Dermoid cyst ovary is an additional formation of ovarian tissue, consisting of a thick-walled capsule, inside which contains a mucus-like mass with various inclusions (skin, adipose tissue, sebaceous glands, hair, bones, teeth, nervous tissue). Clinically, a dermoid cyst ovary manifests itself when it reaches a large size: in this case, abdominal and lower back pain, dysuric disorders, defecation disorders may be noted. Dermoid cysts are prone to inflammation, often there is a twist of the cyst leg. Diagnostics includes gynecological examination, ultrasound, MRI, laparoscopy. Treatment is operative – cystectomy, wedge-shaped ovarian resection or ovariectomy.
General information
Dermoid cyst (dermoid, mature teratoma) is a benign ovarian tumor that occurs in 15-20% of women with ovarian cysts. Dermoid cyst ovaryusually has a round or oval shape, smooth outer walls, and can grow up to 15 centimeters in diameter. Inside, the teratoma cavity is lined with a multilayer epithelium and filled with jelly-like contents with mature fragments of ectoderm, endoderm and mesoderm derivatives (sebaceous and sweat glands, hair, fatty, nervous, bone, etc. tissues).
Dermoid cyst ovary develops from embryonic embryonic leaves, which, when intrauterine tissue differentiation is disrupted, remain in the ovaries. Dermoid cyst ovaryt can occur at any age (childhood, adolescence, reproductive, menopausal). The reasons for the formation of mature teratomas are unknown; in their development, the provoking role of hormonal changes during puberty and menopause, abdominal injuries is assumed. Dermoid cyst ovary grow slowly, usually have a unilateral localization (more often right-sided). In 1-3% of cases, the degeneration of the dermoid cyst ovary into squamous cell carcinoma is noted.
Symptoms
In the initial stages, this disease does not manifest itself symptomatically and may become an accidental finding during gynecological examination or ultrasound. Clinical manifestations of a dermoid cyst ovary are associated with its reaching large sizes (15 cm or more). During this period, the patient has feelings of bursting and heaviness, soreness in the lower abdomen, sometimes an increase in the size of the abdomen. An increase in the cyst may be accompanied by pressure on the bladder or rectum, which is manifested by increased urination, impaired intestinal function (constipation or diarrhea).
Dermoid cyst ovary does not cause hormonal changes and menstrual function disorders, but has a tendency to a complicated course. With inflammation of mature teratomas, the body temperature rises to 39 ° C, there is pronounced weakness and abdominal pain. In case of twisting of the leg of the dermoid cyst ovary, a clinic of acute pelvioperitonitis develops with symptoms of irritation of the peritoneum, fever, sharp incessant pain with irradiation into the leg and rectum.
Sometimes a dermoid cyst ovary may be detected for the first time during pregnancy. If the teratoma is small in size, does not cause disruption of neighboring organs and is not complicated, it is not touched during pregnancy. In this case, treatment of mature teratoma is recommended after childbirth. Pregnant women with an identified dermoid ovarian cyst should be specially registered with a gynecologist.
Diagnostics
With a two-handed (vaginal-abdominal or recto-abdominal) gynecological examination, the dermoid cyst of the ovary is palpated in the form of an elastic, rounded, mobile and painless formation located anteriorly and to the side of the uterus.
In gynecology, ultrasound of the pelvis with transvaginal and transabdominal sensors has the greatest information in the detection and diagnosis of dermoid ovarian cyst. Ultrasound scanning determines the size of the cyst, the thickness of the capsule and the intensity of blood supply, the ECHO density of its contents, the presence of inclusions in its cavity, often calcifications. In doubtful situations, the diagnosis of mature teratoma is confirmed during computer diagnostics and MRI.
With a complicated course of dermoid ovarian cyst, puncture of the posterior vaginal arch, laparoscopy is indicated; to exclude ectopic pregnancy, a pregnancy test is indicated. With a dermoid ovarian cyst, tumor markers-antigens (CA-125) are necessarily examined, which make it possible to exclude malignancy of the formation. In the process of diagnosis, a mature teratoma is differentiated from other types of cysts and ovarian cysts.
Treatment
The only way to eliminate dermoid cyst ovary is their surgical removal. The volume of the operation is determined depending on the age of the patient, the size and the quality of the formation.With dermoid cyst ovary complicated by inflammation or twisting of the leg, the operation is carried out in an emergency mode and in volumes dictated by the situation.
In girls and young women, cystectomy, wedge–shaped resection of the ovary is performed; in premenopausal women, oophorectomy, sometimes adnexectomy from the lesion side. Removal of dermoid cyst ovary is performed during laparoscopy or laparotomy. If a histological examination confirms the diagnosis of a dermoid ovarian cyst, treatment ends there. It is recommended to plan pregnancy after removal of a mature teratoma 6 months – 1 year after surgery.
Forecast
With timely removal of dermoid cyst ovary, the prognosis for specific functions (menstrual, sexual, childbearing) is favorable. The re-occurrence of mature teratomas is extremely rare, in cases where microscopic rudiments of dermoid cysts were present in the ovary at the time of surgery. After the operation, preventive examinations by a gynecologist and ultrasound control are carried out twice a year.
If dermoid cyst ovary is not removed, any physical activity (jumping, bending, turning) can contribute to the twisting of the cyst leg. Also, the presence of a cyst carries a potential danger of suppuration of its contents and malignant degeneration.
