From the Guidelines
For a left ovarian dermoid cyst that has grown from 2.5 cm to 4.5 cm, yearly US surveillance is recommended, as the risk of malignancy in sonographically diagnosed dermoids is quite low 1.
Management of Dermoid Cysts
The management of dermoid cysts is primarily focused on monitoring their growth and assessing the risk of malignancy. According to the American College of Radiology (ACR) Appropriateness Criteria, sonographically diagnosed dermoids can be safely followed with yearly US surveillance 1. This approach is supported by a recent study by Gupta et al, which demonstrated that the risk of malignancy in classic "benign"-appearing lesions, including dermoids, is less than 1% 1.
Risk of Malignancy
The risk of malignancy in dermoid cysts is low, but it increases with the size of the cyst. However, for cysts less than 10 cm, the risk of malignancy is still relatively low 1. A recent meta-analysis by Parazzini et al found that the risk of malignancy in unilocular cysts, including dermoids, was 0.6% 1. Therefore, for a cyst that has grown from 2.5 cm to 4.5 cm, the risk of malignancy is still considered low.
Surveillance vs. Surgery
While surgical removal of the cyst is an option, it is not necessarily recommended for all cases. The ACR Appropriateness Criteria suggest that sonographically diagnosed dermoids can be safely followed with yearly US surveillance 1. Surgery may be considered if the cyst is large, if there are concerns about malignancy, or if the patient is experiencing symptoms. However, for a cyst that is 4.5 cm in size, surveillance is a reasonable approach.
Key Points
- Yearly US surveillance is recommended for sonographically diagnosed dermoids 1.
- The risk of malignancy in dermoid cysts is low, but it increases with the size of the cyst 1.
- Surgery may be considered if the cyst is large, if there are concerns about malignancy, or if the patient is experiencing symptoms.
- For a cyst that has grown from 2.5 cm to 4.5 cm, the risk of malignancy is still considered low, and surveillance is a reasonable approach 1.
From the Research
Management of Growing Left Ovarian Mature (Dermoid) Cyst
- The management of a growing left ovarian mature (dermoid) cyst, increasing in size from 2.5 cm to 4.5 cm, typically involves laparoscopic surgery 2, 3, 4, 5.
- Laparoscopic cystectomy or salpingo-oophorectomy are common procedures used to treat dermoid cysts, with the choice of procedure depending on the size and location of the cyst, as well as the patient's overall health 2, 3, 4.
- The risk of complications, such as torsion, rupture, and malignant transformation, increases with the size of the cyst, making timely treatment important 2, 6.
- Laparoscopic surgery has been shown to be a safe and effective treatment for dermoid cysts, with minimal risk of chemical peritonitis and other complications, even in cases where the cyst is ruptured or spilled during surgery 2, 3, 5.
- The use of laparoscopy allows for a shorter hospital stay, less postoperative pain, and a faster recovery time compared to traditional open surgery 4, 5.
Factors to Consider in Management
- The size of the cyst is an important factor in determining the best course of treatment, with larger cysts potentially requiring more extensive surgery 2, 3.
- The risk of rupture and spillage of the cyst contents during surgery is higher for larger cysts, but this can be minimized with proper surgical technique and postoperative care 2, 5.
- The patient's overall health and medical history should also be taken into account when determining the best treatment plan 3, 4.