Dermoid Cyst Ovary Causes Notes

Cystic Swellings

A cyst is a swelling containing fluid. True cysts are lined by endothelium or epithelium. They contain clear serous fluid, mucoid material, pus, blood, lymph or toothpaste-like material. The false cysts do not have lining epithelium.

They can be degenerative cysts as in the case of tumours which undergo tumour necrosis or tumour degeneration, or may be merely a collection of fluid which is walled off by coils of bowel as in tuberculous encysted ascites or an exudation cyst as in pseudopancreatic cyst.

Classification Of Cyst

1. Congenital cyst
   • Sequestration dermoid cyst
   • Branchial cyst
   • Thyroglossal cyst
   • Lymphangioma
   • Cysts of embryonic remnants: Cyst of the urachus, vitellointestinal duct cyst.
2. Acquired cyst
   • Retention cyst — Sebaceous cyst, galactocoele, spermatocele, Bartholin’s gland cyst
   • Distension cyst — Thyroid cyst, ovarian cyst
   • Exudation cyst — Hydrocoele
   • Degenerative cysts — Tumour necrosis
   • Traumatic cyst — Haematoma, implantation dermoid cyst
   • Cystic tumours — Cystadenoma of the pancreas, cystadenoma of the ovary
3. Parasitic cyst
   • Cysticercosis
   • Hydatid cyst

Read And Learn More: Clinical Medicine And Surgery Notes

Aneurysm—Tests

• Expansile pulsations—Finger separation sign
• Proximal compression test—Size ↓
• Distal compression test—Size may↑
• Ik Thrill and Bruit are present
• pulses may be weak

Complications Of Cysts In General

1. Infection, for example, sebaceous cyst
2. Calcification, for example, haematoma, multinodular goitre with cyst, hydatid cyst
3. Pressure effects — Ovarian cyst pressing the iliac veins
4. Haemorrhage within thyroid cyst
5. Torsion — Ovarian dermoid
6. Transformation into malignancy
7. Ovarian cachexia — Large ovarian tumour 1 with pedal oedema, anorexia, loss of weight, and lordosis.

Dermoid Cyst

This is a cyst lined by squamous epithelium containing desquamated cells. The contents are thick and sometimes toothpaste-like which is a mixture of sweat, sebum desquamated epithelial cells and sometimes even hair.

Clinical Types Of Dermoid Cyst

1. Congenital/sequestration dermoid

• They occur along the line of embryonic fusion, due to dermal cells being buried in deeper planes.
• The cells which are sequestrated in the subcutaneous plane proliferate and liquify to form a cyst. As it grows, it indents the mesoderm (future bone) which explains the bony defects caused by dermoid cysts in the skull or facial bones.
• Thus, they can occur anywhere in the midline of the body or the face.
  1. Median nasal dermoid cyst: At the root of the nose at the fusion lines of the frontal process.
  2. External and internal angular dermoid cyst: At the fusion lines of frontonasal and maxillary processes.
  3. In the suprasternal space of Burns
  4. Sublingual dermoid cyst
  5. Pre-auricular dermoid cyst — in front of the auricle
  6. Post-auricular dermoid cyst behind the auricle.

Origin Of Dermoid Cyst

• The face is developed from 5 processes—2 maxillary, 2 mandibular and 1 frontonasal process
• Dermoid cyst occurs in the line of embryonic fusion of these processes

Dermoid Cyst Clinical Features

1. Though congenital, the cyst manifests in childhood or during adolescence. A few cases also manifest in the 30–40 years age group.
2. Typically, the patient presents with a painless, slow-growing swelling.
3. It is a soft, cystic and fluctuant swelling. Transillumination is negative.
4. Rarely, it may be putty in consistency.
5. The underlying bony defect gives the clue to the diagnosis.
6. The classical location of the cyst (along the line of fusion) is a feature of the sequestration dermoid cyst.

2. Implantation dermoid cyst

• This is common in women, tailors, and agriculturists who sustain repeated minor sharp injuries.
• Following a sharp injury, a few epidermal cells get implanted into the subcutaneous plane. There, they develop into an implantation dermoid cyst.
• Hence, it is typically found in the fingers, palms and soles of the foot. As the cyst develops in the areas where the skin is thick and keratinised, it feels firm to hard in consistency.

3. Teratomatous dermoid cyst

• Teratoma is a tumour arising from totipotential cells. Thus, it contains ectodermal, endodermal and mesodermal elements – hair, teeth, cartilage, bone, etc.
• Common sites are the ovary, testis, retroperitoneum, and mediastinum.

4. Tubulo-embryonic dermoid cyst

• They arise from ectodermal tubes. A few examples are thyroglossal cysts and post-anal dermoid cysts.
• Ependymal cyst of the brain.

Treatment of Dermoid Cyst

Excision of the cyst.

Epidermoid Cyst—(Wen)

This is also called a sebaceous cyst. This occurs due to obstruction to one of the sebaceous ducts, resulting in the accumulation of sebaceous material. Hence, this is an example of a retention cyst.

• Sites: Scalp, face, back, scrotum, etc. It does not occur in the palm and sole, where sebaceous glands are absent. In the scalp and scrotum, multiple cysts are often found

Clinical Notes

A 24-year-old, female patient was admitted with acute lower abdominal pain of 2 days’ duration. There was guarding and rigidity of the abdominal wall with rebound tenderness. Pervaginal examination was normal. At exploration, there was a twisted ovarian teratoma on the left side with gangrene.

• It was excised. The opposite ovary, on careful examination, revealed a small teratomatous dermoid cyst which could be enucleated. The significance of this case report lies in the fact that both ovaries should be examined in cases of ovarian dermoid cysts.

Epidermoid Cyst Clinical Features

1. They are slow-growing and appear in early adulthood or middle age.
2. Hemispherical or spherical swelling located in the dermis. The central keratin-filled punctum which is a dark spot is a diagnostic feature of this cyst. The punctum indicates blockage of the duct.
3. In 20–30% of cases instead of opening into the skin, the sebaceous duct opens into the hair follicle, hence punctum is not seen.
4. Smooth surface, round borders, soft and putty in consistency, non-tender.
5. The cyst can be moulded into different shapes which is described as a sign of moulding.
6. A sign of indentation refers to pitting on pressure over the swelling.
7. The swelling is mobile over the deep structures, and the skin is free all around except for an area of adherence at the site of the punctum.
8. In the scalp, loss of hair is a feature of the swelling because of the constant slow expansion of the cyst.

Epidermoid Cyst Treatment

• Incision and avulsion of the cyst with the wall. Very often, during dissection, the cyst wall ruptures. Care should be taken to excise the entire cyst wall. If not, recurrence can occur.
• When it is small it can be excised along with the skin.

Epidermoid Cyst Complications

1. Infection can occur due to injury or scratch resulting in an abscess. The cyst will be tender, red and hot. It should be treated like an abscess by incision and drainage. After one to two months, the cyst can be excised.
2. Sebaceous horn results due to slow drying of contents which are squeezed out, especially if a patient does not wash the part. Thus, it is not common to find a large sebaceous horn nowadays because of better ways of living and sanitation.
3. Calcification
4. Cock’s peculiar tumour1 refers to an infected, ulcerated cyst of the scalp with pouting granulation tissue with everted edge resembling epithelioma
5. Rarely, basal cell carcinoma can arise in a long-standing sebaceous cyst.