A sac-like growth on the ovaries which contains bits of hair, teeth, nails and even eyes.
Ovarian Dermoid Cysts
• What Are Ovarian Dermoid Cysts?
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|What Are Ovarian Dermoid Cysts?
Dermoid cysts (image), technically known as mature cystic teratomas, are benign tumors or growths which occur in men and women. These growths can contain pockets of hair, blood, fat, bone, teeth, nails, eyes, cartilage, sebum and thyroid tissue. Some dermoid cysts develop while a person is developing as an embryo and are present at birth, such as those which appear on the eye, face, brain or lower back (image). Occasionally dermoid cysts can develop after an accident. Ovarian dermoid cysts develop in the ovaries during a woman's reproductive years. For the purpose of this article we will focus on ovarian dermoid cysts.
Dermoid cysts of the ovaries are capsules of tissue which are covered in a thick layer of leathery skin. They can grow on one or both ovaries and usually contain hair, nails, teeth, eyes and sebaceous glands. Most do not cause symptoms, however if the tumor grows it can result in complications. Possible complications include:
• Abdominal pain. See, what type of pain do ovarian cysts cause?
Ovarian dermoid cysts are rarely a medical emergency. The only time they are likely to become so is where ovarian torsion occurs. In America ovarian torsion is the 5th most common gynecologic surgical emergency and accounts for about 3 percent of cases of acute gynecologic complaints. It occurs where the cysts grows large enough to put pressure on or twist the ovary. This compromises blood flow to the ovary and can cause sudden and severe vomiting, fever and pain accompanied by constipation or diarrhea. In such instances, the doctor's first priority will be to rule out other possible causes such as ectopic pregnancy and appendicitis. As pregnancy increases the risk of ovarian torsion 5-fold, a pregnancy test will be carried out. See also, what are the signs of ovarian cysts?
Ovarian dermoid cysts develop from totipotential cells. These are sometimes referred to as 'master cells' because of their ability to develop into any kind of body tissue and in fact can produce a whole human being. It appears that these cells become over stimulated in women during their reproductive years causing the growth of cysts. Why this should be the case is not clear but it is likely to be linked to hormone levels, specifically the presence of estrogen. They occur more frequently in women diagnosed with polycystic ovary syndrome and endometriosis. See also, does the coil increase the risk of ovarian cysts?
As most cysts are asymptomatic (show no symptoms) they are more likely to be discovered during a routine pelvic examination or while undergoing an ultrasound scan for another reason such as pregnancy. An abdominal or transvaginal ultrasound will be carried out to determine the exact type, location, size and amount of cysts present. The vast majority of women only develop one dermoid cyst.
Although in most instances ovarian dermoid cysts are harmless, it is still considered best practice to have them removed surgically. If they are not treated ovarian torsion can develop, this can restrict blood flow to the ovaries and eventually cause fertility problems. Unless a cyst ruptures causing an emergency, surgery is usually elective. The most common procedure is laparoscopic surgery, of which there are different types. One study reported that 57 percent of women with ovarian dermoid cysts undergo a cystectomy, 36 percent have a total oophorectomy, 6 percent have a partial oophorectomy and the remainder have a laparoscopy-assisted vaginal hysterectomy.
Laparoscopic Assisted Vaginal Hysterectomy
Generally it is advised to have a dermoid cyst removed, even if it is not causing problems. This is because it can continue to grow and cause peritonitis, a potentially fatal infection of the abdomen. Additionally there is always the risk that a cyst will rupture, causing a medical emergency. Women of childbearing age are encouraged to remove dermoid cysts because the risks of ruptures increase with pregnancy. See also, do ovarian cysts usually need to be surgically removed?
As the risks of surgery and undergoing anesthesia are higher for pregnant women, surgery is only usually performed where the cyst has grown beyond 6 cm in diameter (some doctors even prefer to wait until 12cm unless the cyst has ruptured). The procedure is carried out by laparoscopy and ideally should be done in the second trimester of pregnancy.
One study by the Department of Obstetrics and Gynecology, Laval University Hospital Center compared the recurrence rate of women treated for ovarian dermoid cysts by laparoscopy (small incision) versus laparotomy (large incision). They estimated the probability of a recurrence after two years was 7 percent in the laparoscopy group and 0 percent in the laparotomy group. They also noted that laparoscopic surgery results in shorter hospital stays and less blood loss than a laparotomy, but it is associated with a considerably higher risk of recurrence. The researcher’s hypothesized that the rate of recurrence may be higher with a laparoscopy because the surgeon does not have as clear a view of the pelvic area and the existence of a second cyst may be missed.
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