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Unusual Site of Dermoid Cyst
Safoura Rouholamin1, Maryam Hashemi1, Zahra Dayani1, Elham Madani2
1 Department of Obstetrics and Gynecology, School of Medicine, Isfahan University of Medical Sciences, Beheshti Hospital, Isfahan, Iran
2 Department of Obstetrics and Gynecology, Faculty of Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| Date of Submission | 10-Jul-2022 |
| Date of Acceptance | 29-Oct-2022 |
| Date of Web Publication | 31-Aug-2023 |
Correspondence Address:
Elham Madani
Fellowship of Laparoscopic and Hysteroscopic Surgery, Isfahan University of Medical Sciences, Isfahan
Iran
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/abr.abr_227_22
Epidermoid and dermoid cysts are benign tumors lined by stratified squamous epithelium. Any region of the body that is covered by squamous epithelium has the potential ability to develop them. Herein, we reported two rare cases with benign cystic teratoma at unusual sites in the genital system. The first case was a 29-year-old G1P1L1 female admitted in our center with pelvic pain 2 months ago. Magnetic resonance imaging (MRI) showed a mass in the posterior cul-de-sac with severe fat content. The patient underwent laparoscopy. Histopathological study of the removed mass showed a dermoid cyst. The second patient was a 35-year-old G3L1Ab2 female who was admitted to our clinic with the chief complaint of abnormal uterine bleeding since one year ago. The ultrasonography represents a hyperecho 65 × 27 mm mass lesion in the endometrial canal progressing toward cervical canal. After laparotomy, a degenerated myoma was resected. Surprisingly, histopathological study of the removed mass showed a mature cystic teratoma. To the best of our knowledge, it is the first study which reports cystic teratomas in the cervix region.
Keywords: Cervix, dermoid cyst, teratoma, unusual site
How to cite this article:
Rouholamin S, Hashemi M, Dayani Z, Madani E. Unusual Site of Dermoid Cyst. Adv Biomed Res 2023;12:215 |
| Introduction | |  |
Epidermoid and dermoid cysts are benign tumors lined by stratified squamous epithelium.[1] When the lining presents only epithelium, it is called epidermoid cyst. While the wall of dermoid cysts has mature skin appendages and the lumens contain hair and keratin, it is a dermoid cyst. Finally, when other tissues (e.g., muscle, cartilage, and bone) are present, the cyst is a teratoma.[2]
Infection of pilosebaceous gland and migration of epidermis to the deep of skin by trauma are the possible reasons for developing such cysts. Any region of the body that is covered by squamous epithelium has the potential ability to develop them.[3]
In this case series study, we reported two rare cases with benign cystic teratoma at unusual sites in the genital system. To the best of our knowledge, it is the first study which reports cystic teratomas in the cervix region.
| Case Reports | | |
Case 1
A 29-year-old G1P1L1 female admitted in our center with pelvic pain 2 months ago. Her past medical history was not notable except two surgeries: cesarean section and tonsillectomy. Her abdominopelvic examination was normal. Vaginal sonography showed normal uterus in size and shape. Endometrial thickness was 8 mm, and there was a mixed echo lesion with a specific limit about 120 × 97 × 83 mm in the posterior aspect of the uterus that was separately from the ovaries. The lesion had crescent cystic component with approximate dimensions of 87 × 26 mm with a dirty shadow that was compatible with teratodermoid sarcoma.
Magnetic resonance imaging (MRI) showed a heterogeneous signal mass measuring 108 × 95 mm in the posterior cul-de-sac with severe fat content which seems to be separate from ovaries. Tumor markers including CEA, CA19-9, CA125, AFP, BHCG, and LDH were in the normal range.
According to the medical team's decision, the patient underwent laparoscopy with the diagnosis of degenerated myoma, and the mass was completely removed from the posterior region of the cervix. Contrary to imaginations, histopathological study of the removed mass showed a dermoid cyst. The patient was discharged from the hospital with a stable general condition [Figure 1]. | Figure 1: (a) Benign cystic teratoma with parasitic site, (b) histology confirmed a benign cystic teratoma
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Case 2
The patient was a 35-year-old G3L1Ab2 female who was admitted to our clinic with the chief complaint of abnormal uterine bleeding (menorrhagia) since one year ago. Her past medical history revealed no significant points. Six months ago, she underwent laparotomy and myomectomy which made AUB better for two months. According to rebleeding after two months and the ultrasonography representing a hyperecho 65 × 27 mm mass lesion in the endometrial canal progressing toward cervical canal that showed suspicious large myoma or polyp, she became a candidate for hysteroscopy. Laboratory data including tumor markers was completely normal. During hysteroscopy, a large myoma occupying the whole cavity was seen, but due to the large size of the mass, resectoscopy was not possible. After laparotomy, a 5 × 6 cm degenerated myoma was resected. Surprisingly, histopathological study of the removed mass showed a mature cystic teratoma. Finally, the patient was discharged with satisfactory status.
| Discussion | | |
Ovarian germ cell tumors (OGCTs) are derived from primordial germ cells of the ovary. They may be benign or malignant. These neoplasms comprise approximately 20–25% of ovarian neoplasm overall.[4] Benign cystic mature teratomas (dermoid cysts) are the most common OGCTs.
Dermoid cysts arising from germ cell sources are mostly found in paraxial and midline locations. They can be congenital or acquired when found in gonads, but they are always congenital when found at extragonadal locations like intracranial, cervical, retroperitoneal, or mediastinal site.[5] Parasitic dermoid cysts are extremely rare entities, and their actual incidence is unknown.
Abnormal arrest of germinal cells in the dorsal mesentery during their embryonic migration to the genital ridge may lead to development of multiple ovaries and subsequently formation of parasitic dermoid cysts at various sites.[6]
Most teratomas are cystic and composed of mature differentiated elements; they are better known as dermoid cyst.[7] Mature cystic teratomas contain mature tissue of ectodermal (e.g., skin, hair, sebaceous glands), mesodermal (e.g., muscle), and endodermal origin (e.g., lung, gastrointestinal).[8]
Most women with dermoid cysts are asymptomatic. If present, symptoms depend upon the size of the mass. Torsion is not uncommon; the incidence of torsion is more common in pregnancy and puerperium, and it has been reported in 16% of cases.[9]
Rupture of dermoid cysts with spillage of sebaceous material into the abdominal cavity can occur, but it is uncommon. Chemical peritonitis may subsequently develop and lead to formation of dense adhesions.
These tumors have a characteristic ultrasound appearance,[10] and a definitive diagnosis is made at the time of surgical excision. Ovarian cystectomy is suggested in order to make a definitive diagnosis, preserve ovarian tissue, and avoid potential problems. Dermoid cysts may be removed via either laparoscopy or laparotomy.
[Table 1] summarized a few similar cases of parasitic dermoid cysts which are reported in the literature[5],[11],[12] [Table 1]. | Table 1: A summary of previous studies reporting unusual sites of dermoid cysts
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| Conclusion | | |
To the best of our knowledge, this case series is the first study which reports cystic teratomas in the cervix region. The purpose of this report was to express that dermoid cysts (or teratomas) could also include in the differential diagnosis list of cervical masses.
Ethics approval and consent to participate
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
This study was financially supported by Isfahan University of Medical Sciences, Isfahan, center of Iran.
Conflict of interest
There are no conflicts of interest.
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[Figure 1]
[Table 1]
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