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I am a 34 year old female, and I had my right ovary and tube removed during C-section, due to a 4.5 cm dermoid cyst. The cyst was found during an ultrasound scan, five years back. The surgeon said a cystectomy was no possible because the cyst had completely replaced the ovary. Could you please confirm if the attached histopathology report says anything about the ovarian tissue? I had no symptoms, no pain, no torsion, and the right ovary was functioning in spite of the cyst. I became pregnant twice due to ovulation from the right ovary. What is the medical condition due to which the entire ovary is replaced by a dermoid cyst? Thank you.
I have gone through your attached reports (attachment removed to protect patient identity).
Let me tell you, your right-sided cyst was having benign germ cell tumor that is a dermoid cyst, which is called as a mature cystic teratoma. Such a cyst is filled with cheesy material, tooth, hair, etc.
Here, the size of the cyst is large. So, during operation, if cyst removal is found difficult, then the ovary needs to be removed. In a benign cystic tumor, ovary can be functional, so you became pregnant, although a cyst was present. In teratoma usually, surgical removal is needed, rather than medication.
Thank you for the quick reply. My concern is regarding the indication for the procedure. I was told by another gynecologist that dermoid cyst replacing an ovary completely is rare except if the cyst is very large. I am not sure what the size of the cyst was at the time of surgery because the pathology report says size 5.5 cm. Is it the size of the ovary or cyst? Was there no ovary? Could you please explain what it means by 'ovary completely replaced by cyst'? Does it mean there was no ovarian tissue? I was wondering if a pathologist could confirm how enlarged the cyst was and if the report actually says if the cyst had totally replaced the ovary. Before surgery, I was told about ovarian cystectomy only and ovary removal or omentectomy in the case of malignancy. Could you let me know if there was any indication of malignancy to do omentectomy or if it is the standard procedure done during salpingo-oophorectomy? Thank you very much.
As I have said, the dermoid cyst is a mature cystic teratoma, in which the ovary is filled with cheesy material, hair follicle, teeth, etc., like ectodermal content, it is mentioned in your histopathology report as well.
In teratoma, the surgical approach is needed, and laparoscopy is the gold standard treatment for that. It is controversial to remove the whole ovary or only the cyst.
But according to routine practice and as per few studies, it is better to do cystectomy if possible. If it seems malignant, then the entire ovary is removed.
In USG (ultrasonography), the cyst can be identified as malignant by gross changes like necrosis, high papillary structures, solid tumor, ascites, etc. So when USG suggest malignant changes, at that time clinical correlation is needed, and if needed, CT scan and other higher investigation are done to exclude malignancy.
But in your case, during operation, it was found that ovary is totally effaced by ovarian cystic. You can do cystectomy only when separate ovarian tissue and the cyst are seen. Here, no separate ovarian tissue was present during operation, and only teratoma cyst was seen, so the entire ovary was removed.
And in histopathology report, the size of ovarian cyst is mentioned. It is not ovary size but it is the size of the effaced ovary by the cyst. So, it was the right call. And as it was a benign tumor, there is no need to worry.
Thank you for your medical opinion regarding this. Could you please let me know if the histopathology report says there is no ovarian tissue left? At the ultrasound scan at 34 weeks pregnancy, I was told cyst enlargement is consistent with pregnancy. Could pregnancy be a reason why separate ovarian tissue was not seen? Regarding omentum, the report says no lesions or lymph nodes are identified. I would really appreciate your medical opinion regarding why this would have been medically necessary. Yes, I am glad it was a benign tumor, but I am just trying to figure out what warranted the removal of ovary, tube, and omentum, during ovarian cystectomy. No tests prior to surgery indicated malignancy and no unexpected malignancy was found during surgery. Thank you very much for your time in addressing my concern.
Histopathology report showed that there was a presence of a cyst, but it is not mentioned that no ovarian tissue is left but ovary itself is effaced by the cyst.
Yes, pregnancy sometimes can lead to enlargement of the cyst.
Teratoma (cystic dermoid benign tumor), some time can convert into malignant one and in that case, along with ovary, fallopian tube, and part of omentum is removed as debulking surgery according to the need.
Grossly, it might not show a metastatic lesion, but if the malignant conversion occurs in teratoma, then omentum might have a metastatic deposit, which needs further aggressive chemotherapy treatment. Another point is, if adhesions are found during operation, then it might be removed.
And in teratoma, it is better to remove ovary and tube both as per few study. If a fallopian tube cyst is also present, then both ovary and fallopian tube are removed. If it is not possible to resect the cyst completely, then the entire ovary is removed.
The part of your omentum was removed to look for metastatic deposits. Or there might have been adhesions, which leads to its removal. Omentum metastatic is rare. Consult your gynecologist for examination whenever follow-up is advised. And if you still have a doubt, then consult your treating gynecologist with keeping my answer in mind.
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