Ovarian dermoid cyst (cystic teratoma) is a certain type of germ cell tumor. The vast majority (98%) of these tumors are benign (mature) and only 2% are malignant (immature). Dermoids derive from certain cells within the ovary that have the ability to generate different tissues such as hair, skin, bone, cartilage and sebaceous (greasy) fluid.
These tumors can expand and create large masses within the ovary. Due to its significant size, such ovary may undergo torsion (twisting) causing blockage of ovarian blood supply (ischemia) which results in severe pain and possibly loss of the ovary. Spontaneous leakage from or rupture of the dermoid may also happen generating severe inflammation inside the abdomen. Often, these complications necessitate emergency surgery.
Timely diagnosis of ovarian dermoid/s can preclude complications and prevent emergency surgery. Proper bimanual pelvic exam and pelvic sonogram usually are the most efficient means to detect ovarian dermoids. Sometimes CT scan needs to be done as well.
Elective (non-emergent) surgery is best suited to remove the dermoid without compromising the ovary and avoiding spillage of it’s contents inside the abdomen. Minimally invasive surgery, such as laparoscopy or robotically assisted laparoscopy further reduce these risks. Careful and precise extraction of the dermoid while preserving healthy ovarian tissue and avoiding abdominal spillage is paramount. If properly performed, such an operation is outpatient with a relatively short recovery of one to two weeks. Correct completion of such surgery should preserve future fertility.