Dermoid ovarian cyst in an adolescent girl

  • Reading time:4 mins read
  • Post last modified:April 14, 2022
  • Post category:Medical News

19-year-old unmarried girl was referred to Gynaecology & Obstetrics department of Care Hospital under Dr. Madhulika Rai by a local physician with symptoms of vague abdominal pain of 1 month duration. There was no history of bowel/bladder disturbances, loss of weight/appetite, no history of menstrual irregularities. No relevant medical and surgical history.

General condition—good. Body mass index (BMI) 19.8 kg/m2. No icterus, lymphadenopathy, oedema. Vital signs—stable. Breast/thyroid/spine—normal.

A 26-week size firm non-tender mass with smooth surface palpable. Upper and lateral borders well defined. Lower border not felt. Restricted transverse mobility present. No bruit over mass. No ascites.

Rectal mucosa free, same firm mass felt anteriorly.

Routine investigations within normal limits.

CA125 = 52 IU/mL. Renal function test—within normal limits. Liver function test—within normal limits. Chest X-ray —normal

Ultrasonography revealed large left ovarian tumour of 28×19 cm; with mixed echogenicity; with fat, fluid contents and multiple septations. Uterus—anteverted, normal size. No free fluid seen.

Multidimensional CT of the abdomen and pelvis confirmed the ultrasound findings.

The most probable diagnosis for this 19-year-old patient, when first examined was ovarian tumour. The reason being a 26-week firm mass arising from pelvis, no menstrual discomfort. The next question—What type of tumour? —probably a germ cell tumour as 60% of ovarian tumours less than 20 years of age are germ cell tumours.

Next important aspect was to rule out malignancy. Clinically it appeared to be a benign tumour as the patient’s general condition was good. BMI 19.8 kg/m2 no ascites. Therefore, clinically we concluded that it could possibly be a benign tumour of the ovary. Ultrasonography helped us to diagnose the condition as a dermoid ovarian cyst. Multidimensional CT of the abdomen and pelvis was performed to confirm the diagnosis and to note the amount of normal ovarian stroma.

Exploratory laparotomy proceeded to left ovariotomy and salpingectomy.

We resorted to laparotomy with a subumbilical vertical right paramedian incision due to the large size (to avoid accidental rupture and subsequent peritonitis). The left ovarian dermoid cyst was large (28×19 cm) involving the whole of the left ovary without any normal ovarian tissue and the left fallopian tube was stretched over the dermoid cyst. Therefore left ovariotomy and salpingectomy was performed.

Laparotomy findings—

Left large ovarian dermoid cyst (28×19 cm)

  • Undergone torsion once;

  • Capsule intact, lying free, no adhesions;

  • Tube stretched over it;

  • Partly cystic and partly firm areas, involving the whole of the left ovary.

Uterus anteverted normal in size. The whole of the left ovary was involved in the dermoid cyst without any normal ovarian tissue. 

The postoperative period was uneventful. The patient was discharged on the seventh postoperative day after suture removal. Histopathology confirmed the diagnosis of dermoid ovarian cyst.

Questions or concerns?

If you have additional questions, we’re here for you. Call or WhatsApp us and we’ll answer all your questions.