Southern Luzon State University

A CASE PRESENTATION

College of Allied Medicine

Presented by: to:

Ms. Angelique C. Chua Dr. Dulce Raeses

BSN III- SLSU Group 4

DERMOID CYST
Cardinal Santos Medical Center Case

Definition
are also known as ovarian neoplasms a cystic teratoma that contains developmentally mature skin, thus; may contain substances such as nails and dental, cartilage-like, and bonelike structures If limited to the skin or subcutaneous tissue, dermoid cysts are thin-walled tumors that contain different amounts of fatty masses; occasionally, they contain horny masses and hairs.

Definition (cont.)
develop from the ovary's germ cells cells that produce the egg and the beginnings of all human tissues may be present at birth but are not noticed until adulthood grow slowly and are not tender unless ruptured usually occur on the face, inside the skull, on the lower back, and in the ovaries Superficial dermoid cysts on the face usually can be removed without complications

Major Areas of Occurence

Dermoid cysts in the brain: occur very rarely here; need to be removed if they cause problems. Dermoid cysts in the brain: Dermoid cysts occur very rarely here. A neurosurgeon may need to remove them if they cause problems. Ovarian dermoid cysts: develop during reproductive years; can cause torsion, infection, rupture, and cancer. Dermoid cysts of the spinal cord: A sinus tract, which is a narrow connection from a deep pit in the skin, usually connects these very rare cysts to the skin surface; can become infected.

Pathophysiology
Dermoid cysts in the skin and subcutis occur mostly on the face, neck, or scalp. In addition to the skin, dermoid cysts can be intracranial, intraspinal, or peri-spinal. Intra-abdominal cysts, such as cystic tumors of the ovary or omentum, occur as well.

Frequency
United States No information is available about the prevalence of dermoid cysts In gynecology, dermoid cysts are relatively rare tumors, a cystic teratoma that most often occurs in individuals aged 15-40 years In neurosurgery, dermoid cysts are rare In dermatology and pediatrics, dermoid cysts are relatively uncommon.

Frequency (cont.)
International the same as the prevalence in the United States Of the 2639 eyelid tumors from a Chinese study, the 5 most common eyelid benign ones were:
o inflammatory

lesions o melanocytic nevi o Papillomas o dermoid cysts and epidermoid cysts o epithelial cysts

Mortality/ Morbidity
Although dermoid cysts are located in connection with the spinal channel (as described in neurosurgery literature), no deaths are directly linked to ruptures of the cyst or to the spreading of fatty and occasionally, infected masses in subarachnoid, ventricular, or subdural compartments. However, rupture or spread can lead to severe neurologic complications such as secondary spinal subdural abscesses.

Risk Factors


Race
No racial predilection is apparent; however, most cases of dermoid cysts in the literature are described in white persons.

Sex
Dermoid cysts of the ovary are sex restricted, that is, they occur only in the female population. In other dermoid cysts, no sex predilection has been found.

Age
Dermoid cysts have been described in persons of all ages:

Risk Factors (age)

Dermoid cysts on the face, neck, or scalp are subcutaneous cysts that are usually present at birth. Intracranial or perispinal dermoid cysts are most often found in infants, children, or young adolescents.  Intra-abdominal dermoid cysts are described in females aged 15-40 years.  Most dermoid cysts on the floor of the mouth occur in individuals aged 10-30 years. There are few descriptions of oral dermoid cysts in newborns or children.


Clinical History


Dermoid cysts that are congenital and localized on the neck, head, or trunk are usually visible at birth. In some instances, careful medical examination may help to find most dermoid cysts. Intracranial, intraspinal, or intra-abdominal dermoid cysts may be suspected after specific or nonspecific neurologic or gynecologic symptoms occur. In these instances, imaging studies may help in distinguishing dermoid cysts from other tumors or organ malformations.

Clinical History (cont)



A congenital intracranial frontotemporal dermoid cyst may be first evident as a cutaneous fistula, although intracranial extension and cutaneous sinus tract formation are rarely seen with these dermoid cysts. Unilateral upper eyelid swelling may be the first sign, with imaging studies demonstrating a soft tissue orbital dermoid cyst arising from the lacrimal gland.

Clinical History (cont.)

An eyelid dermoid cyst attached to a tarsus may be evident as a firmly adherent nontender upper-eyelid nodule. Dermoid tumors in the medial canthal area may present as masses adherent to the lacrimal canaliculi.

Physical
Dermoid cysts can appear as cutaneous cysts on the head, as cysts on the floor of the mouth or elsewhere in the head, within the parotid gland, or as cysts in the testes or penis. They can be quite large. Specialists in various disciplines may consider dermoid cysts to be different entities.

Specifics
o

Cutaneous Cysts o most commonly occur on the head (forehead), mainly around the eyes, occasionally, they occur on the neck or in a midline region o When on the head, dermoid cysts are often adherent to the periosteum. o Usual diameter of the lesions is 1-4 cm

Specifics
o

Dermoid cysts can occur elsewhere in the head (eustachian tube; only 12 patients were noted) Dermoid cysts can occur in the testes or penis (extremely rare). For gynecologists and general pathologists a dermoid cyst is primarily associated with a cystic tumor of the female ovary.

Signs and Symptoms

Firm and painless palpable mass Cyst(s) that grows or changes color Pain and/or fever may indicate rupture of cyst Specific signs and symptoms varies depending on the location of the cyst

Diagnosis
Imaging Studies Radiography, CT scanning, and MRI are helpful in making the correct differential diagnosis of dermoid cysts. MRI is particularly helpful in diagnosing intracranial or intramedullary dermoid cysts and in assessing the dissemination of fatty masses or droplets. MRI is helpful in planning surgical procedures and in assessing therapeutic success

Diagnosis (cont.)
Histologic Findings Dermoid cysts are a result of the sequestration of the skin along the lines of embryonic closure. If connected with the ovary, dermoid cysts are true teratomas.

Treatment
Surgical Care
Surgical excision is the treatment of choice in any localization.  Surgically remove dermoid cysts.  In some patients, surgery should be performed even more carefully than usual because the fatty content of the cyst may spread to the surrounding tissues or anatomic structures, especially if the cyst is infected with bacteria.  The spread of these contents can cause foreign body reactions and severe complications.

Complications
For

ruptured spinal dermoid cyst, dissemination of fatty droplets in the cerebrospinal fluid or dilation of central canal of the spinal cord. In other patients, subarachnoid and ventricular fat dissemination can occur after the cerebellopontine angle dermoid cyst is resected. Spinal subdural abscesses are a possible complication because of the bacterial infection of spinal dermoid cysts in a dermal sinus tract.

Did you know that

A ruptured intracranial dermoid cyst be an incidental finding on an MRI performed for other purposes or because of a persistent headache?

Nursing Responsibilities
Complete and accurate assessment and history taking Perioperative nursing care for client requiring surgery Health education regarding disease;
Incidence Characteristics Signs and symptoms Diagnosis Treatment, and Possible complications

Nursing Responsibilities
Provide support for the client presence, empathy and positive regard (malignant). Provide support for the family (malignant). Promote positive self concept. Health teachings such as:
Watchful observation of masses present. Consultation of any masses with or without associated symptoms to health care provider. Immediately seek medical assistance when pain and/or fever occurs (rupture).

THE END

Special thanks to the following persons:

Dr. Dulce Raeses Cardinal Santos Medical Center Annex and Main Nursing Staffs Pretty group mates Scary group mates Audience