Dermoid Cyst (Teratoma)

Introduction

• Description: The most common ovarian tumor in young, reproductive-aged women is the cystic teratoma or dermoid, which originates from a germ cell and contains elements from all three germ cell layers. These tumors may be benign or malignant (1%–2% malignant, usually in women older than 40 years). Dermatoid cysts account for 20%–25% of all ovarian tumors, one-third of all benign tumors, and 70% of tumors in young women aged 10–30 years.

• Prevalence: 15%–25% of ovarian tumors.

• Predominant Age: 20s–30s (75%); most patients are younger than 40 years.

• Genetics: No genetic pattern.

Etiology and Pathogenesis

• Causes: Unknown. Considered to arise from a single germ cell during the first meiotic division at approximately 13 weeks of fetal life. They routinely have a chromosomal makeup of 46,XX.

• Risk Factors: None known.

Signs and Symptoms

• Asymptomatic (50%–60%).

• Adnexal mass (<10 cm in diameter in 80% of patients; bilateral in 10%–15% of patients)—the contents of cystic teratomas are of low density; they are often found “floating” anterior to the uterus or broad ligament, displacing the uterus posteriorly.

• May manifest with pain secondary to torsion (approximately 10%) or bleeding into the cyst, a sense of pelvic heaviness, or dysmenorrhea.

• Thyroid storm (when thyroid tissue predominates: struma ovarii) or carcinoid syndrome (rare).

Diagnostic Approach