Dermoid Cyst - Causes, Symptoms and Treatment

A dermoid cyst develops from a totipotential germ cell as a pocket or cavity under the skin that contains tissues normally present in the outer layers of the skin and the cell is retained within the egg sac (ovary). 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 the prime age of detection is in the childbearing years. A dermoid cyst is lined with epithelium, which contains tissues and cells normally present in skin layers, including hair follicles, sebaceous (skin oil), and sweat glands. Dermoid cysts can range in size from a centimeter (less than a half inch) up to 45 cm (about 17 inches) in diameter and are usually found on the head or neck, and sometimes on the face. These cysts can cause the ovary to twist (torsion) and imperil its blood supply. The larger the dermoid cyst, the greater the risk of rupture with spillage of the greasy contents which can create problems with adhesions, pain etc. Although the large majority (about 98%) of these tumors are benign, 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). Torsion (twisting) of the ovary by the cyst is an emergency and calls for urgent surgery.

The term dermoid cyst can be found in the vocabulary of dermatologists, dermatopathologists, general pathologists, gynecologists, neurosurgeons, or pediatricians. These are also very rare. Only a handful of cases involving dermoid cysts located here are reported each year. The term dermoid cyst does not appear to be restricted to a single kind of lesion nor is it used in only a single medical discipline. Removal of these cysts is extremely complicated. However, they may twist on themselves and cause severe pain, and occasionally they rupture, producing peritonitis, or irritation of the abdominal and pelvic cavity. The tumor is covered by a thick dermislike wall that contains multiple sebaceous glands and almost all skin adnexa. The calcification will be apparent on x-ray . On gynecologic ultrasonography the sebum appears bright. Other cell types may be present as derivatives of the germ layers ; ectoderm, mesoderm, or endoderm.

Causes of Dermoid cyst

A dermoid cyst is a congenital defect (present from birth) that occurs during embryonic development when the skin layers do not properly grow together. They generally change in size and shape and are often first detected after an upper respiratory tract infection, which causes enlargement of the mass. Most branchial cleft cysts are located in front of the stenocleidomastoid muscle in the lower neck and they may have an external opening or pore from which drains a mucus-like material. A dermoid cyst is lined with epithelium, which contains tissues and cells normally present in skin layers, including hair follicles, sebaceous (skin oil), and sweat glands. These glands and tissues secrete their normal substances, which collect inside the cyst, causing it to grow and enlarge.

Common Causes of Dermoid-cyst :

Dermoid cysts occur when skin and skin structures become trapped during fetal development.
Histogenetically, dermoid cysts are a result of the sequestration of skin along the lines of embryonic closure.
Dermoid cysts are true hamartomas.
Dermoid cysts occur when skin and skin structures become trapped during fetal development.

Symptoms of Dermoid cyst

Skin cyst.
Ovarian cyst.
Ovarian swelling.

Treatment of Dermoid cyst

Surgically remove dermoid cysts.
Intracranial, intramedullary, and ovarian dermoid cysts are difficult to treat, and sophisticated neurosurgical or gynecologic surgical techniques are often needed to remove the lesion and prevent possible complications.
Dermoid cysts in other parts of the body such as intracranial cysts, intraspinal cysts, intra-abdominal cysts and cystic tumours of the ovary may be difficult to treat and require special surgical techniques to remove the lesion and prevent possible complications.
The patient waits and gets re-examined in one to three months to see if the cyst has changed in size. This is a common treatment option for women who are in their childbearing years, have no symptoms, and have a fluid-filled cyst. It also might be an option for postmenopausal women.

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