Content

Dermoid formation is very interesting to study because it differs in nature from tumors. An ovarian dermoid cyst is a teratoma, and the most unusual elements can be found inside it. This can be hair, bones, nails, fatty, nervous and other types of tissue. The question arises, what is the reason for this filling of the capsule.

What is a dermoid cyst on the ovary in women?

The disease is of germinal origin. The reason that possibly explains the appearance of the disease may be a violation of tissue division during embryogenesis. The resulting tumor is located near the ovary, closer to the uterus. The dermoid grows on a long stalk, is not fused to the skin, has a complex structure, resembles a capsule with various types of tissues:

• bone;
• muscular;
• fatty.

The walls of the tumor are thin, but very dense, consisting of connective tissue. Dermoid growth is diagnosed in 20% of women who have cystosis. Cysts are classified as liquid neoplasms, and ovarian teratoma is formed due to mitosis of cells, like a tumor, and in structure can be single-chamber, less often two-chamber and multi-chamber.

Symptoms

The disease may be asymptomatic until the tumor begins to grow due to hormonal changes in the body. Discharge from an ovarian cyst is observed, and the following signs also appear:

• the stomach begins to ache in the pelvic area;
• the urge to urinate increases;
• long and painful menstruation.

With small tumors, the disease proceeds almost unnoticed. The appearance of specific pain leads women to additional examinations, during which a dermoid tumor is diagnosed.

Causes of occurrence

Medicine has not clearly identified the cause of this type of disease. The most accurate explanation is a violation of embryogenesis, as with ovarian and paraovarian cysts. Cyst formation occurs at an early age. Active growth occurs during hormonal changes in the body, these can be:

• puberty;
• pregnancy;
• menopause

Hormonal levels often affect active growth, and the ovarian cyst increases in size during menopause. However, menopause is not considered the root cause of the disease. A teratoma may not appear for a very long time; due to its small size, it is sometimes not even visible on an ultrasound. If a girl regularly visits a doctor and undergoes gynecological examinations, then the disease is detected even before its development.

Why is a mature teratoma dangerous?

Teratoma sometimes reaches significant sizes, like an endometrioid cyst or epidermal cyst - up to 10-15 cm. On average, the size of teratomas is 4-6 cm. During the active growth of the neoplasm, ovarian tissue is replaced by coarser ones that can tolerate a state of oxygen deficiency.

The neoplasm, increasing in size, compresses the blood channels of the appendages. The second ovary copes with the resulting load without any problems, and the disease is asymptomatic. In a more complex case, a teratoma can completely suppress the development of the ovary. The enlarged organ becomes twisted due to stress, which causes severe pain. If torsion of the cyst pedicle occurs, emergency intervention is required. In 1.5% of cases, teratoma can develop into a malignant neoplasm or cause bilateral inflammation.

Contraindications

Contraindications include effects that lead to an increase in the temperature of the lower abdomen. The adverse effect is compression of the abdominal cavity; increased blood circulation leads to capsule growth. If you have an illness, it is better to avoid hormonal medications. Additional hormones will provoke a change in the size of the dermoid.

Women often wonder if it is possible to get pregnant when they have been diagnosed with a dermoid cyst. If the size of the formation is small and does not cause discomfort, then pregnancy is possible even in the presence of a cyst. But after childbirth it is better to resort to surgery. Further changes in hormonal levels threaten the active growth of dermoid formation.

Diagnostics

The asymptomatic course of the disease in most cases leads to the fact that the disease is detected only during routine examinations by a gynecologist. At the first stage of diagnosis, an oval freely movable formation is detected, while palpation does not cause pain. Confirmation of the diagnosis requires accurate research; ultrasound is an informative method. In the photo you can see what a cyst looks like; it is a small oval formation near the appendage. Additionally, a computed tomography scan may be prescribed to clarify the diagnosis.

Treatment of cysts of the left and right ovary

More often, ovarian dermoid cystoma is diagnosed on the right side of the body, while cysts of the left organ may be asymptomatic throughout life. This phenomenon can be explained by the peculiarities of embryo development. Anatomically, the left and right ovaries develop differently. In most cases, the right organ is larger than the left and copes with more load during the ovulatory period. The right ovary is better supplied with blood.

Treatment of both the left and right ovaries is similar. Dermoid often requires surgery. If the size of the tumor is less than 3 cm and it does not bother you, then the patient simply remains under observation. But it is better to remove the cyst in order to avoid emergency cases of the formation developing into a cancerous tumor.

A dermoid cyst on the ovary cannot be cured with medication or using folk remedies. Vaginal suppositories will not make the teratoma resolve. Physiotherapy doesn't work either. At the moment there is no medicine that would help in the resorption of formations of this type.

How to remove an ovarian cyst

Removal of a teratodermoid cyst involves surgery. The doctor acts on the same principle as when cutting out benign tumors. During the operation, they try to avoid traumatic effects on the organs so that the ovarian cyst does not burst and fertility is preserved. There are several types of operations:

• cystectomy - removal of the capsule within healthy tissue, the organs are not operated on;
• resection – removal of a part of the damaged ovary;
• removal together with a damaged ovary is carried out in emergency cases, during suppuration.

In modern clinics, laparoscopy is used instead of abdominal intervention for cystectomy and ovarian resection. At the same time, it is possible to influence how long the operation lasts and preserve fertility. Resumption of fertility depends on the size of the unaffected part of the ovary. If more than half of the healthy tissue remains, then fertility can be restored after 6 months.

Rehabilitation of the female body after surgery lasts up to two months. After 2 weeks, the woman is already able to move fully. If the operation and rehabilitation are successful, complications can be avoided.

Video

– additional formation of ovarian tissue, consisting of a thick-walled capsule, inside of which contains a mucus-like mass with various inclusions (skin, adipose tissue, sebaceous glands, hair, bones, teeth, nervous tissue). Clinically, an ovarian dermoid cyst manifests itself when it reaches a large size: in this case, pain in the abdomen and lower back, dysuria, and defecation disorders may occur. Dermoid cysts are prone to inflammation, and torsion of the cyst pedicle is often observed. Diagnostics includes gynecological examination, ultrasound, MRI, laparoscopy. Surgical treatment of ovarian dermoid cysts is cystectomy, wedge resection of the ovary or oophorectomy.

General information

Dermoid cyst(dermoid, mature teratoma) is a benign ovarian tumor that occurs in 15-20% of women with ovarian cysts. An ovarian dermoid cyst usually 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 multilayer epithelium and filled with jelly-like contents with mature fragments of derivatives of ectoderm, endoderm and mesoderm (sebaceous and sweat glands, hair, adipose, nervous, bone and other tissues).

A dermoid cyst develops from embryonic germ layers, which, when intrauterine tissue differentiation is disrupted, are stored in the ovaries. Ovarian dermoid cyst can occur at any age (childhood, adolescence, reproductive age, menopause). The reasons for the formation of mature teratomas are unknown; In their development, the provoking role of hormonal changes during puberty and menopause, and abdominal injuries is assumed. Ovarian dermoid cysts grow slowly and are usually unilateral (usually right-sided). In 1-3% of cases, dermoid ovarian cysts degenerate into squamous cell carcinoma.

Symptoms of ovarian dermoid cyst

In the initial stages, an ovarian dermoid cyst does not manifest itself symptomatically and can become an incidental finding during a gynecological examination or ultrasound. Clinical manifestations of ovarian dermoid cyst are associated with its reaching large sizes (15 cm or more). During this period, the patient experiences feelings of fullness and heaviness, pain in the lower abdomen, and sometimes an increase in the size of the abdomen. An enlarged cyst may be accompanied by pressure on the bladder or rectum, which is manifested by increased urination and bowel dysfunction (constipation or diarrhea).

Ovarian dermoid cyst does not cause hormonal changes and menstrual dysfunction, but has a tendency to have a complicated course. With inflammation of mature teratomas, body temperature rises to 39°C, severe weakness and abdominal pain appear. In the case of torsion of the pedicle of a dermoid ovarian cyst, a clinical picture of acute pelvioperitonitis develops with symptoms of peritoneal irritation, a rise in temperature, and sharp, incessant pain radiating to the leg and rectum.

Sometimes an ovarian dermoid cyst may be detected for the first time during pregnancy. If the teratoma is small in size, does not cause disruption to the functioning 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 identified ovarian dermoid cysts should be specially registered with a gynecologist.

Diagnostics

During a two-manual (vaginal-abdominal or recto-abdominal) gynecological examination, the ovarian dermoid cyst is palpated as an elastic, round, mobile and painless formation located anterior and to the side of the uterus.

Treatment of ovarian dermoid cyst

The only way to eliminate ovarian dermoid cysts is to surgically remove them. The extent of the operation is determined depending on the patient’s age, size and good quality of the formation. For dermoid ovarian cysts complicated by inflammation or torsion of the pedicle, the operation is performed in an emergency mode and in volumes dictated by the situation.

In girls and young women, a cystectomy, a wedge-shaped resection of the ovary, is performed; in premenopausal women - oophorectomy, sometimes adnexectomy on the affected side. Removal of an ovarian dermoid cyst is performed during laparoscopy or laparotomy. If histological examination confirms the diagnosis of ovarian dermoid cyst, treatment ends there. It is recommended to plan pregnancy after removal of a mature teratoma after 6 months. – 1 year after surgery.

Forecast

With timely removal of the ovarian dermoid cyst, the prognosis for specific functions (menstrual, sexual, reproductive) is favorable. Recurrence of mature teratomas is extremely rare, in cases where at the time of surgery there were microscopic rudiments of dermoid cysts in the ovary. After the operation, preventive examinations by a gynecologist and ultrasound monitoring are carried out twice a year.

With an unremoved ovarian dermoid cyst, any physical activity (jumping, bending, turning) can contribute to torsion of the cyst stalk. Also, the presence of a cyst carries the potential danger of suppuration of its contents and malignant degeneration.

Which are diagnosed by gynecologists, dermoid cyst accounts for 20%.

This neoplasm, although small in size, does not pose a threat to a woman’s life, however, if it begins to actively grow, it must be removed.

Such a cyst does not affect reproductive function and does not in any way affect the menstrual cycle, because it is not a hormonally active tumor.

As for its possible transformation into cancer, this happens extremely rarely - 1-3%.

The essence of pathology

Any cyst is a capsule or sac-like formation, inside of which there is .

Growths formed in the ovary can be true or. The latter have a tendency to, and the true ones, although benign, are necessarily removed.

A dermoid cyst is a true cyst - its contents are the result of cell division of its capsule-shaped membrane.

This cyst is also called dermoid, the shape of the dermoid is oval or round, the walls are thin but strong.

Most often, single-chamber formations are found, but sometimes it is possible to observe. A mature cyst has a mucous fluid inside it, sometimes you can find sebaceous glands, adipose tissue, and even hair and teeth in it.

The dermoid does not grow quickly, however, if there are factors that provoke its growth, it can reach up to 15 cm in diameter.

As for the age group, a dermoid can form at absolutely any age of a woman, including a newborn girl.

Most often, a neoplasm is diagnosed because it has a larger volume and is better supplied with blood, which is why ovulation in it is more frequent.

Scientists do not yet know exactly why a dermoid develops; the formation of a cyst occurs in utero and is stored in the ovaries. Therefore, a neoplasm can be detected in childhood. However, not all dermoids reach mature forms; this requires certain factors, such as hormonal changes or abdominal trauma. Sometimes doctors choose observational tactics and conservative methods to treat dermoid formation, and quite often the tumor disappears on its own. If a woman experiences complications or negative symptoms that manifest themselves when the cyst is large, it is removed.

Symptomatic manifestations

The initial stages of dermoid are practically not accompanied by a clinical picture, and quite often they are discovered by chance during routine examinations by a gynecologist or ultrasound.

If the cyst reaches 15 cm or more, the woman complains of a feeling of heaviness in the abdomen, a feeling of fullness, and in some cases an increase in the size of the abdomen may be observed.

A large cyst can put pressure on the intestines and bladder, resulting in problems with the functionality of these organs - the patient suffers from constipation or diarrhea, and urination becomes more frequent.

CAREFULLY!

Despite the fact that dermoid does not affect reproductive function and does not lead to disruptions in the menstrual cycle, it is often complicated.

And the remedies are not effective in this case, so they are resorted to quite rarely.

Surgical treatment can be postponed in the following cases::

1. Age up to 12 years, provided that the cyst does not affect the health and development of the child and does not increase in size.
2. The period of bearing a child.
3. Infectious or inflammatory diseases in the genital organs, in this case, the disease is first eliminated, and then the timing of surgical removal of the cyst is determined.

As maintenance therapy, hormonal drugs can be prescribed - most often Duphaston or oral contraceptives (Logest or Janine), vitamins, anti-inflammatory and antimicrobial drugs.

As for alternative medicine, the following collection can be used to stop the growth of a tumor:

• viburnum leaf;
• flax seed;
• calendula flowers;
• birch leaf.

All ingredients are taken in equal proportions, mixed well, and a tablespoon of the mixture is poured with a glass of boiling water.

The product is simmered in a water bath for 15 minutes, then filtered and drunk 5 times during the day.

If there are prerequisites for the complication of the cyst, its active growth or a clear clinical picture, drug treatment is not advisable; surgical intervention is necessary.

Surgical intervention

To gain access to the ovary, surgeons use two types of surgery:

• laparoscopy.

In the first case, this is a traditional abdominal operation, which is performed through an incision in the abdominal wall.

Laparoscopy is a more modern, but also more expensive method of surgical intervention, in which access to the cystic formation is carried out through several punctures, instruments and a camera are inserted into them to monitor the process.

This intervention is characterized by a shorter recovery period, however, it requires special equipment, which not all clinics are yet equipped with.

During laparoscopy, a special gas is injected into the body cavity, which helps to understand the peritoneal wall, the doctor makes three punctures, and, watching his actions on a computer monitor, removes the cyst.

Electrocoagulation is used to stop bleeding.

After the operation, all incisions are glued together with special medical glue..

The stitches that remain after the intervention are removed after two weeks.

Dermoid cyst and pregnancy

Dermoid on and does not affect the development of the fetus in any way, and in the absence of complications, the neoplasm is not removed during the period of gestation.

But large cysts can impair blood circulation in the reproductive organs, and the uterus, which is also constantly increasing in size, can contribute to this process.

Therefore, if the tumor grows, it is better to remove it before the 16th week of pregnancy.

In addition, natural childbirth can lead to rupture of large cysts, and such a situation can threaten the woman’s life.

But, as a rule, dermoid cysts are simply observed during pregnancy, and their treatment is postponed.

Other types

Doctors classify cystic formations in the ovaries based on the structure of the tumors and their nature.

There are two groups that are fundamentally different from each other:

1. Functional cysts. Such neoplasms are not essentially tumors; they are a bubble filled with fluid. Such formations occur due to hormonal imbalances and dysfunction of the ovaries. As a rule, after several menstrual cycles a woman gets rid of such cysts, but if necessary, conservative or surgical treatment is possible. Examples of functional formations can be (), .

A dermoid cyst is a benign neoplasm and is a type of fibroepithelial formation that has walls made of connective tissue and contains ectoderm elements inside (fat, skin scales, hair, teeth).

Typically, a dermoid cyst is surrounded by an oval or irregularly shaped capsule and can reach the size of a walnut.

This type of cyst occurs when embryogenesis is disrupted at the junction of embryonic cavities and furrows. It can develop on the scalp, ovaries, anterior mediastinum, abdominal wall, pelvic and retroperitoneal tissue, kidneys, liver, brain, skull bones.

Treatment of dermoid cyst is surgical.

Causes of dermoid cyst

To date, the exact causes of dermoid cysts have not been established and are under study. But a number of hypotheses have been put forward on this matter.

It is believed that dermoid cysts are the result of a disorder of embryogenesis, when some elements of all germ layers are preserved in the ovarian stroma.

Dermoid neoplasm can occur at any age, but the reasons that provoke its growth have not been clarified. But, nevertheless, clinical data confirm the assumptions about the influence of hormonal and traumatic factors on the development of dermoid, that is, a dermoid cyst can arise during the period of hormonal changes in the body (menopause, puberty), as a result of a blow.

The theory about the influence of a hereditary factor has not found statistical confirmation, but scientists continue to study the connection between failures in embryonic development and the formation of cysts.

Currently, dermoid cysts account for about 15% of all cystic neoplasms, which are explained by the theory of impaired embryogenesis.

According to this theory, the following causes of dermoid cysts are identified:

• Separation of the blastomere during egg division, from which elements of the germ layers are then formed;
• Separation of cells of the germ layers with their subsequent accumulation in zones of tissue separation (2-8 weeks of embryogenesis);
• Disturbance in the initial stages of division of a fertilized egg or pathology of embryogenesis of a twin (bigerminal theory).

Symptoms of a dermoid cyst

Usually small dermoids do not manifest themselves in any way. Symptoms of a cyst of this kind become noticeable when the neoplasm reaches a size of more than 5-10 cm, its inflammation or suppuration, and pressure on neighboring organs.

A dermoid cyst can be easily detected if it is located on the scalp. In other situations, a cyst is discovered accidentally during its inflammation, torsion, or during a routine examination.

An ovarian dermoid cyst is manifested by constant aching or nagging pain in the lower abdomen. In this case, the process of digestion and urination may be disrupted. If an ovarian cyst becomes inflamed, it can cause severe abdominal pain and fever. When an ovarian cyst is torsioned or ruptured, symptoms of an “acute abdomen” develop.

A characteristic sign of pararectal dermoid in the late stage of development is difficult and painful defecation with ribbon-like feces.

When a mediastinal dermoid cyst has developed, a dry cough, persistent shortness of breath, transient tachycardia, cyanosis of the skin, and bulging of a cystic formation on the anterior chest wall occur.

Dermoid of the eyebrow can be localized in the area of ​​the bridge of the nose, in the middle of the forehead, on the back of the nose, above the eyebrows, deforming the soft tissues of the face. It is easily diagnosed, as it has a typical location and is detected in infancy.

Dermoid cysts on the face can also affect: the edge of the eye, eyelids, nose, temples, scalp, orbit, lips, oral cavity, ears, nasolabial folds.

Dermoids are also localized on the tissue of the eye, on the buttocks, and abdomen.

Diagnosis of dermoid cyst

Radiography is of great importance in the diagnosis of dermoid cysts (if the dermoid is located in the mediastinum, then the most informative diagnostic methods in this case are pneumomediastinography and tomography; if it is necessary to identify a dermoid in the abdominal cavity, then pneumoperitoneum and pneumoretroperitoneum are used).

On an x-ray, dermoid formations located in the skull appear as defects and depressions in the bones of the skull with clear, smooth contours. Dermoid of the presacral space causes deviation of the coccyx and a marginal defect of the sacrum. A mediastinal cyst usually looks like a homogeneous ovoid shadow in the middle or upper part.

The following are also used to diagnose dermoids: echotomography, computed tomography, ultrasound, laparoscopy, color Doppler mapping.

Treatment of dermoid cyst

The only treatment for dermoid cysts is surgery. Removal of a dermoid cyst can be performed from 5-7 years of age, when the body is already able to tolerate anesthesia.

The cyst is excised within the boundaries of healthy tissue; excision of the nearby area is performed somewhat less frequently (to prevent possible complications). Removal of a dermoid cyst can be performed both under local and general anesthesia - it all depends on the nature and location of the cyst.

For small tumors, the operation takes no more than 30 minutes. More complex operations require large and purulent cysts, as well as dermoids of the brain.

The operation to remove the tumor consists of opening the cyst, removing its contents, and draining the cavity (in case of suppuration). Deep excision of the capsule can also be performed to prevent recurrence of the disease.

Currently, surgical techniques such as endo- and laparoscopy and laser technologies are widely used to remove cysts. When performing laparoscopy, incisions are made almost bloodlessly, since laser, electrical instruments, and ultrasound are used for this. Laparoscopic removal of an ovarian dermoid cyst is considered especially effective, since it allows a woman to preserve her reproductive function. The only area where it is difficult to perform laparoscopic intervention is the brain, especially if the cyst is in a hard-to-reach place. In this case, craniotomy is performed. But even in this case, the prognosis for the patient during such an operation remains favorable.

If the cyst suppurates, then before performing the operation, anti-inflammatory treatment is carried out and they wait until a stable remission occurs.

Despite the fact that a dermoid cyst grows slowly and has a benign course, when it reaches a certain size it can lead to disruption of the functioning of nearby organs or to bone atrophy. In addition, the cyst may rupture and its contents penetrate into adjacent cavities or onto the skin; in some cases, suppuration of the cyst or its malignancy is possible (5-8% of cases). That is why doctors insistently recommend mandatory removal of such a tumor.

A dermoid cyst, or mature teratoma, of the ovary is a non-hormonally active tumor that arises from embryonic cells and is detected at any age. It is also called dermoid. A cyst is a sac of dense connective tissue. Inside it there is mucus-like content, which has inclusions from various tissues: nervous, fatty, epithelial, as well as hair, nails, teeth, bones, etc.

The dermoid is located more often on the right, which is determined by the anatomy and physiology of the right ovary, which is more active and has a blood supply. The bilateral form is rare.

If the neoplasm is small in size, it usually does not affect the condition of the female body and is detected accidentally during a pelvic ultrasound.

But a dermoid cyst can grow, reaching large sizes, putting pressure on neighboring organs, causing difficulty urinating and defecating, and pain.

Pain syndrome also occurs when the cyst ruptures, becomes inflamed, or its stem is torsioned. The last complication leads to peritonitis. In rare cases, the cyst degenerates into a malignant tumor.

It is believed that the cause of the development of dermoid in the ovary is hormonal changes. This conclusion was made on the basis that dermoid cysts are more often diagnosed during periods of endocrine changes in the female body:

• in girls at puberty;
• in pregnant women;
• in postmenopause.

Sometimes another cause is identified - injuries in the abdominal area.

But both etiological factors are not considered true. It would be more correct to say that endocrine changes and trauma only initiate the growth of the cyst, and not its occurrence.

The true reasons for the development of dermoid in the ovary

The etiology of the development of teratoma in the ovary has not been fully determined.

Scientists agree that a dermoid cyst is a congenital pathology, that is, it arose during the prenatal development of a girl, which can probably be facilitated by various factors affecting the pregnant woman, especially at the very beginning of pregnancy:

• physical influences, for example, extreme temperatures, radiation, etc.;
• chemical factors (medicines, toxins);
• biological (infections).

Reasons for the appearance and development of teratomas

A special role is played by chromosomal abnormalities, which can arise both during embryogenesis and in germ cells even before fertilization.

Note! It is at the stage of organ formation, which occurs at the beginning of the gestational period, that pregnant women need to take special care. In addition, by adhering to a healthy lifestyle, the expectant mother reduces the risk of anomalies not only in her children, but also in her grandchildren, since the girl’s supply of eggs is formed even before birth.

However, theories about the path of tumor development vary. Among them there are 3 versions.

The source of teratomas is primordial germ cells

Dermoid cysts are formed from primordial germ cells (PGCs) of the embryo, which, during intrauterine development, undergo a migration stage for the further formation of genital organs. As a result of any disturbances, the ACC gives rise to a tumor containing elements from the three germ layers. This theory explains the predominant localization of teratomas in the ovaries in women and the testicles in men.

Failures in germ layer differentiation

At the initial stage of development, the embryo consists of three germ layers.

During embryogenesis, elements are displaced relative to each other. In addition, they have a mutual influence that determines further differentiation.

However, due to chromosomal abnormalities or unfavorable external influences, the movement of sections of the three embryonic layers and their development is disrupted. As a result, groups of cells of the same layer find themselves in an uncharacteristic place for them, for example, ectodermal areas in the ovary. It is this process that ultimately leads to the formation of a dermoid cyst.

Underdeveloped twin

There is also another popular and interesting opinion. This is the so-called “Embryo in an Embryo” version.

According to it, teratoma is the result of multiple pregnancy, when a strong fetus absorbs a weaker twin, which often has chromosomal abnormalities.

Thus, all the described theories explain that the formation of the dermoid occurs during the period of intrauterine development. Already after exposure to trigger mechanisms, for example, hormonal changes, the dermoid cyst begins to grow, which ultimately leads to the appearance of unpleasant symptoms.

Important! The origin of mature ovarian teratomas is further proof of the importance of taking precautions by a woman carrying a child. Since any impact can have consequences that can manifest themselves at any moment in the life of a born person.

Video - Ovarian dermoid cyst