Page 50 - World Journal of Laparoscopic Surgery

CASE REPORT
Wandering Dermoid Cyst of Ovary: A Case Report

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Rajneet N Bhatia, Nozer K Sheriar, Sachin K Dhaduk 3
Received on: 24 January 2022; Accepted on: 26 February 2022; Published on: 05 September 2023
AbstrAct
Background: Mature cystic teratomas (dermoid cysts) are most frequently seen in the reproductive age-group. Torsion is the most common
complication of dermoid cysts, with detachment from the adnexa in rare circumstances.
Case description: A 38-year-old patient presented with dull pain in right lower abdominal region. Tenderness was elicited in the right iliac fossa
with right forniceal fullness on per vaginal examination. The ultrasound diagnosis of a mature cystic teratoma was confirmed on computerized
tomography. Laparoscopy showed torsion of the right adnexa, with the dermoid cyst seen detached and within the pouch of Douglas. The
wandering dermoid cyst was removed laparoscopically, en masse using an endobag without spillage.
Conclusion: The rare possibility of detachment of the dermoid cyst with or without the entire ovary exists in cases of torsion necessitating
recognition and appropriate surgical removal.
Keywords: Case report, Cystic teratomas, Dermoid cysts, Pouch of Douglas, Torsion of adnexa.
World Journal of Laparoscopic Surgery (2023): 10.5005/jp-journals-10033-1550

bAckground 1 Department of Obstetrics and Gynecology, PD Hinduja Hospital,
Mature cystic teratomas also known as dermoid cysts, are the most Aviva Clinic For Women, Mumbai, Maharashtra, India
common germ cell neoplasia of the ovary. They are derived from 2 Department of Obstetrics and Gynecology, Breach Candy Hospital,
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one or more of the three germ cell layers. Their incidence ranges PD Hinduja Hospital, Holy Family Hospital, Aviva Clinic For Women,
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from 5 to 25% of all ovarian tumors. Torsion of the pedicle is the Mumbai, Maharashtra, India
most frequent complication of dermoid cysts and is seen in 16.1% 3 Department of Obstetrics and Gynecology, PD Hinduja Hospital,
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of all cases. Torsion interferes with the blood supply and may thus Mumbai, Maharashtra, India
result in venous congestion and aseptic inflammation of the tumor Corresponding Author: Rajneet N Bhatia, Department of Obstetrics
wall. In acute torsion, the ovary or the entire adnexa may undergo and Gynecology, Aviva Clinic For Women, Mumbai, Maharashtra, India,
necrosis due to ischemia, whereas in subacute or chronic torsion Phone +91 9619696674, e-mail: rajneet1910@gmail.com

the dermoid cyst or ovary could adhere to adjacent structures and How to cite this article: Bhatia RN, Sheriar NK, Dhaduk SK. Wandering
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develop a new collateral circulation. In rare situations, the cyst or Dermoid Cyst of Ovary: A Case Report. World J Lap Surg 2023;16(1):
the entire ovary along with the cyst may completely detach from its 49–51.
primary pedicle and form a parasitic dermoid or ovary. The reported Source of support: Nil
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incidence of this entity is as low as 0.4% of all ovarian teratomas. Conflict of interest: None
We describe one such case of a wandering dermoid diagnosed and Patient consent statement: The author(s) have obtained written
managed laparoscopically. informed consent from the patient for publication of the case report
details and related images.
cAse description
A 38-year-old woman, with previous three cesarean deliveries, concentration was found to be 79.1 U/mL (normal values 0–35 U/mL)
presented with a complaint of pain in the right lower abdomen since with other tumor markers including CEA (0.35), beta hCG (<0.1), and
a month. The pain was described to be dull in nature with radiation AFP (1.01) within normal limits.
to the back and thigh. Menstrual history was unremarkable with Magnetic resonance imaging was suggested for further
no significant medical history. There were no urinary- or bowel- evaluation but patient who suffered claustrophobia, opted
related complaints. to avoid it. Instead a detailed evaluation of the abdomen and
On examination, her abdomen was soft with minimal pelvis was undertaken using contrast-enhanced computerized
tenderness in right iliac region with no rebound tenderness. Per tomography (CECT). The scan revealed a solid cystic mass lesion
vaginal examination revealed bulky, mobile, anteverted uterus in the pouch of Douglas with the right ovary lying anterosuperior
with right forniceal fullness. to the lesion. The lesion showed well-defined margins with
Pelvic ultrasound revealed a large adnexal mass lesion with minimal enhancement of the solid component along with fat
the right ovary not separately visualized from the lesion. The lesion tissue and calcific foci within it. The fat planes with adjacent pelvic
had solid and cystic components with thick walls showing internal organs were maintained with no obvious pelvic or abdominal
debris and marginal echogenic focus. The routine hematological lymphadenopathy. These features were consistent with mature
and biochemical markers were within normal limits. CA-125 cystic teratoma (Figs 1 and 2).

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