Dermoid Cyst of Ovary Brian Lee March 2013 Dr. Joy Sclamberg.

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Presentation transcript:

Dermoid Cyst of Ovary Brian Lee March 2013 Dr. Joy Sclamberg

Case Presentation – MRN: HPI: 46F presents with abdominal pain x1 week. Improved with NSAIDs initially but unremitting after. + nausea/emesis, BRBPR PE: Abd: Mildly tender in RLQ and LLQ, + rebound tenderness Vaginal: Large mass noted in left adnexal region extending medially, mildly tender. ~10cm. Labs: CMP - normal, CBC - normal, lipase – normal DDX: Diverticulitis, Ovarian Cyst, Ruptured Ectopic Pregnancy, Appendicitis

Imaging 3 Options: US Pelvic/Transvaginal, CT Abdomen/Pelvis, MRI Pelvis

Pelvic Diagram 4

Right Adnexa US Sagittal

Right Adnexa US Transverse

Right Adnexa US Sagittal Doppler

Left Adnexa US Sagittal

Left Adnexa US Transverse

Left Adnexa US Sagittal Doppler

Left Adnexa US Sagittal

Left Adnexa US Transverse

Pelvic Mass US Sagittal ML-LT

Abdomen/Pelvis – Normal Image CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Axial

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Abdomen/Pelvis CT Coronal

Teratoma 30 Benign teratomas (or dermoid cysts) are germ cell neoplasms with differentiated tissues of all 3 germ cell layers in a complex pattern. Usually benign; however, differentiated dermoid cysts may become malignant and turn into squamous cell carcinomas. Can also torse or hemorrhage or become infected, causing emergent presentation. Diagnosis with imaging. Options include unilateral oophorectomy or salpingooophorectomy.

Follow-Up 31 1 week later: Laparoscopic left salpingooophorectomy. Normal appearing right ovary and tube. Left dermoid cyst about 11 cm in size, torsed around adnexa, unable to distinguish between ovarian and cystic tissue Path: Ovary with mature cystic teratoma (dermoid cyst). 135g, 11.5 x 7.0 x 5.0 cm bilobed cyst. The cyst is filled with tan gummous material and brown hair. The strictured area of the cyst is firm and calcified. The area of wall thickening has a hemorrhagic, tan cut surface with areas of caseation. No ovarian tissue is identified.

32 Thank You!