Uncomplicated ovarian dermoid cyst

Specialty: Gynecology and breast.

• Mature cystic ovarian teratoma
• ovarian cyst with sebaceous content
• benign ovarian germ cell tumor

Why it occurs

• Benign tumor originating from pluripotent germ cells of the ovary that differentiate into mature tissues derived from the three embryonic leaves (ectoderm, mesoderm and endoderm), accumulating sebum, hair, bone fragments, cartilage and thyroid tissue inside.

Initial workup

High-resolution transvaginal gynecological ultrasound (an ovarian mass is observed with pathognomonic ultrasound characteristics: presence of a hyperechogenic focus with posterior acoustic shadow corresponding to calcifications or teeth (Rokitansky plug), floating fine hyperechogenic lines compatible with hair (dermoid meshwork sign) and liquid-fatty content). Tumor markers: Ca-125, Ca 19-9 (frequently elevated in benign teratomas) and alpha-fetoprotein (AFP) to rule out malignant immature teratoma in girls or young women. MRI of the pelvis to confirm the diagnosis in doubtful cases thanks to the high sensitivity to detect intracystic fat.

Standard management

• There are no drugs capable of dissolving a dermoid cyst. The definitive treatment for teratomas larger than 4-5 cm or symptomatic is surgical removal of the cyst while preserving the healthy ovarian parenchyma (laparoscopic ovarian cystectomy) due to the latent risk of adnexal torsion (note: close ultrasound follow-up is advised in small dermoid cysts less than 3 cm in pregnant women or those who wish to preserve their fertility without undergoing immediate surgery).