Introduction: Mature cystic teratoma (MCT) of the ovary
The most common tumor of ovarian germ cells in reproductive age is 10-20% of all ovarian neoplasms.-Dermoid cysts are usually clinically silent and are detected incidentally on medical imaging.They will be created in two ways: Congenital: it is the result of ectoderm implantation during embryogenesis, when the neural groove is closed.Acquired: due to surgery or trauma, which results in tissue implantation into the peritoneal cavity.A dermoid cyst is a single lesion, a subcutaneous nodule. It is pale in color or fleshy or pearly in color.It is covered by an epidermis-like epithelium that contains derivatives: mesoderm or endoderm or ectoderm, tissues such as skin, hair, or teeth.Most cystic teratomas are congenital. They occur in the second and third decades of life. They are usually unilateral and in 10% of cases they are bilateral and multicystic.The annual growth rate of dermoid cyst is 1.8 cm per year in premenopausal women. This cyst with a slow growth pattern often causes a delay in diagnosis.It has a 1-2% chance of becoming a malignant tumor and will cause ovarian cancer, which is the most common squamous cell carcinoma.
Methods: Giant cysts can be up to 30-40 cm in size، They need to be removed due to pressure symptoms and risks of malignancy. Their treatment is done by full midline laparotomy and oophorectomy.Management of adult teratoma is influenced by malignancy, age of the patient, and the need for fertility preservation. Cyst removal is an effective treatment. Chemotherapy and drug therapy are considered targeted when any malignancy is present, or when it is combined with other ovarian cancers.Diagnosis will be done using sonography and MRI. MRI has 100% sensitivity.Surgery is the definitive treatment for dermoid cysts. This cyst may recur after surgery in 11% of cases, and re-surgery is required in 3% of cases. Surgery is performed either as ovary preservation or oophorectomy.
Results: Laparoscopy is a treatment that protects reproductive health and skin appearance. If the size of the cyst is less than 5 cm, this method is used. The fluid inside the cyst is aspirated by a vacuum aspirator using a Veress needle to prevent it from spilling into the lumen. In this method, the probability of cyst rupture is 100-15%. The risk of intraperitoneal rupture and peritonitis and adhesion is high.Laparotomy، The main basis of surgery for large and bilateral ruptured cysts. The risk of rupture is lower than laparoscopy.Mini laparotomy is minimally invasive. A small incision of 1-4 cm will be made. It is a way to preserve more ovarian tissue.Oophorectomy is performed in menopausal people , they have muscle pain in the lower body and the probability of malignancy is high.Dermoid cyst has a significant effect on fertility.The results showed that the removal of the ovarian dermoid cyst significantly reduces the ovarian reserve according to the size of the cyst itself. The presence or removal of the cyst has no effect on the result of IVF, but it reduces the ovarian reserve according to the AMH levels.
Complications: twisting 16% _ Malignant degeneration 2% _ 1% infection _ Hemolytic anemia 1% _ Cyst rupture 1-2%.
Conclusion: The exact cause of dermoid cyst rupture is unknown، It is rare spontaneously because the cyst has a thick capsule، It usually occurs during pregnancy and may cause two complications: 1- Acute peritonitis and sudden release of the contents of the mass.2-Chronic granulomatous peritonitis (more common)which causes chronic leakage of contents and causes adhesion and ascites.
Chemical peritonitis is a serious and rare complication during cyst removal with laparoscopy. To prevent it, they use abdominal lavage. It is successfully managed with a lot of pelvic washing and bowel rest.
According to the research timely diagnosis and doctor's help are useful in improving the quality of life. Also, international cooperation is necessary for research and clinical trials in this field.