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Dermoid cyst of the ovary

A dermoid cyst (also called as “mature teratoma”) is a sac-like growth that may be present at birth. It contains structures such as hair, fluid, teeth or skin glands that can be found on or in the skin. In some cases, especially when in the ovary, it also contains thyroid or brain tissue. Ovarian dermoid cysts, which not uncommonly are found in both ovaries, can develop in a woman during her reproductive years. The word “teratoma” is derived from Greek work “teraton” meaning monster. It was initially used by Virchow in 1863. The term “dermoid cyst” was coined by Leblanc in 1831.

Keywords: Bilateral ovaries, dermoid cyst, asymptomatic condition

Introduction

Mature cystic teratomas account for 10-20% of all ovarian neoplasms and are the most common neoplasm in patients of reproductive age group. Mature teratomas are usually benign, but in 0.1-0.2% of cases, it may undergo malignant transformation. They may remain asymptomatic or may present with acute abdomen due to torsion, infection, or rupture. Spontaneous rupture of the teratoma is rare and has been occasionally reported. Here we present a case of deroid cyst of ovary, which is bilateral and which is a rare presentation.

Discussion

Cystic teratomas make up approximately 15-25% of ovarian neoplasms. Almost 10-15% is bilateral. They are composed of well-differentiated derivatives of three germ layers-ectoderm, mesoderm and endoderm. Mature cystic teratomas, often referred to as dermoid cysts, are the most common germ cell tumors of the ovary in women of reproductive age and are usually asymptomatic until they reach considerable size. Though they are common in reproductive age, but they can occur at any age including the post-menopausal woman. Most are 5-10 cm in diameter when diagnosed and on sectioning they usually contain thick sebaceous material, tangled hair and various dermal structures. One of the major complications seen in cystic teratomas is torsion, a partial or complete twisting of the ovarian suspensory pedicle causing severe pain, nausea and tissue necrosis. Malignant transformation is uncommon, occurring in approximately 0.1-0.2% of cases usually in older women. Ovarian teratomas have a predisposition to right lateral side.

Endometriosis co-existing with bilateral dermoid cysts of the ovaries is a rare occurrence although both benign conditions are said to be common in women in reproductive age group. This association has a clinical relevance because an endometriotic pathology can reveal a silent teratoma with bilateral ovarian localization.

In general, removing a dermoid cyst is not an emergency procedure. If a dermoid cyst ruptures, becomes inflamed, or causes pain or fever, a person should seek immediate medical advice. Treatment depends also upon the patients age. In younger woman, it may be possible to remove the dermoid cyst while still leaving behind normal ovary tissue for needed hormone benefits or future pregnancy. Autoimmune hemolytic anemia has been noted occasionally in patients with teratoma of the ovary, especially mature cystic teratoma.

Ovarian teratoma commonly has an indolent course and presents with abdominal pain due to complications such as torsion, hemorrhage, or infection. Spontaneous rupture of teratoma is rare due to its thick wall and it usually occurs in the peritoneal cavity. Rupture into a hollow viscus due to adhesions is extremely rare complication, which may present as perforation peritonitis.
Although ovarian teratomas are common day, we present this case because of its bilateral presentation, which is rare and the mode of treatment and the complications if not treated properly.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max e Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including dermoid cysts of ovary.

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Big and plenty of fibroids

Uterine fibroids are tumors that grow in a woman’s womb (uterus). These growths are typically not cancerous (benign)

Causes

Uterine fibroids are common. As many as one in five women may have fibroids during their childbearing years. Half of all women have fibroids by age 50.

Fibroids are rare in women under age 20. They are more common in African Americans than White, Hispanic, or Asian women.

No one knows exactly what causes fibroids. They are thought to be caused by:

• Hormones in the body
• Genes (may run in families)

Fibroids can be so tiny that you need a microscope to see them. They can also grow very large. They may fill the entire uterus and may weigh several pounds or kilograms. Although it is possible for just one fibroid to develop, most often there is more than one.

Fibroids can grow:

• In the muscle wall of the uterus (myometrial)
• Just under the surface of the uterine lining (submucosal)
• Just under the outside lining of the uterus (subserosal)
• On a long stalk on the outside the uterus or inside the uterus (pedunculated)

Symptoms

Common symptoms of uterine fibroids are:

• Bleeding between periods
• Heavy bleeding during your period, sometimes with blood clots
• Periods that may last longer than normal
• Needing to urinate more often
• Pelvic cramping or pain with periods
• Feeling fullness or pressure in your lower belly
• Pain during intercourse

Often, you can have fibroids and not have any symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause. A recent study also showed that some small fibroids shrink in premenopausal women.

Evaluating Uterine Fibroid Size for Removal

Women with large or symptom-producing fibroids may need to have an imaging study done to evaluate uterine fibroid size to determine whether it needs to be removed. The risk of not getting treatment is that fibroids sometimes grow to a size that often leads to significant symptoms, eventually requiring removal.

Larger fibroids or those that continue to grow may lead to complications.

• If submucosal fibroids are found on the inside of the uterus and are large enough to misshape the uterine lining, they should be removed to prevent reproductive problems. (iii)
• If fibroids are larger than a 12- to 14-week pregnancy (about the size of a large grapefruit), the risk of complications during surgery, such as injury to the ureter or bladder, increases. (i)
• Left untreated, very large fibroids can begin to degenerate or burst, even if they aren’t causing any symptoms. (i) Degeneration occurs when the growing fibroid outgrows its blood supply, causing the cells of the fibroid to die. This typically causes abrupt, severe pain and tenderness.
• When fibroids reach the size of a grapefruit (4 – 6 inches), there is a rare association with blood clots in the lungs, which can be deadly. (i)
• Rapidly growing large fibroids may be a sign of a rare cancerous form of fibroid, called a leiomyosarcoma. This type of tumor can’t be differentiated from a non-cancerous (benign) fibroid using ultrasound, MRI, or other imaging studies. However, this type of fibroid only occurs in less than 1percent of uterine fibroids, and these cancerous tumors are not believed to grow from a benign fibroid. (ii)

Treatment Options for Uterine Fibroids

There are several uterine fibroid treatment options:

• Uterine fibroid embolization (UFE) uses tiny particles about the size of sugar crystals that are injected into the blood vessels that lead to the uterus. The particles block the flow of blood to the fibroid, causing it to shrink and die. This minimally invasive procedure can be performed by an interventional radiologist on an outpatient basis. It doesn’t require open surgery and offers relief of symptoms with fewer risks, less pain, and a faster recovery compared to surgical procedures.
• Magnetic resonance imaging-guided (MRI) ultrasound surgery uses ultrasound waves to destroy fibroids. Waves are directed at the fibroids through the skin with the help of magnetic resonance imaging.
• Endometrial ablation destroys the lining of the uterus. This procedure is best for small fibroids that are less than 3 centimeters in diameter. (v)
• Hysterectomy is the surgical removal of the uterus. Because this surgery removes the fibroids along with the uterus, there is no chance of becoming pregnant after undergoing a hysterectomy.
• Myomectomy is another surgical option to remove all types of fibroids. There are three approaches to performing a myomectomy: hysteroscopy, laparotomy, and laparoscopy.

How large do uterine fibroids need to be before being surgically removed?

The normal uterine size is the size of a lemon or 8 cm. There isn’t a definitive size of a fibroid that would automatically mandate removal. Your healthcare provider will determine the symptoms that are causing the problem. Fibroids the size of a marble for instance, if located within the uterine cavity, may be associated with profound bleeding. Fibroids the size of a grapefruit or larger may cause you to experience pelvic pressure, as well as make you look pregnant and see increased abdominal growth that can make the abdomen enlarged.

It’s important for the healthcare provider and patient to discuss symptoms which might require surgical intervention.

Dr. Ruchi Tandon is a Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of Gynecological conditions including Fibroids. She is one of the best fibroids surgeon in south delhi.

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Antenatal care or pregnancy care in the COVID pandemic

The COVID-19 pandemic has everyone anxious and in fear. If you are pregnant, undoubtedly you have a lot of queries about whether coronavirus poses a threat to you and your baby. The answers are not crystal clear yet, due to the evolving nature of the disease. Knowledge from past epidemics due to similar respiratory illnesses help understand and manage viral infections during pregnancy. Here are the common queries among pregnant women answered.

What effect does coronavirus have on pregnant women?

Generally, pregnant women do not appear to be more risky than healthy adults to develop a more serious disease or any complications if affected by coronavirus. Mostly, they will only experience mild to moderate flu-like symptoms.

If you are pregnant and your flu-like symptoms are getting worse, it could mean that your chest infection is getting more severe, and you may require hospitalization. If you develop more severe symptoms or your recovery is getting delayed, contact a first response hospital near you immediately.

What effect will coronavirus have on my baby if I test positive for COVID-19?

As this is a very new virus, all the information and evidence is still not available to us. There is no evidence to suggest an increased risk of miscarriage if exposed to COVID-19. There is also no evidence of vertical transmission, which refers to the ability of the virus to pass to your unborn baby during pregnancy.
In a study of nine pregnant women in China who tested positive for COVID-19, all nine babies tested negative for the virus and were healthy overall. One pregnant lady in London tested positive for coronavirus and later her newborn also tested positive. However, it is unclear whether the baby contracted the viral infection in utero or shortly after birth. Expert opinion is that the baby is unlikely to be exposed during pregnancy, and it is unlikely for the baby to have any defects in development as a result. As of now, there isn’t any new evidence that says otherwise.

What are the effects of Coronavirus in the first trimester?

Pregnant women who were part of The Lancet study were all in their second or third trimesters. There is still no data on pregnant women who tested positive for the virus in their first trimester. Patients who may get infected with symptoms like high fever may increase the risk of birth defects, though there is no evidence for this yet.

Are pregnant women a vulnerable group for Coronavirus?

It is not yet known if pregnant women are more susceptible to be infected by COVID-19 when compared to the normal population. Despite this, pregnant women are advised to reduce social contact by social distancing. It is an established fact that in some women, pregnancy alters how the body fights some viral infections. Though evidence for coronavirus is still insufficient, it is for this reason that pregnant women are advised to be extra cautious during this pandemic.

Will I be able to breastfeed my baby if I have suspected or confirmed coronavirus?

Yes. The benefits of breastfeeding your infant far outweigh the risk of transmission of coronavirus through breastmilk. The main risk of breastfeeding is due to the close contact between you and your baby which can pose a risk of droplet infection that can spread to the baby while breathing. Discuss the risks and benefits with your treating doctor and family before you make a decision.

Here are some steps to follow to minimize the risk of transmission:

• Wash your hands before feeding or touching the baby, breast pump or bottles
• Try to avoid coughing or sneezing while you feed
• Wear a face mask while feeding, if available.
• If you are using a breast pump, follow instructions for cleaning and sterilizing properly.
• Consider asking one of your healthy family members to feed your baby if you are expressing milk.

Precautions for pregnant women against Coronavirus

Here are some actions you can take to prevent getting the disease during pregnancy:

• Wash your hands frequently. Hand hygiene can really protect you from exposure to COVID-19. You may hear this over and over but with good reason.
• Practice social distancing. Always maintain a distance of at least 2 metres or 6 feet from others when you are in a public place. Avoid contact with others as much as possible.
• Get your flu vaccination on time. Though the flu vaccine does not protect you from exposure to COVID-19, it does make you less susceptible to influenza, which can cause complications during pregnancy.
• Use a tissue when you cough or sneeze, throw the tissue in the dustbin. Wash your hands right after.
• Do not ignore any respiratory symptoms. If you develop a cough or any respiratory distress, do not hesitate to call your doctor. After taking a detailed history, your doctor will decide if you need to get tested for COVID-19.
• Go virtual. As much as possible, consider virtual consultations instead of prenatal visits to your gynecologist. Try to minimize or altogether avoid spending time in the doctors waiting room or in the hospital. However, some tests will require you to be there in person such as the ultrasound, blood tests and fetal testing.
• Work from home whenever possible.
• Stay safe. Symptoms such as high fever with or without continuous cough may indicate a possible coronavirus infection. Avoid coming in close contact with anyone showing these symptoms & take the time to look for support from your family and friends. Keep in touch via emails, messages or video chats. Consider taking up a new hobby or acquiring a new skill. Do things that make you happy and put your mind at ease such as taking a long shower, meditating or reading a book. Exercise as per your doctor’s advice and regularly do your Kegels and squats as recommended.

Do not stress too much if your due date is nearing, as hospitals have a system in place for safe deliveries and to ensure minimal risk of exposure for newborns.

Dr. Ruchi Tandon is a reputed Gynecologist practicing in leading hospitals in South Delhi namely Max and Apollo hospitals with over 14 years of experience in handling all kinds of pregnancies. She is known for her bedside manners and etiquette towards pregnant women.