1. Dermoid Cyst of Ovary Brian Lee March 2013 Dr. Joy Sclamberg

2. Case Presentation – MRN:0833836 2 HPI: 46F presents with abdominal pain x1 week. Improved with NSAIDs initially but unremitting after. + nausea/emesis, BRBPR PE: Abd: Mildly tender in RLQ and LLQ, + rebound tenderness Vaginal: Large mass noted in left adnexal region extending medially, mildly tender. ~10cm. Labs: CMP - normal, CBC - normal, lipase – normal DDX: Diverticulitis, Ovarian Cyst, Ruptured Ectopic Pregnancy, Appendicitis

3. Imaging 3 Options: US Pelvic/Transvaginal, CT Abdomen/Pelvis, MRI Pelvis

4. Pelvic Diagram 4

5. Right Adnexa US Sagittal

6. Right Adnexa US Transverse

7. Right Adnexa US Sagittal Doppler

8. Left Adnexa US Sagittal

9. Left Adnexa US Transverse

10. Left Adnexa US Sagittal Doppler

11. Left Adnexa US Sagittal

12. Left Adnexa US Transverse

13. Pelvic Mass US Sagittal ML-LT

14. Abdomen/Pelvis – Normal Image CT Axial

15. Abdomen/Pelvis CT Axial 5208288

16. Abdomen/Pelvis CT Axial 5208288

17. Abdomen/Pelvis CT Axial 5208288

18. Abdomen/Pelvis CT Axial 5208288

19. Abdomen/Pelvis CT Axial 5208288

20. Abdomen/Pelvis CT Axial 5208288

21. Abdomen/Pelvis CT Axial 5208288

22. Abdomen/Pelvis CT Axial 5208288

23. Abdomen/Pelvis CT Coronal 5208288

24. Abdomen/Pelvis CT Coronal 5208288

25. Abdomen/Pelvis CT Coronal 5208288

26. Abdomen/Pelvis CT Coronal 5208288

27. Abdomen/Pelvis CT Coronal 5208288

28. Abdomen/Pelvis CT Coronal 5208288

29. Abdomen/Pelvis CT Coronal 5208288

30. Teratoma 30 Benign teratomas (or dermoid cysts) are germ cell neoplasms with differentiated tissues of all 3 germ cell layers in a complex pattern. Usually benign; however, differentiated dermoid cysts may become malignant and turn into squamous cell carcinomas. Can also torse or hemorrhage or become infected, causing emergent presentation. Diagnosis with imaging. Options include unilateral oophorectomy or salpingooophorectomy.

31. Follow-Up 31 1 week later: Laparoscopic left salpingooophorectomy. Normal appearing right ovary and tube. Left dermoid cyst about 11 cm in size, torsed around adnexa, unable to distinguish between ovarian and cystic tissue Path: Ovary with mature cystic teratoma (dermoid cyst). 135g, 11.5 x 7.0 x 5.0 cm bilobed cyst. The cyst is filled with tan gummous material and brown hair. The strictured area of the cyst is firm and calcified. The area of wall thickening has a hemorrhagic, tan cut surface with areas of caseation. No ovarian tissue is identified.

32. 32 Thank You!