Dr Sherene Kalloo

Imag­ine be­ing told you have an ovar­i­an cyst con­tain­ing hair, teeth, bone, car­ti­lage, sweat glands, and skin tis­sue. It may sound fright­en­ing, but this is what makes an ovar­i­an der­moid cyst un­usu­al.

Med­ical­ly known as a ma­ture cys­tic ter­atoma, an ovar­i­an der­moid cyst is a type of growth that de­vel­ops from germ cells in the ovary, which have the abil­i­ty to de­vel­op in­to dif­fer­ent types of body tis­sue.

Der­moid cysts are among the com­mon be­nign ovar­i­an tu­mours. They can oc­cur at al­most any age, in­clud­ing child­hood, but are most fre­quent­ly di­ag­nosed in women dur­ing their re­pro­duc­tive years, par­tic­u­lar­ly be­tween 20 and 40 years of age.

What caus­es ovar­i­an der­moid cysts?

The ex­act rea­son why these cysts de­vel­op is not ful­ly un­der­stood. They orig­i­nate from germ cells that have the abil­i­ty to de­vel­op in­to dif­fer­ent types of ma­ture body tis­sue.

What symp­toms should I look out for?

Many women with ovar­i­an der­moid cysts have no symp­toms what­so­ev­er. The cysts are fre­quent­ly dis­cov­ered in­ci­den­tal­ly dur­ing an ul­tra­sound ex­am­i­na­tion per­formed for an­oth­er rea­son or dur­ing a rou­tine gy­nae­co­log­i­cal as­sess­ment.

When symp­toms oc­cur, they may in­clude:

• Per­sis­tent or in­ter­mit­tent low­er ab­dom­i­nal or pelvic dis­com­fort.

• A sen­sa­tion of heav­i­ness or pres­sure in the pelvis.

• Ab­dom­i­nal swelling or dis­ten­sion, par­tic­u­lar­ly with larg­er cysts.

• A pal­pa­ble ab­dom­i­nal mass in some cas­es.

One of the most im­por­tant com­pli­ca­tions is ovar­i­an tor­sion, which oc­curs when the ovary twists around its sup­port­ing struc­tures. This can com­pro­mise its blood sup­ply.

The woman may ex­pe­ri­ence sud­den, se­vere ab­dom­i­nal pain, of­ten ac­com­pa­nied by nau­sea and vom­it­ing. This is a med­ical emer­gency re­quir­ing im­me­di­ate as­sess­ment.

How are der­moid cysts di­ag­nosed?

Ul­tra­sound ex­am­i­na­tion, par­tic­u­lar­ly trans­vagi­nal ul­tra­sound, is the prin­ci­pal in­ves­ti­ga­tion. Some­times, ad­di­tion­al imag­ing, such as mag­net­ic res­o­nance imag­ing (MRI), may be need­ed.

Al­though most der­moid cysts are be­nign, their ap­pear­ance, size and growth pat­tern must be care­ful­ly as­sessed.

Do all der­moid cysts re­quire surgery?

In the past, sur­gi­cal re­moval was of­ten rec­om­mend­ed. How­ev­er, se­lect­ed women with small, un­com­pli­cat­ed cysts and no symp­toms can be man­aged con­ser­v­a­tive­ly.

This means pe­ri­od­ic clin­i­cal as­sess­ment and ul­tra­sound mon­i­tor­ing to de­ter­mine whether the cyst is grow­ing or de­vel­op­ing con­cern­ing fea­tures.

Surgery may be rec­om­mend­ed when:

• The cyst is caus­ing per­sis­tent pain or dis­com­fort.

• It is in­creas­ing in size.

• It is suf­fi­cient­ly large to in­crease the risk of com­pli­ca­tions, par­tic­u­lar­ly tor­sion.

• There are sus­pi­cious ul­tra­sound find­ings.

• There is un­cer­tain­ty about the di­ag­no­sis.

The de­ci­sion must be in­di­vid­u­alised, tak­ing in­to con­sid­er­a­tion the woman’s age, symp­toms, cyst char­ac­ter­is­tics, gen­er­al health and re­pro­duc­tive plans.

In women who de­sire chil­dren in the fu­ture, a cys­tec­to­my, which in­volves re­mov­ing the cyst while pre­serv­ing the healthy ovar­i­an tis­sue, is usu­al­ly per­formed. Small ones can be re­moved la­paro­scop­i­cal­ly (key­hole surgery), al­though larg­er mass­es may re­quire open surgery.

Can der­moid cysts be­come can­cer­ous?

The over­whelm­ing ma­jor­i­ty of ovar­i­an der­moid cysts are be­nign. How­ev­er, in rare cir­cum­stances, ma­lig­nant trans­for­ma­tion can oc­cur. Pub­lished stud­ies gen­er­al­ly place this risk at 0.5–3 per cent, with the risk be­ing greater in old­er women, par­tic­u­lar­ly af­ter menopause, and in some larg­er tu­mours.

This is why prop­er as­sess­ment is im­por­tant, par­tic­u­lar­ly in post­menopausal women or when ul­tra­sound find­ings are sus­pi­cious.

Can der­moid cysts re­turn?

Re­cur­rence af­ter sur­gi­cal re­moval is pos­si­ble but un­com­mon. Women who have had a der­moid cyst re­moved may oc­ca­sion­al­ly de­vel­op an­oth­er one, ei­ther in the same ovary or the op­po­site ovary.

When should I seek med­ical at­ten­tion?

Any woman ex­pe­ri­enc­ing per­sis­tent un­ex­plained pelvic dis­com­fort, ab­dom­i­nal swelling or an ab­dom­i­nal lump should seek med­ical as­sess­ment.

How­ev­er, sud­den se­vere ab­dom­i­nal pain, par­tic­u­lar­ly when as­so­ci­at­ed with nau­sea or vom­it­ing, re­quires im­me­di­ate at­ten­tion be­cause of the pos­si­bil­i­ty of ovar­i­an tor­sion.

There is cur­rent­ly no es­tab­lished method of pre­vent­ing ovar­i­an der­moid cysts.

The im­por­tant mes­sage: Ear­ly as­sess­ment, rou­tine as­sess­ment, ap­pro­pri­ate ul­tra­sound mon­i­tor­ing and in­di­vid­u­alised treat­ment are es­sen­tial. Our ob­jec­tive as gy­nae­col­o­gists is not sim­ply to re­move a cyst, but to pro­tect a woman’s health, pre­serve her ovar­i­an func­tion and safe­guard her fu­ture re­pro­duc­tive po­ten­tial when­ev­er pos­si­ble.

Dr Sherene Kalloo

MDW, MBBS, DGO, DM, FACOG

Spe­cial­ist Ob­ste­tri­cian & Gy­nae­col­o­gist