Dermoid ovarian cyst from what. Dermoid ovarian cyst: causes and methods of treatment. The true causes of the development of dermoid in the ovary

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Dermoid cyst, dermoid (dermoid) is a benign formation, from the group of choristoms (teratoma). The cavity cyst is formed as a result of the displacement of undifferentiated elements of the germ layers under the skin and includes parts of the ectoderm, hair follicles, pigment cells, and sebaceous glands.

Dermoids, mature teratomas are formed in violation of embryonic development (embryogenesis) and are formed along the lines of developing parts of the body of the fetus, embryonic connections, folds, where there are all conditions for separation and accumulation of germ layers.

Most often, a dermoid cyst is localized on the skin of the head, in the eye cavity, in the oral cavity, on the neck, in the ovaries, in the retroperitoneal and pelvic zone, pararectal tissue, less often the dermoid is formed in the kidneys and liver, in the brain. Dermoid teratoma is usually small in size, but can reach 10-15 centimeters or more, has a rounded shape, most often one chamber, which contains parts of undeveloped hair follicles, sebaceous glands, skin, bone tissue, crystallized cholesterol. The cyst develops very slowly, is not expressed by specific symptoms, and is distinguished by a benign, prosperous course. However, a large dermoid can disrupt the functions of nearby organs due to pressure on them, in addition, up to 8% of diagnosed dermoid cysts are malignant, that is, they develop into epithelioma - squamous cell carcinoma.

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Causes of a dermoid cyst

The etiology, causes of a dermoid cyst are still being studied, and basically doctors are guided by several hypotheses. It is believed that dermoids are formed as a result of a violation of embryogenesis, when some elements of all three embryonal folia - germ layers are preserved in the ovarian stroma. The neoplasm develops at any age, the causes of the dermoid cyst that provoke its growth have not yet been established. However, versions of traumatic, hormonal factors have been clinically confirmed, that is, a dermoid can develop as a result of a blow, damage to the peritoneum, or during a period of hormonal changes - puberty, menopause. The hereditary factor is not yet considered statistically confirmed, although geneticists continue to study the phenomenon of failure in embryonic development, and its relationship with the formation of cysts.

The history of the study of the etiology and pathogenesis of dermoid formations began in the 19th century with veterinary medicine, when the famous animal doctor Leblen undertook the study of a cyst filled with hair follicles found in the brain of a horse. In the future, the description of dermoid cysts became widespread in "human" medicine, doctors came to grips with the study of benign neoplasms, consisting of residual elements of amniotic constrictions. To date, dermoid cysts occupy about 15% of all cystic formations and are etiologically explained by the generally accepted theory of impaired embryogenesis in three variants.

There are the following common causes of a dermoid cyst:

• Separation of cells of the germ layers and their accumulation in the areas of tissue separation at the germinal stage (2-8 weeks).
• Separation of the blastomere at the earliest stage - during the division of the egg, then elements of three germ layers are formed from the separated blastomere.
• Bigerminal (bigerminale) version - a violation of the initial stages of division of the zygote (fertilized egg) or pathology of the development of the twin embryo.

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Pregnancy and dermoid cyst

As a rule, the first pregnancy and the dermoid cyst are detected at the same time, that is, the dermoid can be detected during an ultrasound scan of a pregnant woman. If a mature teratoma is small, its size does not exceed 10 centimeters, the neoplasm is subject to observation, surgery, including laparoscopy, is not performed, the dermoid cyst, which does not disrupt the function of nearby organs and does not grow during pregnancy, is removed after childbirth, or during caesarean section.

It is believed that pregnancy and a dermoid cyst are quite compatible with each other, according to statistics, among the total number of benign formations on the ovaries, dermoids occupy up to 45% and only 20% of them are removed during the gestation period.

A dermoid cyst most often does not affect the fetus and the pregnancy process itself, however, hormonal changes and displacement of organs can provoke its growth and cause complications - torsion, strangulation, and rupture of the cyst. They try to remove a complicated dermoid cyst by laparoscopic method, but not earlier than 16 weeks. A special case is the large size of the cyst, its torsion or infringement, as a result of which necrosis and the “acute abdomen” clinic develop, such a neoplasm is removed urgently.

You should also debunk the myth, which is very popular among pregnant women, the dermoid cyst does not resolve in principle - under no circumstances. Neither pregnancy, nor folk or medications are able to neutralize the dermoid, so if the cyst did not interfere with the bearing of the child, it will still have to be removed after childbirth.

Most often, when removing dermoids, a sparing, minimally invasive method is used - laparoscopy, the transvaginal method is used less frequently.

Symptoms of a dermoid cyst

As a rule, a small dermoid does not manifest itself clinically, this is due to its slow development and localization. Basically, the symptoms of a dermoid cyst begin to be noticeable when the formation grows more than 5-10 centimeters, suppurates, inflames or provokes pressure on neighboring organs, less often manifests itself as a cosmetic defect. Most often, the symptoms of a dermoid cyst are visible, if the neoplasm is localized on the scalp, it is difficult to miss, especially in children. In other cases, the dermoid is diagnosed during an accidental or planned examination or during exacerbation, suppuration, or torsion of the cyst.

• Dermoid ovarian cyst. A neoplasm of more than 10-15 centimeters is displaced or causes pressure on nearby organs, manifesting itself as constant pulling, aching pains in the lower abdomen. The abdominal cavity is tense, the stomach is enlarged, the process of digestion is disturbed, urination becomes more frequent. An inflamed, purulent cyst can cause fever, severe abdominal pain, torsion, or rupture of the cyst, which is clinically manifested by symptoms of an "acute abdomen".
• Pararectal dermoid in the initial stage of development does not show specific signs. Symptoms of a dermoid cyst are more noticeable if the cyst begins to press on the lumen of the rectum, causing difficulty, pain during bowel movements. A characteristic feature is ribbon-like feces.
• Dermoid cyst of the mediastinum develops asymptomatically and can be detected on x-ray during a routine or random examination. The clinic is noticeable only when the neoplasm presses on the pericardium, trachea, lungs, or provokes a percutaneous fistula. There is persistent shortness of breath, dry cough, cyanosis of the skin, transient tachycardia, with large sizes tumors - bulging cysts on the anterior wall of the chest.

What does a dermoid cyst look like?

It is easiest to describe an external formation, although internal cysts differ little from external ones - they are almost identical to each other in terms of the consistency of the contents, its composition and the density of the capsule.

The classic dermoid is a cavity surrounded by a dense capsule, ranging in size from a small pea to 15-20 centimeters. As a rule, a dermoid formation consists of one chamber (cavity) filled with dense or soft contents from keratinized parts, sweat glands, hair follicles, sebaceous elements, particles of the epidermis, and bone. Dermoid cysts grow very slowly, but their growth can only be stopped by surgery, the cyst never resolves and does not decrease in size. Over the past ten years, cases of malignancy of dermoids have become more frequent, especially if they are localized in the pelvic organs or in the peritoneum.

What does a dermoid cyst look like? It depends on where it is located:

• Head area:
  • Nose bridge.
  • eyelids.
  • Lips ( soft tissues mouth).
  • Neck (under the lower jaw).
  • Nasolabial folds.
  • Nape.
  • Fiber of the eye, periorbital region.
  • Nasopharynx (in the form of dermoid polyps).
  • Rarely - the area of ​​\u200b\u200bthe temples.
• Other parts of the body, internal organs:
  • Stomach.
  • Buttocks.
  • Ovaries.
  • Anterior mediastinum.

A dermoid formation can form on bone tissue, then it looks like a small concave fossa with clear edges. Also, dermoids are very similar to atheromas, but unlike them, they are more dense and not soldered to the skin, more mobile and have clear boundaries.

Dermoid ovarian cyst

A dermoid ovarian cyst is considered a benign neoplasm that can become malignant only in 1.5-2% of all diagnosed cases. Mature teratoma, which forms in the tissues of the ovary, looks like a dense capsule with contents from embryonic elements - adipose, sebaceous tissue, hair particles, bone, keratinized inclusions. The consistency of the capsule is quite dense, surrounded by a jelly-like liquid, the size of the cyst can be from a few centimeters to 15-20 cm. The etiology of the cyst dermoids is unclear, but most likely associated with pathological embryogenesis at the stage of organ formation in the embryo. In addition, mature teratoma develops and increases to a formation visible on ultrasound during the period of hormonal changes - at puberty or during menopause. A dermoid ovarian cyst is diagnosed during routine examinations, registration for pregnancy, according to statistics, it occupies from 20% of all cysts and up to 45% of all benign tumors of the female body. The course of the disease, as well as the prognosis - favorable, the cyst is treated only by surgery.

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Dermoid cyst of the superciliary arch

Mature brow teratoma is a congenital neoplasm of connective tissue that is diagnosed at an early age. The dermoid cyst of the superciliary arch deforms the soft tissues of the face, localizing in the region of the bridge of the nose, above the eyebrows, in the middle of the forehead closer to the nose, on the back of the nose.

The clinic of the dermoid of the maxillofacial zone is always not specific in terms of sensations, but visually clear in terms of observations. The superciliary dermoid cyst is one of the most easily diagnosed neoplasms, since it has a typical location, it is defined as an external deformation of the face in the early stages, usually in infancy. Often, the dermoid can be very small and unmanifested, and begins to develop rapidly during puberty, this is especially true for boys. The cyst is movable to the touch, not soldered to the skin, sweaty, clearly limited and almost painless on palpation. Pain can occur as a signal of inflammation, suppuration of the cyst, in such cases, the surrounding skin is also inflamed, and the body reacts to infection with common symptoms - from fever to nausea, dizziness and weakness.

The dermoid cyst must be removed surgically, if this is not done in a timely manner, the dermoid can deform the bone tissue of the bridge of the nose, and form not only a cosmetic defect, but also internal pathological changes in the brain, nasopharynx.

Dermoid cyst of the eye

Dermoid or choristoma of the eye is a benign neoplasm, most often of congenital etiology. The dermoid cyst of the eye is localized in the upper part of the orbit - in the upper lateral region, and manifests itself as a tumor of various sizes in the area of ​​the upper eyelid. Much less often, the dermoid is located in the middle of the corners of the eyes; they are practically not found on the lower eyelid. The dermoid cyst of the eye is not accidentally called epibulbar, since in 90% it is localized above the eyeball (epibulbaris) - in the cornea, sclera, and on the apple, extremely rarely - on the cornea.

The benign dermoid of the eye has a rounded shape, looks like a dense, rather mobile capsule, not soldered to the skin, the cyst leg is directed to the bone tissues of the orbit. Education develops asymptomatically in the sense of discomfort, it is painless, however, increasing in size, it can provoke a pathological anomaly - microphthalmos or a decrease in the size of the eye, amblyopia - various visual impairments in a normal eye that are not corrected by glasses ("lazy" eye).

The dermoid cyst of the eye is formed at the initial stage of embryogenesis, in the period up to the 7th week, the neoplasm is an accumulation of tissue rudiments in the form of a capsule with cystic contents of dermal, hair particles. These hairs are often visible on the surface of the cyst and interfere not only with vision, but are also a rather unpleasant cosmetic defect.

As a rule, dermoid choristomas of the eye are diagnosed at an early age due to their visual clarity, the only slight difficulty is the differentiation of dermoid and atheroma, brain hernia. Dermoid is characterized by its asymptomatic nature and is never accompanied by dizziness, nausea and other cerebral symptoms. In addition, X-ray reveals a dermoid "root" in the bone tissue with clear edges.

Treatment of dermoid cysts of the eye is most often surgical, especially with epibulbar types of cysts, the prognosis is favorable in 85-90% of cases, however, surgery may slightly reduce visual acuity in the future, corrected with additional therapy, contact lenses or glasses.

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Dermoid cyst of the conjunctiva

The dermoid cyst of the conjunctiva is a lipodermoid, lipodermoid, so named because, unlike a typical cyst, it does not have a capsule and consists of lipid, adipose tissue, dressed in stroma. In fact, this is a lipoma of the conjunctiva of a congenital little-studied etiology, closely associated with pathology, atrophy of the muscle that lifts the upper eyelid (levator), as well as with a change in the location of the lacrimal gland. Most likely this is due to an intrauterine irritating factor affecting the embryo.

Dermoid cyst of the conjunctiva is considered a benign choristoma and accounts for 20-22% of all diagnosed eye tumors. Most often, lipodermoid is detected in children at an early age due to its obvious localization and combination with other eye anomalies. During pathogenetic examination or biopsy in the dermoid, as a rule, fatty elements, particles of sweat glands, and less often hair follicles are found. Due to the fact that the content and the formation itself has a lipophilic structure, the dermoid cyst tends to grow into the cornea to its deepest layers. The dermoid cyst of the conjunctiva looks like a mobile, rather dense tumor under the upper eyelid on the outside of the palpebral fissure. The size of the dermoid can be different, from millimeter parameters to several centimeters, when the formation closes the eye and the lacrimal gland.

The dermoid develops very slowly, but steadily progresses, occasionally penetrating even beyond the orbit of the eyeball up to the temple area. With palpation and pressure, a large dermoid easily moves deep into the region of the orbit.

As a rule, a biopsy is not required to clarify the diagnosis, and the conjunctival dermoid is treated only surgically. At the same time, doctors try to minimize the risk of damage to the connective sheath in order to avoid eversion or shortening of the eyelid.

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Dermoid cyst on eyelid

Most often, a dermoid cyst on the eyelid is localized outside or inside the upper skin fold and looks like a rounded formation of a dense consistency ranging in size from a small pea to 2-3 cm in diameter. As a rule, the skin of the eyelid is not inflamed, the eyelid itself can retain normal mobility if the dermoid is small and grows slowly. Cysts on the eyelids are rarely bilateral, the dermoid is located in the lateral, less often in the medial part of the eyelid and is well palpable in the form of a tumor limited by a capsule, elastic, painless, rather mobile.

Diagnosing a dermoid cyst of the eyelid is quite simple, since it is visible to the naked eye, a biopsy is rarely prescribed for clinical symptoms similar to those of a cerebral hernia. If the formation is not reduced during palpation, does not go deep, there is no dizziness, nausea and headache, and radiography of the cyst shows its clear contours, then the dermoid can be considered definite and subject to surgical treatment.

Typically, the cyst is detected at an early age of up to 2 years and is subject to regular monitoring, since it develops extremely slowly and indications for immediate surgery are not urgent. If there is no sharp increase, limitation of eyelid mobility, ptosis of the 2nd-4th degree, there is no pressure on the eyeball or optic nerve, the dermoid cyst on the eyelid is operated on at a later age, starting from 5-6 years old, the intervention is performed under general anesthesia in a hospital setting. The course of development of the dermoid is benign in 95% of cases, the cyst stops growing as soon as the growth of the eye ends and, in fact, it is only a cosmetic defect. However, there is a small risk of malignancy and the possibility of tumor progression (no more than 2%), so almost all ophthalmologists recommend removing the dermoid as soon as possible.

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Orbital dermoid cyst

An orbital cyst, which is diagnosed as a dermoid cyst, can develop over decades and begins to increase rapidly during hormonal storms - in puberty, during pregnancy and during menopause. However, most often the dermoid cyst of the orbit is determined before the age of 5 years and accounts for up to 4.5-5% of all neoplasms of the eye.

The tumor is formed from undifferentiated epithelial cells that accumulate near the junction of bone tissues, the cyst is localized under the periosteum. The formation is round in shape, often yellowish due to secreted cholesterol crystals from inner wall capsules. Lipid elements, particles of hair, sebaceous glands can be found inside. Most often, the dermoid is located in the upper quadrant inside the orbit of the eye, without provoking a displacement of the eyeball (exophthalmos), if the cyst is localized outside, then it causes exophthalmos of the apple down-inward.

The dermoid cyst of the orbit develops asymptomatically, complaints can only concern swelling of the upper eyelid and some discomfort when blinking. Also, the formation can be located deep in the orbit, such a cyst is diagnosed as a knuckle-shaped Cronlein cyst or a retrobulbar dermoid cyst. With such localization, the tumor provokes exophthalmos, the apple is displaced to the side opposite to the location of the cyst. In such situations, the patient may complain of a feeling of fullness in the orbit, pain and dizziness.

Diagnosis of the orbital dermoid does not cause difficulties, it is immediately differentiated from cerebral hernia or atheroma, in which the tumor visually increases on inspiration, with bending and other physical efforts. In addition, atheromas and hernias are characterized by a slowdown in pulsation with pressure, since the cavity of the cyst is permeated with vessels, which is not found in the dermoid with dense contents. A clarifying and confirming diagnostic method is computed tomography, which visualizes the localization, shape and clear contours of the cyst.

Orbital dermoid is treated with an operation, which is performed according to indications in case of rapid progression of the tumor, the danger of its suppuration, or in connection with a violation of visual functions.

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Dermoid cyst above the eyebrow

A benign neoplasm in the brow area is most often a dermoid, that is, a congenital cyst filled with embryonic elements. The etiology of the development of dermoids has not been fully understood, but there is a theory accepted by many doctors that speaks of a violation of embryogenesis, when parts of the ectoderm are displaced and separated at an early period of embryo formation. Over time, these elements are grouped and encapsulated by the epithelial membrane. Inside the cyst, parts of the sebaceous and sweat glands, keratinized elements, hair follicle cells, and bone tissue can be found. The cyst also contains a jelly-like lipid fluid and cholesterol crystals.

Surgeons say that the zone of arches is the most typical place that a dermoid cyst above the eyebrow chooses for itself. The size of the formation ranges from millimeter parameters to 3-5 centimeters in diameter, the older the person, the larger the dermoid, which increases in parallel with the growth of the head.

The dermoid cyst above the eyebrow is removed at the age of 5-6 years, previously it is observed and not touched. If the formation does not cause harm, does not disrupt visual functions, does not suppurate, it can be left under observation for longer. However, due to possible inflammation resulting from bruises, head trauma, concomitant infectious diseases and in order to eliminate the risk of degeneration into a malignant tumor, the dermoid should be removed as soon as possible and under favorable conditions. The course and prognosis of dermoid cysts are usually favorable, recurrences after surgery are rare if the cyst was not completely removed.

Dermoid cyst on the face

The favorite place that the dermoid cyst chooses for its location is the face, the head.

A dermoid cyst on the face, on the head can develop in such areas:

• Edge of the eye.
• Eye socket (orbital cyst).
• Hairy area of ​​the head.
• The area of ​​the superciliary arches.
• eyelids.
• Whiskey.
• The oral cavity (bottom).
• Lips.
• Nasolabial folds.
• Neck (under the lower jaw).

A dermoid cyst on the face develops and grows very slowly, often over decades. Patients seek help from a surgeon only in case of its sharp increase and a clear cosmetic defect, less often in situations where the cyst suppurates or becomes inflamed. It is extremely rare for a neoplasm to cause functional disorders, most often it happens with a cyst of the oral cavity - it becomes difficult to talk and even eat.

Palpation of the cyst does not cause pain, if the tumor is small, growing, it can become inflamed, especially when localized on the bottom of the mouth in the middle, in the hyoid bone or in the chin area. Cysts of this kind seem to protrude under the tongue, interfering with its work (it rises).

Dermoids on the face are subject to surgical treatment, as a rule, it is indicated at the age of 5 years, not earlier. The operation is performed in a hospital under general anesthesia, taking into account the patient's state of health and size, localization of the cyst. The course of the disease is favorable, relapses are extremely rare.

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Dermoid cyst of the eye

The dermoid of the corner of the eye is considered to be a completely benign formation and differs from other types of cysts in a favorable course and prognosis.

The dermoid cyst of the corner of the eye can be very small in size - from millet grain to rather obvious, visually manifested formations of 4-6 centimeters. The main danger of the dermoid in front of the eyes lies in the potential for germination in depth and a small percentage of malignancy (up to 1.5-2%). Also, external localization and access to the cyst provokes the risk of injury, inflammation and suppuration.

If the dermoid, located in the corner of the eyes, does not impair vision, does not interfere with the development of the orbit, eyelids, does not provoke ptosis, it is observed and not treated until the age of 5-6 years. A cosmetic defect at an early age is not an unconditional indication for surgery, although in the future it cannot be dispensed with. In addition, surgery is contraindicated in the presence of chronic diseases, cardiac pathologies, since radical treatment involves the use of general anesthesia.

In cases of cyst growth, its increase, excision (excision) is performed, especially when amblyopia (visual impairment) develops. It should not be delayed with treatment, since the dermoid cyst of the corner of the eye can grow further and affect the nearby tissues of the eyeball, eyelids. Complications and relapses are possible, as after any other operation, but their risk is minimal and cannot be compared with the clear benefits of removing the dermoid.

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Dermoid cyst of the coccyx

The dermoid of the sacrococcygeal zone, due to the constant increase, provokes the deviation of the coccyx and the appearance of symptoms similar to the epithelial coccygeal course.

Previously, these diagnoses were identical and were treated in the same way, at present, in clinical practice, the diseases are differentiated and there are various definitions - dermoid cyst of the coccyx, fistula of the coccyx, pilonidal sinus, and so on. There are no significant differences in the diagnosis, but these formations are still different in their etiological features, although the true causes of coccyx dermoids have not yet been established.

Dermoid cyst of the coccyx, etiology.

In clinical practice, two versions of the development of dermoids in the sacrococcygeal region are accepted:

• Epithelial dermoid cyst is formed as a congenital, embryonic defect caused by incomplete degenerative formation (reduction) of the ligaments and muscle tissue of the tail.
• The dermoid of the coccyx develops due to pathological embryonic abnormalities and the separation of growing hair follicles penetrating the subcutaneous tissue of the coccygeal region.

Interestingly, the static data show an almost zero percentage of a dermoid cyst in the coccygeal bone in representatives of the black race, and a large percentage in representatives of the Arab countries and the inhabitants of the Caucasus. A dermoid cyst in the coccyx is diagnosed mainly in men, women suffer from it three times less often.

Localization of the dermoid is typical - in the middle of the intergluteal line with an end in the subcutaneous tissue of the coccyx with frequent opening in the form of a fistula (epithelial passage).

Such a move ensures constant discharge of the contents of the cyst, and blockage leads to its inflammation, infection. In the contents of the cyst, particles of hair, fat, or elements of the sebaceous glands are found.

For the dermoid cyst of the coccyx, suppuration is characteristic, which provoke obvious clinical manifestations. An uncomplicated dermoid cyst of the coccyx can develop asymptomatically for years, rarely manifesting itself as transient pain during long sedentary work. Suppuration provokes an increase in body temperature, throbbing pain, a person cannot sit, bend over, squat.

The coccyx dermoid is treated only in a radical way - by surgery, with the help of excision of the epithelial passage, scars and possible fistulas simultaneously. Most often, surgery is performed under local, local anesthesia when the cyst is in remission, without suppuration. Further treatment involves taking antibiotics, sanitation of the coccyx area, local anesthesia.

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Dermoid cyst on head

A dermoid is a formation in the form of a cyst with a capsule and contents from the elements of hair, sebaceous glands, fats, bone tissue, keratinized particles, scales. A dermoid cyst on the head is the most common localization of benign formations of congenital etiology. The inner and outer walls of the cyst are most often similar in structure to the skin and consist of the usual dermal layers - cuticle, epithelium.

The typical arrangement of dermoids on the head is as follows:

• Upper eyelids.
• The corners of the eyes.
• The bridge of the nose or the area of ​​the superciliary arches.
• Lips.
• Nasolabial folds.
• Nape.
• Submandibular region.
• Floor of the mouth.
• Eye socket, conjunctiva.
• Rarely, the cornea of ​​the eye.

Since the dermoid cyst on the head is formed as a result of impaired embryogenesis in the places of embryonic furrows and branches, it is most often located in three areas:

• Mandibular zone.
• periorbital zone.
• Perinasal area.
• Less commonly, dermoids are localized at the bottom of the oral cavity, in the tissues of the neck, temples, in the region of the masticatory muscles, and on the cheeks.

Dermoids of the head, like all other benign congenital cysts, develop slowly and gradually, they can retain their small size for many years without clinical manifestations and without causing any discomfort, except cosmetic. Treatment of dermoid cysts of the head is carried out in an operative way, in stationary conditions under general anesthesia. The course and outcome of the operation are favorable, relapses are possible only in the case of a combination of dermoids with other tumor or inflammatory processes, as well as in case of incomplete excision of the cyst.

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Dermoid cyst on the neck

The dermoid cyst on the neck belongs to the group of congenital mature teratomas. The cavity of the cystic formation is filled with contents characteristic of the dermoid - hair follicles, keratinized scales, fatty, sebaceous elements, skin particles. Most often, dermoids of the neck are localized in the sublingual region or in the zone of the thyroid-lingual passage. Geneticists studying the etiology of dermoids claim that neck cysts form in the period up to the 5th week of embryo development, when the thyroid gland and tongue are formed.

A dermoid cyst on the neck is visible almost immediately after the birth of a child, however, small formations may go unnoticed due to typical infantile folds. The cyst develops very slowly and does not interfere with the child, does not cause pain. Pain may occur in case of inflammation of the formation or its suppuration. Then the first sign appears - difficulty in swallowing food, then intermittent breathing appears.

The dermoid cyst of the neck, located in the area of ​​the hyoid bone, provokes skin deformation, is visible to the naked eye, in addition, the cyst can be hyperemic and have an orifice in the form of a fistulous opening.

Dermoids of the neck are treated with the help of an operation that is performed at the age of 5-7 years, earlier surgery is possible only in emergency conditions - the risk of malignancy, acute inflammatory process or dysfunction of swallowing, breathing. The treatment of this type of cyst is difficult, the operation is performed under general anesthesia and may have complications due to the close location of the cyst and many functionally important muscles.

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Dermoid cyst of the brain

Among all neoplasms of the brain, dermoid is considered the safest and most treatable.

The dermoid cyst of the brain is formed at the earliest stages of embryogenesis, when skin cells, the purpose of which is the formation of the face, enter the spinal cord or brain. The etiology of all dermoids has not been fully clarified, but its congenital nature does not cause doubt among doctors. It should also be noted that dermoid formations are most often localized on the surface of the head, but not on the brain itself, such cases are diagnosed extremely rarely, mainly in boys under the age of 10 years.

The typical localization that a dermoid cyst of the brain chooses is the cerebellopontine angle or midline structures.

Symptomatically, the cyst may not appear for a long time, pain and cerebral manifestations in the form of dizziness, nausea, and coordination disorders are rare in the case of a sharp growth of the tumor or its growth, suppuration.

The method of treatment is only surgical, the method will be determined depending on the location and size of the cyst. Endoscopy or craniotomy may be used. The outcome is usually favorable, the rehabilitation period is also rarely accompanied by complications. The dermoid of the brain is operated on no earlier than 7 years for urgent indications.

Pararectal dermoid cyst

Pararectal dermoid cyst is a mature teratoma, which contains elements of keratinized particles, hair, elements of sebaceous and sweat secretions, skin, cholesterol crystals. The etiological causes of pararectal dermoids are not specified, but it is believed that they are associated with embryonic developmental defects, when the germ layers begin to separate into a place atypical for organ formation.

Clinically, a pararectal dermoid cyst is seen as a round, convex formation, painless to the touch. Such a dermoid quite often breaks spontaneously, forming a fistula or even an abscess. Unlike the coccyx dermoid, the adrectal cyst opens into the perineum or rectum.

Most often, a dermoid is diagnosed during a routine rectal examination using palpation or in case of suppuration, inflammation. In addition to palpation, sigmoidoscopy and fistulography are performed. It is believed that the coccyx dermoid and pararectal cyst are similar in symptoms, so it is necessary to differentiate them, in addition, it is necessary to exclude rectal tumors, which are often combined with dermoids.

Pararectal formations are prone to malignancy more often than benign cysts localized in other areas, so early diagnosis and timely surgery are necessary conditions to minimize risk.

Dermoid cyst in a child

A dermoid cyst in a child is usually detected very early, in 60-65% of cases in the first year of life, in 15-20% in the second year, and extremely rarely in more late dates. The early detection of benign cysts is associated with embryonic, dysontogenetic etiology, that is, formations are formed at the prenatal stage and are visible almost immediately after birth.

Fortunately, a dermoid cyst in a child is a rarity; among all benign childhood neoplasms, it is no more than 4%.

Dermoid in children is an organoid cyst consisting of tissues various structures, organs. Hair follicles, particles of bone, nails, teeth, skin, sebaceous glands can be found in the capsule. Cysts develop slowly but constantly and can be localized on the head, in the eye area, coccyx, in internal organs - in the ovaries, brain, kidneys. Accordingly, the dermoid cyst can be external or internal. Cysts increase without provoking clinical symptoms, however, all of them are subject to excision after the age of 5-7 years, as they are potentially dangerous in terms of dysfunction of nearby organs, in addition, there is a risk of their development into malignant tumors (1.5-2% of cases) .

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Can a dermoid cyst resolve?

The myth that dermoids can disappear on their own should be debunked. The question of whether a dermoid cyst can resolve can be considered unreasonable, because the very content of the formation suggests that lipid elements, particles of teeth, skin, bone parts, hair, in principle, cannot disappear and dissolve in the body.

Of course, many try folk methods, delaying the operation, especially if it concerns a child. However, one must recognize the fact that dermoids never resolve either with drug treatment or with herbal treatment.

Can a dermoid cyst resolve - definitely cannot. Unlike cysts of another type, such as follicular cysts, dermoids consist of a very dense capsule with contents that only need to be cut out, just like a bad tooth, which are not capable of disappearing by themselves at the behest of magic spells or herbal lotions. Dermoids may not be operated on if they do not interfere with the functioning of other organs and systems and the cosmetic defect does not cause an acute desire to neutralize it. Nevertheless, it is necessary to recall the risk of malignancy, that is, the potential for the development of a dermoid cyst into cancer, including squamous cell. Therefore, radical excision of the cyst is the only way to get rid of it forever.

Incomplete removal of the cyst capsule due to the deterioration of the patient's condition during the operation.

Large cysts on laparoscopy.

With insufficient drainage of purulent contents.

As a rule, recurrence of a dermoid cyst is rare, more often the operation takes place with minimal risk and trauma, the sutures are almost invisible and dissolve quickly. Radical excision of the cyst is indicated only if the cyst is frozen in development, or after inflammation is in the stage of stable remission.

Dermoid cyst treatment

Dermoids are subject to surgical treatment, as a rule, excision of such cysts is carried out from 5-7 years of age and later.

Treatment of a dermoid cyst involves excision (excision) within the boundaries of healthy tissues, and the nearby area is less often excised to neutralize possible complications. Surgery is performed both under general anesthesia and under local anesthesia, for example, with the dermoid of the coccyx.

If the formation is small in size, the treatment of a dermoid cyst does not exceed half an hour, more complex procedures are required for large purulent cysts.

Also, a long operation is expected for a dermoid cyst of the brain.

Today, medical technologies are so perfect that after the intervention, the patient can practically forget about the operation on the second day, laser methods for removing cysts, endoscopy, and laparoscopy are especially effective.

In addition, surgeons strive to minimize injuries to nearby tissues, to apply such virtuoso cosmetic sutures that even during facial surgery, the patient eventually forgets that he once had a cosmetic defect in the form of a dermoid. The operation consists in opening the cyst, evacuating the cystic contents and draining the cavity if it suppurates. It is also possible deep excision of the capsule to exclude recurrence of the cyst. Treatment of a dermoid cyst has a favorable outcome and is considered one of the safest in surgical practice.

Dermoid cyst laparoscopy

Laparoscopy has long been popular due to its low trauma and effectiveness. Currently, laparoscopy of a dermoid cyst is the gold standard in surgical practice, which is used to excise a dermoid of any size, even a maximum of up to 15 centimeters.

With laparoscopy, the incisions are practically bloodless, as surgeons use electrical, laser instruments and ultrasound. All this in combination allows not only to control the process well, but also to seal damaged tissues simultaneously with cuts, processing their edges. Particularly effective laparoscopy of a dermoid cyst during ovarian surgery, since any woman seeks to preserve her childbearing function and, indeed, after six months, conception is quite possible and will not cause any complications. In addition, the laparoscopic method is also good in a cosmetic sense, because postoperative scars are almost invisible and dissolve within 2-3 months without a trace.

The only area where laparoscopy may not be appropriate is the brain, especially if the dermoid is located in a hard-to-reach place. Then trepanation of the skull is inevitable, however, even with such a surgical intervention, the prognosis is quite favorable.

Dermoid cyst removal

Dermoid cyst removal is possible only surgical method, the choice of which depends on the location of the neoplasm, its size, the state of health of patients and other factors.

As a rule, the removal of the dermoid is carried out no earlier than the age of five, when the organ is already able to endure both local and general anesthesia.

If the cyst has purulent contents, it is removed only after anti-inflammatory treatment and the transition to the stage of stable remission. When the formation develops slowly and without inflammation, the removal of the dermoid cyst is carried out in a planned manner using conventional surgery or the laparoscopic method.

The cyst is opened, its contents are scraped off, while the doctor makes sure that all the elements are evacuated without a trace in order to avoid relapses, the same is done with the cyst capsule. Excision of the capsular walls is important, especially if the cyst has grown deep into the surrounding tissues. Surgical intervention is carried out within the boundaries of healthy tissues and lasts from 15 minutes to several hours with intervention in the brain (trepanation).

With small dermoids localized on the coccyx or head area (epidermal cysts), local anesthesia is possible, however, small children who are not capable of a long stay in the operating environment are subject to general anesthesia.

Removal of a dermoid cyst is not only desirable, but mandatory, given the risk of suppuration, dysfunction of many organs due to an increase in the dermoid, and also due to the risk of malignancy, albeit low - up to 2%.

Treatment of a dermoid cyst with folk remedies

Unlike other diseases that you can try to neutralize with phototherapy and non-traditional methods, the treatment of a dermoid cyst with folk remedies is a myth. In addition to wasting time and increasing the risk of suppuration, inflammation and the transformation of a cyst into a malignant tumor, such treatment will not bring anything else.

Dermoids are treated only by surgery, usually less traumatic and effective. Lotions, compresses, decoctions, conspiracies and other methods will not be able to help, this is a fact that is not even disputed. No matter how much a person wants to avoid surgery, especially if we are talking about a child, it will have to be done, because the dermoid is simply not able to dissolve due to its embryonic contents, consisting of hair, fat, sebaceous elements, bone particles. Treatment of a dermoid cyst with folk remedies will not replace a really effective method - surgery.

A dermoid ovarian cyst is a congenital benign formation characterized by slow growth and asymptomatic course. Other names for pathology are mature teratoma or dermoid. The cyst is detected predominantly in young women and often becomes an accidental finding during ultrasound. On the early stages education is easily confused with other benign and malignant tumors of the ovary.

The dermoid cyst is not hormonally active and does not affect the menstrual cycle. The formation of small sizes does not interfere with the implementation of the reproductive function: it does not prevent the conception, bearing and birth of a child. Problems arise with the rapid growth of the tumor or its malignant degeneration. The tactics of treatment is determined by the size of the cyst, the presence of complications and other significant factors.

General characteristics of the pathology

A mature teratoma is a complex of germinal tissues that should have been involved in the formation of other organs, but for some reason ended up in the ovary. Dermoids are germ cell tumors, that is, they form from germ cells.

Mature teratoma is a benign tumor.

Types of mature teratomas:

• Solid education;
• cystic education. It sounds like a dermoid cyst in the diagnosis.

Separately, highly specialized teratomas are isolated - struma (consists of thyroid tissue) and ovarian carcinoid (similar in structure to intestinal tissues).

In the International Classification of Diseases of the Tenth Revision (ICD-10), mature teratoma is coded D27 - a benign ovarian mass. If the type of tumor or cyst is unclear, the pathology is coded N83.2 (unspecified ovarian cyst).

On a note

Mature teratoma is equally common on both the right and left ovaries. There is an opinion that formation on the right is detected in 60-70% of cases, but this assumption has not been proven.

What does a dermoid look like?

Mature teratoma consists of highly differentiated tissues - derivatives of all three germ layers:

• Ectoderm - the source of development of the skin, intestines, nervous system, sense organs;
• Mesoderm, which gives rise to muscle, cartilage and bone tissue, as well as blood vessels and kidneys;
• Endoderms are the basis for the development of the mucous membranes of internal organs, lungs and endocrine glands.

The composition of the dermoid cyst is dominated by elements of the ectoderm, which is why it got its name.

Education characteristics:

• In most cases, the dermoid cyst is single-chamber. Perhaps the appearance of partitions and the formation of cells;
• It is surrounded by a dense capsule. The thickness of the shell can be different and depends on its structure;
• The cut surface of the dermoid is smooth and shiny.

Dermoid cyst looks like a round formation in the structure of the ovary. A mature teratoma may contain various tissues. Most often, its contents are skin, muscles, hair, nails, bones and teeth. Areas of adipose, vascular, nervous tissue are revealed. In rare cases, elements of other internal organs are found in the structure of education.

On a note

The literature describes cases when a dermoid cyst turned out to be a dead twin in utero. In January 2018, a complex operation was performed at the Krasnoyarsk Regional Clinical Hospital to remove a giant tumor in a 40-year-old patient. It is known from the medical history that the pathology long time remained asymptomatic. The reason for going to the doctor was the appearance of dull pains in the lower abdomen, radiating to the gluteal region. The examination revealed an ovarian cyst measuring 15×15×25 centimeters. Education occupied the entire cavity of the small pelvis, displaced the uterus, rectum and bladder. The cyst has been removed. The operation lasted over three hours. During the examination, it turned out that the cyst is a mature teratoma containing the remnants of the twin's tissues.

The doctors who performed the operation are not surprised by this conclusion of the histologist. The dermoid cyst in this case turned out to be a twin who died in the early stages of intrauterine development. Similar situations are described in the medical literature, but they are extremely rare. To date, no more than 70 such stories are known.

According to RIA Novosti, 2018

A photo of a dermoid ovarian cyst is presented below. Contents of a mature teratoma: hair, sebaceous glands, adipose tissue, elements of connective tissue fibers:

Causes of the development of a dermoid ovarian cyst

The exact cause of mature teratoma is not known. It is assumed that the formation of cysts from embryonic tissues is associated with a failure of intrauterine development of the fetus. The laying of internal organs takes place in the first trimester. If something goes wrong during this period, some tissues may be out of place. This is probably what happens in the case of a dermoid cyst.

On a note

The probability of chromosomal abnormalities in the development of congenital ovarian tumors, including mature teratoma, is discussed.

Risk factors:

• Reception medicines with teratogenic effect;
• Poisoning with food and industrial poisons;
• radiation exposure;
• The action of very high or extremely low temperatures;
• Infectious diseases (viral and bacterial).

Exposure to these factors during pregnancy can cause the fetus to develop a dermoid ovarian cyst. Mature teratoma occurs as a result of impaired tissue differentiation. This fact is supported by the fact that education is often detected in adolescent girls. It is possible to detect a cyst in a child before puberty and even in a newborn.

A dermoid ovarian cyst is sometimes found in teenage girls.

Despite the congenital nature of the pathology, the dermoid is usually detected in the reproductive age, which is explained by its slow growth and asymptomatic course. The cyst may be an incidental finding in menopause (after 45-50 years).

There are three main ways of development of the dermoid:

• Violation of the processes of division of the blastomere at an early stage of its development, when three germ layers are formed. This theory explains the fact that the contents of the dermoid can be almost any tissue;
• The cyst is formed from germinal germ cells, which at a certain point in their development must undergo migration and turn into full-fledged gametes. Failure at the 2-8th week of pregnancy leads to the appearance of a tumor. This theory explains the predominant localization of teratomas in the ovaries in women and in the testicles in men;
• Teratoma as a result of multiple pregnancy. The formation contains the tissues of the deceased twin.

It is important to know

The existence of dermoid cysts is another reason for a woman to be careful during pregnancy. Even insignificant negative impact in the early stages of fetal formation, it can lead to intrauterine development disorders and the appearance of a tumor in it.

During pregnancy, a woman should be more attentive to her health in order to minimize the risks of violations in the development of the fetus.

How fast does a mature teratoma grow?

Dermoid cyst grows very slowly. The literature describes cases of detection of mature teratoma in young children, but more often pathology is detected in young women aged 25-35 years. It is not uncommon for a cyst to be seen for the first time on an ultrasound during routine pregnancy screening.

The following factors can provoke the growth of a dermoid:

• Puberty and the first menstruation in a girl's life (menarche);
• The onset of pregnancy (regardless of its outcome);
• Climax - the entire period of hormonal changes and the actual menopause (the last menstruation in life);
• Strong emotional experiences, stress;
• Acute infectious diseases;
• Gynecological pathology affecting the hormonal background;
• Operations on the pelvic organs;
• Abdominal injury.

In some cases, it is not possible to determine the provoking factor.

Diagnostic search: the main symptoms of the disease and examination methods

Mature teratoma is characterized not only by slow growth, but also by an asymptomatic course. Education up to 3 cm in diameter does not bother, does not give pain, does not interfere with normal life. The dermoid cyst does not have hormonal activity. With this pathology, the menstrual cycle does not change, there is no bleeding or acyclic spotting from the vagina. If these symptoms are present, you need to look for another cause.

A dermoid cyst gives clinical signs when it reaches a significant size - from 5 cm or more. Education can grow indefinitely. The literature describes cases of removal of a giant mature teratoma - about 15-20 cm in diameter.

A dermoid cyst can grow indefinitely and reach a gigantic size.

Patients with a dermoid cyst present the following complaints:

• Dull pain in the lower abdomen on the affected side. The pain radiates to the groin, buttocks, thigh, lower back. Localization discomfort may change;
• Feeling of discomfort, pressure, heaviness and fullness in the lower abdomen.

Similar symptoms appear when the cyst reaches a diameter of 5-7 cm. With its further growth, signs of compression of neighboring organs and other accompanying phenomena join:

• Enlargement of the abdomen in size;
• Frequent urination. Separation of urine can occur in small portions;
• Constipation. There is a feeling of incomplete emptying of the intestine, pain appears during defecation;
• Pain during intercourse.

When such complaints appear, you should consult a gynecologist. The diagnosis is made after examination.

Diagnosis scheme for suspected mature teratoma:

Gynecological examination

A bimanual examination reveals a rounded mass, usually in front of the uterus. The tumor has a smooth surface, mobile. The long leg of the cyst can be determined. Palpation uncomplicated dermoid dense consistency, painless.

During a bimanual examination, a specialist can identify uncomplicated teratoma by its density.

It is important to know

During a gynecological examination, the doctor can only assume the presence of a tumor, but is not able to determine its type. Differential diagnosis is carried out with a follicular and luteal cyst, ovarian cystadenoma, salpingo-oophoritis and ectopic pregnancy.

Laboratory methods

If a malignant nature of the pathology is suspected, a blood test is performed for the content of tumor markers (CA-125, CA 19-9, CA 72-4). The detection of these substances speaks in favor of tumor malignancy.

Ultrasound procedure

The dermoid cyst on ultrasound looks like a hypoechoic formation with single or multiple inclusions. The contours of the tumor are clear. An acoustic shadow is visible immediately behind the inclusions.

Mature teratomas are difficult for ultrasound diagnosis, because they do not always fit into the classical picture. The tumor can be completely homogeneous or contain inclusions, round or oval, single-chamber and multi-chamber. Polymorphism of echo features does not allow an accurate diagnosis without additional methods research.

Color Doppler mapping provides important information. With doplerometry in a mature teratoma, vascularization is absent. Blood flow can be observed in adjacent tissues of the ovary.

This is what a dermoid ovarian cyst looks like on an ultrasound image.

Other instrumental methods

To clarify the diagnosis, apply:

• X-ray examination. A dermoid cyst is the only ovarian mass that can be seen on a plain abdominal x-ray;
• Magnetic resonance imaging (MRI) - effective method examination, which allows to determine the size and localization of the tumor, as well as to suggest its structure.

Laparoscopy

During exploratory surgery, a dermoid cyst is defined as an irregularly yellow mass. On palpation with an instrument (manipulator), a mature teratoma is dense. hallmark may be the location of the dermoid in the anterior fornix. Other ovarian masses are usually found in the uterine-rectal space.

It is important to know

The final diagnosis is made only after a histological examination of the removed tumor. No other methods give a complete picture of the disease and do not allow you to know the structure of the cyst. Histological examination also helps to distinguish a benign tumor from a malignant one.

Dermoid cyst and pregnancy: possible problems

Mature ovarian teratoma does not affect the hormonal background. It does not interfere with the normal functioning of the reproductive organs, does not prevent the conception and bearing of a child, does not interfere with the course of natural childbirth. With a size of education up to 3-5 cm, you can successfully become pregnant and give birth on time without complications.

Problems arise if the dermoid grows, reaching a large size. A large formation interferes with the growth of the uterus, leads to its displacement and can cause spontaneous miscarriage. It is not uncommon for a teratoma to twist or rupture during pregnancy, requiring urgent surgery.

Gynecologists advise planning a pregnancy after removal of the dermoid cyst - 3-6 months after the operation. Surgical intervention is also possible during gestation, but it is carried out only for special indications (compression of the pelvic organs, the development of complications). If the pregnancy ends in a caesarean section, you can remove the cyst directly during the operation immediately after the extraction of the fetus.

Undesirable consequences of mature teratoma

A dermoid ovarian cyst that is not removed on time can lead to the development of dangerous complications:

Tumor pedicle torsion

Mature teratoma often grows on a thin stalk, therefore it is prone to torsion. Such a complication can be provoked by physical activity, sports, intimacy. With complete torsion, the blood supply to the tumor stops, which leads to the appearance of pronounced symptoms:

• A sharp pain in the lower abdomen, forcing the woman to take a forced position - lying on her side with her legs bent. The pain is poorly relieved by taking analgesics;

When the peduncle of the cyst is twisted, the woman is forced to lie on her side with her legs bent to relieve pain.

• Signs of intoxication (fever, chills, nausea and vomiting), which occur during the development of cyst necrosis against the background of impaired blood flow.

With partial torsion of the pedicle of the formation, the clinical picture may be blurred.

Rupture of the cyst capsule

The provoking factor of this complication is also physical activity. When the capsule ruptures, a sharp severe pain occurs in the lower abdomen with irradiation to the lower back, leg, perineum. There may be bloody discharge from the genital tract. Bleeding is accompanied by a drop in hemoglobin levels and the development of anemia, which is determined by laboratory examination.

Suppuration

A rare consequence of a dermoid cyst. The presence of pathogenic and opportunistic flora in the genital tract can provoke the development of such a complication. The source of infection is most often the uterus or vagina. Much less often, dangerous agents enter the cyst with blood flow from other organs.

Signs of the inflammatory process:

• Increased pain in the lower abdomen;
• Increase in body temperature;
• The appearance of signs of irritation of the peritoneum (determined by the doctor during examination).

Malignization

According to medical statistics, in 1-3% of cases, a mature teratoma can degenerate into cancer. The symptomatology of a malignant neoplasm is not too different from that of a benign tumor, and one cannot do without a special examination. The following symptoms speak in favor of malignancy:

• The appearance of atypical blood flow in the tumor, which is determined by ultrasound;
• Rapid growth in education;
• Enlarged lymph nodes;
• An increase in the content of tumor markers in the blood (CA-125, CA 19-9, CA 72-4).

The final diagnosis is made after histological examination.

At the slightest suspicion of cancer or the development of other complications, surgical removal of the cyst is indicated.

On a note

As it grows, the dermoid displaces normal ovarian tissue. In the initial stages, it is not dangerous, and no significant symptoms occur. With the growth of the formation, the blood supply to the ovary is disturbed, the functional areas are replaced by connective (scar) tissue. The process occurs unnoticed by the woman, since the second ovary works for two. And yet, you should not delay the treatment of dermoid. Operating gynecologists are often faced with a situation where nothing remains of the ovary and it has to be removed along with the cyst.

Surgical treatment of dermoid cyst

Mature teratoma is not able to resolve on its own. It is not affected by hormonal drugs, vitamins, physiotherapy. Ineffective against dermoid cysts and folk remedies. The disease is not cured with the help of herbs, hirudotherapy, massage, auto-training, conspiracies and prayers. Without surgery, it is impossible to get rid of the dermoid.

Neither hormone therapy, nor folk remedies, nor any other types of alternative medicine can save a woman from teratoma.

On a note

On the Internet, you can find various reviews about the treatment of dermoid cysts, including without surgery. It is important to understand that such comments are unsubstantiated and cannot serve as a guideline for choosing a method of therapy. Mature teratoma contains dense tissues of the human body - hair, nails, bones, teeth, muscles. These structures cannot disappear or dissolve under the influence of various dubious methods.

Do dermoid cysts always need to be removed? Gynecologists approve of observational tactics if the formation remains within 3 cm, does not put pressure on neighboring organs and does not interfere with normal life. It is important to understand that the dermoid is not going anywhere. Mature teratoma will remain in the body until the end of a woman's life. The danger lies in the fact that at any moment a cyst can degenerate into cancer, and it is far from always possible to track this process.

It is important to know

Dermoid cyst can be cured only by surgery. If the patient refuses the operation, she should undergo an annual examination by a gynecologist. Regular examination and ultrasound will allow you to control the growth of the tumor and help you notice signs of malignancy in time.

The optimal size of a mature teratoma for surgery is from 50 millimeters. At this stage, the cyst already causes some discomfort, and the woman is ready to get rid of the tumor.

How is a dermoid cyst removed? There are two options:

• Laparoscopic removal of the formation. All manipulations are carried out through punctures in the abdominal wall without an incision;

Laparoscopy is a gentle method of surgical treatment various kinds ovarian cyst.

• Open surgery (laparotomy). The operation is performed by opening the abdominal cavity.

If technically possible, a laparoscopic operation is performed. Recovery after a minimally invasive procedure takes less time, the risk of complications is also reduced. Laparotomy is indicated for tumor malignancy.

The volume of the operation will depend on the size of the formation and the safety of the ovarian tissue. If possible, gynecologists try to remove only the cyst, leaving the appendages. If it is not possible to excise the teratoma, an ovarian resection or oophorectomy (removal of the entire organ) is performed.

The duration of the operation is determined by the condition of the ovary, the size of the tumor and other factors. In the absence of complications, the removal of a mature teratoma measuring 5-10 cm takes about 30-40 minutes with laparoscopy and more than an hour with laparotomy. No surgeon will determine the exact time in advance.

The cost of surgery for a dermoid ovarian cyst ranges from 25 to 50 thousand rubles. The price depends on the volume and complexity of the surgical intervention, the level of the clinic and the skill of the doctor. Under the compulsory medical insurance policy in a state hospital, the operation is performed free of charge for the patient.

Rehabilitation in the postoperative period

Recovery after surgical treatment for a dermoid cyst takes from 3 weeks to 2 months and depends on the type and extent of surgical intervention. The fastest way the body returns to the previous mode after laparoscopy. In the case of abdominal surgery, especially when removing the ovaries, rehabilitation is delayed.

AT postoperative period there are some restrictions and contraindications. In particular, it is recommended:

• Observe sexual rest;
• Do not lift weights;
• Do not play sports;
• Do not visit the sauna, bath, swimming pool, do not sunbathe in the solarium and on the beach;

During the recovery period after surgery, a woman should not take thermal procedures, including sunbathing.

• Eat healthy and avoid foods that cause constipation.

Antibiotics are given after surgery a wide range actions to prevent infectious complications. Anti-inflammatory therapy is carried out, analgesics are taken according to indications.

The restoration of the menstrual cycle occurs within a month after the operation. Menstruation can come with a slight delay - for 5-7 days.

The prognosis for a dermoid cyst is favorable, but only with timely surgical treatment. The recurrence of the disease practically does not happen. The dermoid cyst does not grow back after its qualitative removal. The growth of education suggests that not all of its tissues were removed during the operation. This happens if the doctor, wanting to save the ovary, tried to excise the cyst within healthy tissues.

In rare cases, pathology is detected immediately on both ovaries. In advanced situations, a bilateral oophorectomy may be required, and then an artificial menopause occurs. A woman is prescribed hormone replacement therapy until the age of natural menopause.

A dermoid ovarian cyst is a serious pathology that requires the obligatory observation of a specialist. Guaranteed deliverance from the disease gives only the operation. Many gynecologists advise not to wait for the growth of teratoma and remove it within healthy tissues when it reaches a size of 4-5 cm. This tactic avoids dangerous complications and preserves the woman's health.

An interesting video about teratoma and the reasons for its formation

Dermoid cyst: symptoms, complications and treatment options

Which are diagnosed by gynecologists, the dermoid cyst is 20%.

This neoplasm small sizes does not pose a threat to the life of a woman, however, if it begins to grow actively, it must be removed.

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

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

Essence of pathology

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

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

Dermoid cyst - true - its contents are the result of cell division of its capsular membrane.

In another way, this cyst is called a 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 one can also observe. A mature cyst has a mucous fluid inside it, sometimes sebaceous glands, adipose tissue, and even hair and teeth can be found 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, since it has a larger volume and is better supplied with blood, therefore, ovulation in it is more frequent.

Exactly for what reason the dermoid develops, scientists do not yet know, the laying of the cyst occurs even in utero, and remains in the ovaries. Therefore, a neoplasm can be detected even in childhood. However, not all dermoids reach mature forms; certain factors are needed for this, for example, hormonal changes or abdominal trauma. Sometimes doctors choose observational tactics and conservative methods for the treatment of dermoid formation, and quite often the neoplasm disappears on its own. If a woman has complications or negative symptoms, which manifests itself with a significant size of the cyst, it is removed.

Symptomatic manifestations

The initial stages of the dermoid are practically not accompanied by a clinical picture, and quite often they are discovered by chance during preventive 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, in some cases there may be an increase in the size of the abdomen.

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, urination becomes more frequent.

CAREFULLY!

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

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

Surgery can be postponed if::

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 genitals, in this case, the disease is first eliminated, and then the timing of the surgical removal of the cyst is already prescribed.

Hormonal drugs can be prescribed as maintenance therapy - 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 neoplasm:

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

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

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

If there are prerequisites for the complication of the cyst, its active growth or bright clinical picture, drug treatment is inappropriate, it is necessary surgical intervention.

Surgical intervention

In order 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 control the process.

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

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

Electrocoagulation is used to stop bleeding.

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

The sutures 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 during the period of gestation is not removed.

But large cysts can impair blood circulation in the reproductive organs, in addition, the uterus, which is also growing in size all the time, can contribute to this process.

Therefore, with the growth of a neoplasm, it is better to remove it before the 16th week of pregnancy.

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

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

Other types

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

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

1. Functional cysts. Such neoplasms, in fact, are not tumors, it is a bubble that is filled with fluid. Such formations occur due to hormonal disruptions, and violations of the functionality 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 (), .

Dermoid, mature cystic teratoma, dermoid cyst is a tumor of the ovary of a benign nature, having an oval or round shape and containing inside various tissues that have formed from germ cells. It occurs on average in 15% of women with ovarian cysts. In 1-3% of these tumors degenerate into malignant neoplasms.

Causes of a dermoid ovarian cyst

The tumor consists of a dense connective tissue membrane, smooth on the outside, the inner surface of which is lined with stratified epithelium. Its cavity contains a jelly-like or mucus-like mass and various inclusions in the form of hair, fragments of the epidermis, sebaceous and sweat glands, teeth, adipose, bone and nervous tissues.

Mature teratoma refers to a group of neoplasms that are laid during the period of intrauterine development of the fetus and develop from the germ layers. After the fusion of the sperm with the egg, a zygote is formed, which is a single-celled organism with the properties of both germ cells.

In the process of crushing a fertilized egg, germ layers, or layers, are formed: the outer, or ectodermal, and the inner, or endodermal. The interaction and influence of these layers on each other lead to their gradual separation and the formation of a middle, mesodermal layer between them.

result further development layers is their displacement relative to each other, the formation of symmetry in the placement of cells, the formation of boundaries at the junction, nodules, folds, etc. Initially, the germ layers are homogeneous. But, again, their contact and interaction with each other have a stimulating effect (embryonic induction) on the development of individual cell groups in a certain specific direction.

Thus, specific tissues, structures, organs with the corresponding structure and functions are gradually formed from these embryonic layers:

• from the ectoderm develop tooth enamel, cornea, lens, epithelial layer of the oral cavity, individual components of the organs of hearing and smell, cells of nervous tissues, skin epidermis with its derivatives - sebaceous and sweat glands, nails;
• from the endodermal layer, the epithelium of the mucous membrane of the stomach and intestines, liver cells, secretory cells of the pancreas and digestive tract, thyroid and parathyroid glands, anterior and middle lobes of the pituitary gland are formed;
• from the mesodermal layer, the dermis, skeletal bones and muscles, organs of the genitourinary system, pulmonary pleura and pericardium (outer shell of the heart), peritoneum, cardiovascular and lymphatic systems are formed; from the cells of the middle part of this layer, smooth muscles, blood and lymph, and connective tissue are formed.

The main theory explaining the reason for the formation of a dermoid cyst is the theory of chromosomal failure, as a result of which the normal development of the embryo is disrupted. At the same time, at the junctions of the connection of the embryonic layers, their furrows and crevices, defects occur in the process of cell differentiation and separation of layers, as a result of which a group of cells is split off from one layer and remains in another, not intended for them. Typically, these cells come from the outer germ layer, the ectoderm. In the future, cells abnormal for this layer remain in any organs or tissues formed from it, in this case, in the ovary.

It is assumed that further growth of germ cells and the formation of the above contents of the dermoid can be provoked at any age by trauma to the internal organs. However, it is most likely that this occurs under the influence of significant hormonal changes in the body of a girl in adolescence, women - during pregnancy or during menopause.

Symptoms of the disease

Mature cystic teratoma does not cause menstrual or hormonal disturbances. At the initial stages of its development, the tumor does not manifest itself in any way at all (“silent” benign tumor). It can be an accidental finding during an ultrasound examination of the pelvic organs or as a result of a manual (manual) examination of a woman by a gynecologist, who discovers a mobile, painless, rounded mass with clear contours.

These examinations may simply be preventive, carried out to diagnose and monitor pregnancy, as well as for diseases of the pelvic organs, large intestine, diseases of the lower spine or urinary tract.

The development of a dermoid cyst is very slow, but usually does not stop. The average size of the formation is 7-10 cm, the maximum, as a rule, is 15 cm, but can be more. With significant sizes (more than 15 cm), symptoms such as:

1. Feeling of pressure, fullness or heaviness in the lower abdomen (above the bosom).
2. An increase in the size of the lower abdomen and its asymmetry (with very large sizes).
3. Periodic dysfunctional disorders of the intestine (frequent urge to defecate, constipation, diarrhea) and/or bladder (frequent urination), due to pressure on the lower sections of the large intestine and bladder.

Complications of the disease can be inflammation and suppuration of the tumor, as well as its torsion, which is manifested by the corresponding symptoms.

If pregnancy occurs

A dermoid cyst during pregnancy, if it is not more than 3-5 cm, does not affect the course of the latter and the development of the fetus. However, pregnancy, due to changes in hormonal levels, can stimulate the rapid growth of education.

In addition, an increase in the uterus and displacement of the appendages can lead to torsion of the pedicle and, accordingly, to necrosis of the ischemic (bleeding) ovarian tissue with a rupture of the tumor formation. In this case, it is necessary to urgently remove the dermoid ovarian cyst or remove the latter (oophorectomy) along with the cyst.

In the absence of such complications during pregnancy, only observation is necessary in order to timely diagnose and provide assistance. Removal is performed 4 months - six months after natural childbirth or during a caesarean section, which is performed according to indications not related to the presence of a cyst.

Surgical treatment of dermoid ovarian cyst

Treatment is recommended only surgical, even in the absence of complications and subjective symptoms (in case of accidental detection). This is due to the possibility of malignant degeneration of the tumor. The operation for a dermoid ovarian cyst is carried out mainly. Its appearance depends on the size, nature of the pathological formation and the age of the patient.

In adolescence and early reproductive ages, as well as when planning pregnancy, excision of the dermoid cyst or wedge-shaped resection of the ovary is usually performed, in other cases - oophorectomy or adnexectomy. With any type of surgical treatment, a histological examination of the removed tissues is mandatory.

A dermoid cyst is a neoplasm of a benign nature and is a type of fibroepithelial formations that have connective tissue walls and contain ectoderm elements (fat, skin scales, hair, teeth) inside.

As a rule, the dermoid cyst is surrounded by an oval or irregular capsule and can be as large as a walnut.

This type of cyst occurs in case of violation of embryogenesis at the junction of the 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 a dermoid cyst is surgical.

Causes of a 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 in this regard.

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

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

The theory of the influence of the hereditary factor has not found statistical confirmation, but scientists continue to study the relationship of failure in embryonic development with 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 a dermoid cyst are distinguished:

• The separation of the blastomere during the division of the egg, from which the elements of the germ layers are then formed;
• Separation of cells of the germ layers with their subsequent accumulation in the zones of tissue separation (2-8 weeks of embryogenesis);
• Violation in the initial stages of division of a fertilized egg or pathology of twin embryogenesis (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, 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 by chance when it becomes inflamed, torn, or during a routine examination.

Dermoid ovarian cyst is manifested by constant aching or pulling pains in the lower abdomen. In this case, the process of digestion, urination can be disturbed. If an ovarian cyst becomes inflamed, it can cause severe abdominal pain and fever. When an ovarian cyst is torn or ruptured, symptoms of an "acute abdomen" develop.

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

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

The eyebrow dermoid can be localized in the region 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 determined even in infancy.

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

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

Diagnosis of a dermoid cyst

Of great importance in the diagnosis of dermoid cysts is radiography (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 the dermoid of the abdominal cavity, then pneumoperitoneum and pneumorethroperitoneum are used).

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

For the diagnosis of dermoids are also used: echotomography, computed tomography, ultrasound procedure, laparoscopy, color Doppler mapping.

Dermoid cyst treatment

The only treatment for a dermoid cyst is surgery. Removal of a dermoid cyst can be performed from the age of 5-7, when the body is already capable of tolerating anesthesia.

The cyst is excised within the boundaries of healthy tissues, 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.

With a small neoplasm, 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 neoplasm consists in opening the cyst, removing its contents, draining the cavity (in case of suppuration). A deep excision of the capsule can also be performed to rule out a recurrence of the disease.

Currently, surgical methods such as endo- and laparoscopy, laser technologies are widely used to remove cysts. During laparoscopy, incisions are made almost without bloodshed, since laser, electrical instruments, and ultrasound are used for this. Laparoscopic removal of a dermoid ovarian cyst is considered especially effective, since this allows a woman to preserve her reproductive function. The only area where it is difficult to carry out laparoscopic intervention is the brain, especially if the cyst is in a hard-to-reach place. In this case, trepanation of the skull is performed. But even in this case, the prognosis for the patient during such an operation remains favorable.

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

Despite the fact that the dermoid cyst grows slowly and is characterized by a benign course, when it reaches a certain size, it can lead to disruption of the nearby organs, or to bone atrophy. In addition, the cyst can break through, and its contents will 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 strongly recommend the mandatory removal of such a neoplasm.