Ovarian skin cyst (dermoid cyst) is a type of benign neoplastic lesion (teratoma) found in the small pelvis. Usually, the course is asymptomatic, which makes it difficult to recognize and implement adequate therapeutic management. What are the causes of an ovarian dermal cyst and how is it treated?
Ovarian skin cystis an example of a benign ovarian tumor - mature teratoma. Usually the problem is with young girls. The formation of a cyst is also associated with the embryonic period, when the primary sex cells travel along the mid-body cavity to reach the ovarian germs in the 4th week of pregnancy.
Ultimately, this is where the cells mature into eggs. It happens, however, that at this stage some of them undergo changes in the field of carcinogenesis, i.e. the formation of neoplasms, an example of which is a dermoid cyst. The original cell may then eventually turn into a sex cell, a cancer cell, or an ectoderm-derived completely different cell.
This multi-functionality in medical nomenclature is called a multi-potential structure. Therefore, it should come as no surprise to the final composition of the dermal cyst: secretory glands, sometimes hair or tooth fragments.
In many situations, this is an accidental discovery during a pelvic ultrasound. Sometimes there are discrete ailments, but they are not very characteristic.
These may be abnormal vaginal bleeding or pain in the lower abdomen. The management of an ovarian dermal cyst is primarily surgical and involves the removal of the lesion, currently mainly by means of a laparoscopic technique, and the prognosis itself is very good.
Dermoid cyst symptoms
In most cases, no pathognomonic symptoms are observed. But patients can report:
- pain in the lower abdomen
- breakthrough bleeding
- abdominal discomfort - heartburn, nausea
- pain in the lumbar spine
You should always be aware of the risk of symptoms exacerbation, which is an indication for urgent surgical intervention.The main symptoms of a rapid rupture of the lesion are severe abdominal pain resembling acute appendicitis, peritoneal symptoms (excessive palpation, board-like abdominal integuments), sometimes general symptoms such as fever, chills.
How to recognize an ovarian dermal cyst
The diagnosis of a dermoid cyst is usually accidental, either during pelvic ultrasound or during surgery for some other reason. Morphologically, it is an encapsulated tumor, filled with a yellow mass, very often containing fragments of other tissues, most often teeth. Naturally, it can only be presumed on the basis of its appearance that it is a dermal cyst. The final diagnosis can be made on the basis of the histopathological examination result. Although a skin cyst is benign, you should be aware that there is a risk of potential malignancy.
Treatment of a skin cyst
The procedure of choice is the surgical removal of the pathological structure by laparoscopy. It happens that the change is so extensive that it requires the removal of the entire ovary. The surgical procedure is indicated in particular when we are dealing with complications of a dermal cyst, i.e. evacuation of the contents of the cyst with the development of peritonitis, or the recurrence of the lesion despite its previous removal. Other pathologies that may result from the presence of an ovarian dermal cyst include: torsion of the cyst stem with necrosis of the appendages, purulent state of the cyst that may lead to rupture of the capsule.
Sometimes a dermoid cyst is the starting point for squamous cell carcinoma. With such suspicion, it is suggested to determine the level of the Ca-125 marker, although the increased value does not give 100% certainty about the malignancy of the lesion. Sometimes an increase is seen in the course of endometriosis or inflammation of the appendages.
Worth knowingSuspicion of mature teratoma
Mature teratoma develops in utero, but is diagnosed much later, usually between 20 and 40 years of age, occasionally in old age. The typical localization is the ovary, sometimes even bilateral occurrence is observed. Due to the transmission of cells in the embryonic life along the midline cavity of the body, it is sometimes possible to identify teratoma in the oral cavity, in the form of encapsulated lesions in the brain structures, and in rare cases even inside the spinal cord. Women are much more predisposed to the formation of dermal cysts, but the occurrence of this type of pathology in men is not ruled out. The kernels are then busy.