Q. I had my right ovary and tube removed due to a 4. 5 cm dermoid cyst. Was it the right call?

Hi,

Welcome to icliniq.com.

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.

Take care. Hope your concern is solved.

For more information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist

Hi,

Welcome back to icliniq.com.

I will try to explain your case in detail. 

• 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.

Take care. Hope your concern is solved.

For more information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist

Hi,

Welcome back to icliniq.com.

• 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.

Hope your concern is solved. Take care.

For more information consult a pathologist online --> https://www.icliniq.com/ask-a-doctor-online/pathologist