Dermoid Cyst

INTRODUCTION:
  • A dermoid cyst is a teratoma of a cystic nature that contains an array of developmentally mature, solid tissues. 
  • Most common in skull
  • It frequently consists of skin, hair follicles, and sweat glands, while other commonly found components include clumps of long hair, pockets of sebum, blood, fat, bone, nails, teeth, eyes, cartilage, and thyroid tissue.
  • As dermoid cysts grow slowly and contain mature tissue, this type of cystic teratoma is nearly always benign. 
  • In those rare cases wherein the dermoid cyst is malignant, a squamous cell carcinoma usually develops in adults, while infants and children usually present with an endodermal sinus tumor
TYPES:
  • Ovarian dermoid cysts
  • Dermoid cyst of ovary contains derivatives from all 3 germ layers Endoderm,Mesoderm & Ectoderm
  • Most comon benign ovarian neoplasm.
  • Mostly affect women of reproductive age group.
  • Morphologically dermoid cyst is unilocular with smooth surface.
  • Ovarian mass in x-ray pelvis showing a radio-opaque shadow suggest Dermoid cyst
  • On cross section — cysts are unilocular and typically contain are area of localised growth that prottectes into the cystic cavity called as Rokintansky protuberance / dermoid process.
  • Frequently undergo torsion
  • Its size is Commonly more than 10 cm 
  • It contains sebaceous material and hair with teeth. bone, cartilage, thyroid tissue.
  • If teeth or bone are seen in X-ray in adnexal mass, this finding is pathognomic for teratoma.
  • Dermoid cyst are bilateral in 12% to 15% and frequently arise in association with mucinous cystadenomas.
Periorbital dermoid cysts
  • Dermoid cysts can appear in young children, often near the lateral aspect of the eyebrow. 
  • An inflammatory reaction can occur if a dermoid cyst is disrupted, and the cyst can recur if it is not completely excised.
  • Sometimes complete excision is not practical if the cyst is in a dumbbell configuration, whereby it extends through a suture line in the skull.
  • Dermoid cyst symptoms are minor and the cysts are usually painless.
  • They are not harmful to a child’s health. 
Spinal dermoid cysts
  • Benign ectopic growths thought to be a consequence of embryology errors during neural tube closure.
  • Dermoid cysts more often involve the lumbosacral region than the thoracic vertebrae and are extramedullary presenting in the first decade of life.
  • Acquired or iatrogenic dermoids may arise from the implantation of epidermal tissue into the subdural space i.e. spinal cutaneous inclusion, during needle puncture (e.g. lumbar puncture) or during surgical procedures on closure of a dysraphic malformation.
  • Spinal abnormalities, e.g. intramedullary dermoid cysts may arise more frequently in the lumbosacral region (quite often at the level of the conus medullaris) and may be seen with other congenital anomalies of the spine including posterior spina bifida occulta as identified by the neuroradiological analysis
TREATMENT:
  • Treatment for dermoid cyst is complete surgical removal, preferably in one piece and without any spillage of cyst contents. 
  • Marsupialization, a surgical technique often used to treat pilonidal cyst, is inappropriate for dermoid cyst due to the risk of malignancy.
  • Most references state that it is more feasible to treat bilateral dermoid cysts of the ovaries discovered during pregnancy if they grow beyond 6 cm in diameter. This is usually performed through laparotomy or very carefully through laparoscopy and should preferably be done in the second trimester i.e At 14-16 weeks
Exam Question
  • Ovarian mass in x-ray pelvis showing a radio-opaque shadow suggest Dermoid cyst
  • Dermoid cyst of ovary is teratoma Frequently undergo torsion
  • Most common ovarian tumour in pregnancy is Dermoid cyst 
  • Dermoid cyst of ovary contains derivatives from all 3 germ layers Endoderm,Mesoderm & Ectoderm
  • Dermoid cyst is Commonly more than 10 cm
  • Dermoid cyst Has sebaceous material
  • Dermoid cyst diagnosed during pregnancy should be removed surgically at 14-16 week
  • Dermoid cyst are commonly seen in skull
  • Most common orbital cyst in children is dermoid cyst

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