Common Gynaecological Disorders
These are special variety of ovarian cysts which are developmental in origin and usually require surgery to remove them.
Simple hormone dependent cysts of ovary may get cured with the hormonal medicines but in case of dermoid cyst no medicine will work.
These are bizarre tumors, usually benign, in the ovary that typically contains a wide variety of tissues including hair, teeth, bone, thyroid, etc. A dermoid cyst develops from a totipotential/multipotent (Cell which is having ability to differentiate in many mature tissue structures) germ cell (a primary oocyte) that is retained within the ovary (organ which develops eggs during reproductive age) . Being totipotential, that cell can give rise to all orders of cells necessary to form mature tissues and often recognizable structures such as hair, bone and sebaceous (oily) material, neural tissue and teeth.
Dermoid cysts may occur at any age but most commonly they are detected in child bearing age group. Average age of the detection of dermoid cyst is 30 years of age. Majority of ladies will have dermoid cyst in only one ovary. In some patients dermoid cysts may found in both the ovaries. Very rarely one may have more than one dermoid cyst in only one ovary in single patient.
Size of the dermoid cyst will vary greatly. It can be less than a centimeter up to many centimeters. Largest dermoid cyst removed is around 45 cm size. We have experience of removing dermoid cyst laparoscopically up to 15 centimeter size.
Generally small dermoid cysts will not cause any symptom and are detected incidentally while doing sonography for some other reason.
Larger cyst will cause some pelvic pain backache and pressure symptoms if they are pressing upon surrounding structures like intestines or urinary tract.
Moderate to large dermoid cyst may be of little concern as they may cause some emergency situation due to twist, hemorrhage (bleeding into cyst) or rupture of the cyst.
If the cyst is getting twisted, the blood supply of the ovary hampers and it can cause severe pain in lower abdomen and will need emergency surgery to untwist and remove the cyst. Rupture of the cyst in abdomen will lead to spillage of the oily content and that may irritate the abdominal cavity and lead to pain and fever like symptoms. Long term after rupture abdominal organs will get stuck to each other (intra abdominal adhesions).
As these are mature cells which are present in the dermoid cyst, large majority (about 98%) of these tumors are benign non cancerous, the remaining fraction (about 2%) becomes cancerous (malignant).
Removal of the dermoid cyst is usually the treatment of choice. This can be done by laparotomy (open surgery) or laparoscopy (with a scope). Traditionally in older days open method was routine for removal of such cysts. Now a day, we do laparoscopy only to remove such cysts. The surgery is done under complete-general- anaesthesia and there is no pain during or after surgery. We separate the cyst from normal ovary and remove it through a sterile endo-bag (Sterile bag made up of medical grade plastic which is put inside the abdomen through small 1 cm cut) Once endo-bag is inserted in the abdomen the separated cyst is placed in the bag and mouth of the bag is brought out from the same skin incision and the contented cyst and its contents are removed piece meal and sent for the pathological testing to confirm the diagnosis or to rule out cancer.
Such laparoscopic surgery to remove dermoid cyst is not great difficult. We are doing such surgeries routinely since last 7 years without any complications.
Main advantage to do laparoscopy is small scar of the surgery. Recovery after laparoscopy is very fast. Only couple of days rest is enough after surgery and patient can resume full work within a week’s time. As the skin cuts are small the pain is also less.
Once the cyst is removed completely it cannot form again.