characteristic features on imaging that help with diagnosis:

• Ultrasound: May show characteristic appearance with fatty and calciferous content 1
• MRI: Signs of fatty and calciferous content are pathognomonic for dermoid cysts 1
• CT scan: May show well-defined hypodense lesions 2

Special Considerations

1. Age: Dermoid cysts account for 20% of all ovarian tumors and are most common in younger women of reproductive age 1

2. Monitoring: For typical dermoid cysts less than 10 cm in premenopausal patients, follow-up at 8-12 weeks may be recommended, with annual surveillance if not surgically removed 1

3. Risk factors: In postmenopausal women, there is a higher risk of malignancy or malignant transformation, requiring closer monitoring 1

4. Warning signs: Changes in morphology or developing vascular components within the lesion require further evaluation 1

Management Approach

The management of dermoid cysts depends on their size, location, and patient characteristics:

• Smaller cysts (<10 cm) in premenopausal women may be monitored
• Surgical excision is often recommended, especially if:
  • The cyst is large (>10 cm)
  • There are symptoms
  • There is concern for malignancy
  • The patient is postmenopausal 1

For ovarian dermoid cysts, fertility-preserving surgery is recommended in younger patients 1.