Bilateral dermoid ovarian cyst in an adolescent girl!!
Hello, a 19-year-old unmarried woman with regular menstrual cycles presented with symptoms of vague abdominal pain of 1 month duration. General condition fair. Per abdomen—a firm, non-tender mass corresponding to 26 weeks of gestation with smooth surface, upper and lateral borders well defined, lower border not palpable was observed. Ultrasonography: left ovarian tumour 28×19 cm with mixed echogenicity was seen in the pelvis extending superiorly into the abdominal cavity with fat, fluid contents, multiple septations. Right ovary measures 6×4 cm with 3.7 cm focal hyperechoic lesion. Uterus anteverted, normal size. No free fluid seen. CT confirmed the ultrasonography findings. Cancer antigen (CA) 125 was 52 IU/mL. Exploratory laparotomy followed by left ovariotomy and salpingectomy and right ovarian cystectomy was performed, leaving behind a significant amount of normal ovarian tissue. Cut section of the gross specimen of the left ovarian tumour-dermoid cyst-plenty of sebaceous fluid and a large tuft of hair. The right ovarian cystectomy revealed a dermoid cyst with hair and pellets of sebum. How to cure this condition?
@piya Dermoid cyst is a benign germ cell tumour (very rarely malignant 1.7% typically in women older than 40 years). They are bilateral in 10% cases, usually unilocular with smooth surface, contains hair and sebaceous material, lined in part by squamous epithelium. Teeth, bone, cartilage, thyroid tissue and bronchial mucous membrane are also found in the wall. Sometimes the sebaceous material collects together in the form of pellets.
A conservative surgical approach is of prime importance in a young patient with an aim to preserve ovarian function and future fertility.
Preoperative evaluation of the adnexal mass and the choice of operation techniques are important to reduce intraoperative complications and preserve ovarian tissue.
With improved laparoscopic surgical skills and instrumentation, laparoscopic management of dermoid ovarian cyst is now gaining acceptance. But in a large dermoid ovarian cyst, laparotomy is preferred over laparoscopy in order to avoid spillage with subsequent risk of chemical peritonitis and adhesions.
Laparotomy provides a three-dimensional vision which increases depth perception. This along with the tactile sense enables the surgeon to retain the maximum amount of normal ovarian tissue particularly in bilateral dermoid ovarian cyst in young patients.