Ovarian mature cystic teratomas, also called dermoid cysts, are the most common germ cell tumors, accounting for 70% of ovarian masses in women of reproductive age and 20% in postmenopausal women.
Dermoid cysts and other inguinal masses are frequently encountered in gynecology and obstetrics examinations. One in every 20 women undergoes surgery for a suspicious ovarian mass or cyst during their lifetime. Most inguinal masses in women are benign, and the probability of being malignant varies between one and three in 1000.
In our article, you can find answers to questions such as what is an ovarian dermoid cyst, what are the symptoms of dermoid cysts, the complications it creates, how is dermoid cyst surgery performed?
A dermoid cyst is a type of ovarian teratoma. Ovarian teratomas are histologically divided into monodermal teratomas (carcinoid tumors, neural tumors, struma ovarii),immature teratomas and mature cystic teratomas.
Teratomas consist of various histological types within 3 germ layers including ectoderm, mesoderm and endoderm.
If the teratoma is mature, it is benign and is called mature cystic ovarian teratoma or dermoid cyst. Dermoid cyst constitutes approximately 20% of ovarian germ cell tumors.
Mature cystic teratoma may contain fat, hair, teeth, skin, nails, nerve tissue, muscle and bone tissue originating from 3 germ cell layers. Dermoid cysts can also be observed in many organs other than the ovary (eye, skin, brain).
Dermoid cysts are a common tumor in women of reproductive age, and their frequency is 10 in 100,000 women.
Most dermoid cysts may not cause any complaints or may show very mild symptoms. They can usually be diagnosed by chance with ultrasound or other radiological examinations.
If we list the symptoms of dermoid cysts;
Dermoid cysts are thought to occur as a result of the migration of cell tissue that should not be present in the ovary during the embryological period to the ovary. However, there are some factors that increase the risk of dermoid cysts. To list them briefly;
To list the basic characteristics of dermoid cysts;
Dermoid cyst patients may experience the danger of ovarian torsion in the affected ovary, that is, the ovary turning around itself and disrupting its nutrition. Ovarian torsion is responsible for 16% of the complications related to ovarian mature cystic teratomas, and the most common risk factor for ovarian torsion is the presence of a dermoid cyst.
After the rupture of a dermoid cyst, the contact of the dense fluid inside with the inner abdominal membrane called the peritoneum can trigger a dangerous infection process called chemical peritonitis.
Despite its benign structure, of a dermoid cyst ruptures; It can lead to complications such as peritonitis, Bowel obstruction Abscess.
Most cases present with nonspecific complaints such as abdominal pain, bloating and fever.
During gynecological examination, suspicion of dermoid cyst begins with transvaginal ultrasonography examination. Calcifications within the suspicious inguinal ovarian cystic mass, areas showing mixed density lesions containing fat and fluid density increase the suspicion. Abdominal and inguinal region computed tomography is diagnostic tool for corrrect diagnosis.
For dermoid cyst, Groin Magnetic resonance (pelvic MRI) examination allows us to make a definitive diagnosis by distinguishing the fatty tissue in the cyst.
Dermoid cyst treatment can be grouped under 2 main headings as clinical follow-up and surgical treatment.
Non-surgical follow-up is performed in the following cases in dermoid cyst treatment.
Surgery is required in the treatment of dermoid cyst in the following cases;
Dermoid cyst surgery can be performed with 2 methods.
The method by which dermoid cyst surgery will be performed is decided according to the size of the cyst, the general condition of the patient, suspicion of cancer, rupture of the cyst, and the patient's previous abdominal surgeries. In suitable patients, the first choice is to perform dermoid cyst surgery with the laparoscopic, i.e. closed method, while preserving the ovaries in young patients.
The gold standard in dermoid cyst surgical treatment is the laparoscopic approach. Today, increasing experience in laparoscopic applications has allowed these surgeries to be performed closed.
In young patients or women who want to become pregnant, only the dermoid cyst should be removed without removing the ovary with laparoscopic surgery. In dermoid cyst laparoscopic surgery, if the ovary cannot be preserved in any way in older women, removal of the ovary may be recommended.
A dermoid cyst is considered a benign inguinal mass. Laparoscopic treatment of inguinal masses is appropriate when all the criteria for a benign lesion are present. The criteria for benign ovarian cysts are as follows;
Since dermoid cysts are known as benign ovarian cysts, it is recommended that the surgery be performed laparoscopically. Laparoscopy or closed surgery is the approach we commonly use in Ankara for "benign" cysts between 5 and 10 cm.
The benign or malignant nature of the cyst cannot be determined by imaging alone, so we take precautions to prevent potential laparoscopic spread during surgery. These precautions include using a laparoscopy material bag to remove the cyst, keeping the instruments clean, preventing contamination in the trocar paths where we enter the abdomen and wiping them with chlorhexidine or povidone-iodine mixtures, preventing carbon dioxide gas leakage, closing 10 mm trocar holes with stitches, sending suspicious fluid or abdominal inner membrane biopsy tissue for analysis, not exceeding a short period of one week between the diagnosis of laparoscopic cancer and the start of chemotherapy or complete surgery.
Dermoid cyst surgery is performed in Ankara by surgeons and centers experienced in ovarian-preserving surgery laparoscopy. Surgery to remove only the cyst while preserving the ovarian tissue may be more challenging than surgeries where the entire ovary is removed. Preserving the ovarian vascularization and the ovum-carrying cortex layer is of great importance in the surgery.
Performing dermoid cyst surgery laparoscopically reduces postoperative pain and hospitalization time. In closed surgeries, less bleeding, quicker mobility and a quick recovery process are observed compared to open surgeries.
If the dermoid cyst does not meet the criteria for removal by closed method, surgery is performed by open method. In open dermoid cyst surgery, the surgical incision is decided according to the size of the cyst.
If the size of the cyst is suitable, the abdominal folds are entered from the groin area in the cesarean section line, if the cyst is very large, the abdominal cavity is entered from the midline of the abdomen. After the necessary precautions are taken to prevent the cyst content from spreading around the cystic mass, the dermoid cyst can be separated from the ovary or removed together with the ovary. After bleeding control is achieved, the abdominal folds are closed anatomically.
The duration of dermoid cyst surgery varies according to the size of the cyst and the surgical method. The surgery time increases as the cyst size increases. The closed method takes longer than the open method if the surgeon is less experienced. The average dermoid cyst surgery takes 1-2 hours.
It is common for a dermoid cyst to burst or rupture spontaneouslyIt is not a condition that can be treated. If a dermoid cyst ruptures, it can lead to complications such as chemical peritonitis, intestinal obstruction and abscess.
If a dermoid cyst ruptures during surgery, the fluid and tissue inside the cyst must be quickly removed into a laparoscopic bag and the abdomen must be washed with at least 5 liters of physiological serum. Rupture and incomplete removal of a dermoid cyst may require repeated dermoid cyst surgery.
A dermoid cyst or mature cystic teratoma is a benign ovarian tumor. The probability of this tumor being a malignant tumor called immature cystic teratoma as a result of pathology is 1%. The word immature defines that the cyst is malignant. If the tumor is malignant, complete surgical removal of the ovary is a necessary procedure. In addition, the other ovary and uterus are removed. After surgery, the patient is started on platinum-containing chemotherapy shortly after the surgery.
A dermoid cyst generally does not prevent pregnancy. However, a dermoid cyst can create situations where the pregnancy is complicated and requires surgery during pregnancy. In cases of torsion, which is the rotation of the ovary around itself during pregnancy, or rupture of the cyst, emergency surgery is required.
A dermoid cyst is unfortunately a tumoral condition that cannot be treated with medication. In case of early diagnosis, it is possible to save the ovary safely with laparoscopic intervention. In case of very large or ruptured dermoid cysts, open surgery is preferred.
There is no known herbal treatment option for dermoid cyst. In case of early diagnosis, it is possible to save the ovary safely with laparoscopic intervention.
Although the recurrence rate of dermoid cysts after successful surgery is low, it is not impossible. Especially if the cyst ruptures during surgery or if a section of the cyst capsule remains in the ovary, the recurrence rate increases. In addition, dermoid cysts may recur in the other ovary after surgery.
If dermoid cyst surgery was performed laparoscopically, patients are discharged from the hospital to their homes after a one-night stay. They can return to work within a week. No sexual activity restrictions are recommended after surgery. It is only recommended not to lift heavy objects for 2 months.
There is no time limit for pregnancy after dermoid cyst surgery. Pregnancy is possible as soon as possible.
The most important factor affecting the return to daily life after dermoid cyst surgery is whether the surgery is performed laparoscopically or openly. Closed surgeries are considered the gold standard for dermoid cysts. However, if the dermoid cyst is very large or has ruptured, open surgery is preferred. A single night stay is recommended for closed dermoid cyst surgery, and a two-night stay is recommended for open surgery.
Laparoscopic dermoid cyst surgery is performed with general anesthesia, while open surgery is performed with anesthesia from the waist, which we call epidural.
The recovery process after dermoid cyst surgery varies depending on whether the surgery is closed or open. In closed surgeries, the hospital stay is very short, and the return to daily life is very fast. In closed surgeries, the patient can do their own work in 1-2 days and return to work within 1 week. In open surgeries, the hospital stay is long and the return to daily life is longer.
Dermoid cyst surgery prices vary depending on whether the surgery is closed or open, the hospital where the surgery is performed, and the length of hospital stay.
In your search for the best doctor for dermoid cyst surgery, the experience of the specialist who will perform your surgery in laparoscopic and organ-preserving surgeries is of great importance.
