A dermoid cyst in a child

A dermoid cyst in a child, as well as in an adult, is an organoid tumor formation of a benign nature. Dermoids or as they are also called - mature teratomas are diagnosed in 10-11% of children with soft tissue neoplasms.

The cyst is a dense capsule of connective tissue filled with embryonic elements - parts of the endoderm, exoderm and mesoderm. A dermoid cyst may contain particles of sweat, sebaceous glands, bone and hair inclusions, and skin scales.

Surgeons have identified the following statistical pattern that is characteristic of the contents of a dermoid cyst in children:

• Ectoderm – 100% dermoids.
• Mesodermal elements – 90% of cysts.
• Endoderm – 70% dermoids.

Dermoid formations in children are localized where the embryonic cavities should connect, the so-called “gill” slits:

• head (eyes, bridge of the nose, oral cavity, nasolabial folds, ears, back of the head, neck),
• sternoclavicular joints,
• sacrum,
• testicles,
• testicles,
• mediastinum,
• brain (rare).

A dermoid cyst in a child, as a rule, rarely develops to large sizes, since it is detected in the first year of life. The tumor is considered benign, inflammation or suppuration occurs in rare cases.

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Causes of Dermoid Cyst in a Child

The etiology of the formation of dermoid tumors has not yet been clarified. Among medical specialists studying the nature, the causes of dermoid cysts in children, there are also other versions, today there are more than 15 of them.

1. The most popular theory is "displaced blastomeres", according to which the germ cells, having separated, remain immobile and do not divide until an unfavorable moment, a provoking factor, occurs. Due to the fact that displaced blastomeres have no connection with the body, they begin to encapsulate and form a dense pseudocyst. Indeed, dermoids are not cysts in the classical sense of this formation, since their contents are more similar to a tumor - there is no fluid in the cavity. A dermoid contains parts of all three germ layers, the earlier the blastomeres separate, the more variants of elements in the cyst contents. Thus, it is believed that the causes of the formation of a dermoid tumor are associated with a violation of intrauterine development at the earliest stage - embryogenesis. Violation of the differentiation of embryonic cells, the separation of elements of the three germ layers into zones atypical for them - this is one of the most obvious, studied causes of the appearance of dermoids.

Embryon cell tumors are not common and are detected either at the age of up to 2-3 years, or during puberty, when rapid hormonal changes occur in the child’s body.

2. There is also a theory about a genetic, hereditary factor, and, on the maternal line. According to this version, pathological parthenogenesis (self-activation) is the cause of the formation of dermoid tumors. This theory is also called the "zygote" theory. A zygote (a new stem cell) requires a diploid chromosome set and the same number of chromatids (23 each) from the father and mother. In addition, maternal and paternal genes must undergo genomic imprinting, that is, some of them must leave their "mark". When this stage is missed and the process is disrupted, the mother's chromosomes prevail, and in a pathological sense. In the laboratory, with the help of molecular innovations, a "maternal" factor was identified in the formation of dermoid tumors, which, according to statistics, are most often diagnosed in girls.

The causes of dermoid cysts in children, as well as dermoids in adults, continue to be studied; difficulties in combining versions and determining one etiological basis are associated with a positive factor - dermoids are quite rare.

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Dermoid cyst in a newborn

Dermoids in newborn babies are a consequence of impaired embryogenesis, when all three germ layers separate their cells into an uncharacteristic, atypical zone for them (fusion of “sacral”, embryonic cavities).

Dermoid cyst in a newborn (teratoma neonatus, cysta dermoidea) is detected in 22-24.5% of all cases of diagnosed tumors and is most often localized in the following percentage ratio:

• Sacrococcygeal teratoma – 37-38%
• Newborn girls, ovaries – 30-31%
• Head – 10-12%
• Mediastinal region – 4-5%
• Retroperitoneal localization – 9-10%
• Other zones – 3-4%

Dermoids mainly occur in girls, 4 times more often than in boys.

Since a dermoid cyst in a newborn most often forms in the sacrum area, between the anus and the coccyx, a traumatic hemangioma may develop at the site of the neoplasm during labor. Another complication is that a coccygeal dermoid is predominantly detected in girls, and the tumor can fill the pelvic area, but without damaging or disrupting bone tissue. It should be noted that 90% of such teratomas are determined in utero, when a pregnant woman undergoes an ultrasound examination between 22-1 and 34-1 weeks. Ultrasound or MRI shows an excessively enlarged uterus, and a homogeneous mass is visible in the fetus in the sacrum area. In the case of large fetal cysts, cesarean section is indicated to eliminate possible complications such as cyst rupture.

Features that a dermoid cyst in a newborn has depending on its location:

1. Testicular dermoid in newborn boys is almost 100% benign, unlike mature ovarian teratomas in girls. It should also be noted that such a formation is very rare, and most likely associated with a hereditary factor. The cyst contains sebaceous, fatty and epidermal components, cartilaginous, bone elements have not yet been encountered in surgical practice. Dermoid cysts are detected almost from the first week after birth, less often it is detected at the age of up to one and a half years. Usually, dermoid develops and increases very slowly, it is observed and operated on as early as possible, upon reaching 2-3 years of age. Organ-preserving surgery is performed, the outcome and prognosis are favorable in 100%.
2. Dermoid formations of the retroperitoneal space are also determined at the age of up to one year. Most often, such teratomas are formed in girls, the tumor can be quite large - up to 4-5 centimeters, it compresses nearby organs, the child reacts accordingly - constantly cries, his stomach is tense. Dermoid is well determined by palpation, then by ultrasound. Surgery is indicated only in the case of large tumors, small cysts are subject to observation.
3. Dermoid of the oral cavity or teratoma of the pharynx (polyp) is a benign formation that is visible immediately from the first week of birth. Such a dermoid is localized in the upper dome of the pharynx, consists of a capsule with various contents (rudimentary particles, elements of embryonic tissues). The cyst can be located in the jaw area, in the epignatus zone - the pharynx. Small dermoids of the mouth are operated on when the child reaches three years of age, large cysts can be removed earlier, since the risk of complications is much higher than the risks associated with surgical intervention.
4. Dermoids of the brain in newborns are very rare, as a rule, they are diagnosed at a later age. This is due to the fact that dermoid cysts usually grow slowly, and their development is asymptomatic. Indications for examination for cystic formation may be congenital pathologies of the newborn, endocrine disorders, other deviations detected during the intrauterine period.
5. Dermoid ovarian cysts in girls are also diagnosed at a later age. In newborns, such a disease occurs without clinical manifestations. A possible sign may be an atypical increase in the abdomen and crying of the child. In such cases, the child is examined for diseases of the digestive organs and pelvic organs.
6. Sacrococcygeal dermoid is determined already at the intrauterine stage, and is clearly visible immediately after birth. Clinical symptoms directly depend on the location of the cyst - external or internal. An external cyst is usually larger in size, it can even interfere with the birth process. A tumor located in the middle between the buttocks is most often fused with the coccyx, with an external-internal cyst there is pressure on the rectum and defecation, urination is impaired - incontinence of urine and feces. Coccygeal dermoid is treated only surgically, and as early as possible due to the fairly high risk of inflammation, suppuration and malignancy (development into a malignant tumor). If there are no strict contraindications, the operation is performed from 2 months of age.

It should be noted that a dermoid cyst in a newborn is a very rare phenomenon, as benign tumors of the sacrum occur in only 1 in 26-27,000 births. Dermoid formations are considered benign tumors and have a fairly favorable prognosis if they are removed in a timely manner.

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Symptoms of a dermoid cyst in a child

Like other benign tumors, dermoid formations most often do not show clinical signs for a long time. Symptoms of a dermoid cyst in a child are either detected in the neonatal period, when they are visually noticeable, or are determined by enlargement, inflammation, suppuration, pressure on nearby organs. The clinical picture of dermoids is associated with the localization, size of the cyst, as well as the age of the child. Most often, dermoid neoplasms are located in the head (eyes, bridge of the nose, ears, superciliary, oral cavity, neck, occiput), collarbone, coccyx, less often in the mediastinum, retroperitoneal space. Dermoid can also be localized in the ovaries or testicles.

Symptoms of a dermoid cyst in a child may include:

• In children in the first year of life, dense, elastic formations appear in one of the above-mentioned places.
• The tumor has a round shape.
• The dermoid cyst is dense and elastic to the touch.
• The cyst does not have a tight connection with the skin and is not fused with it.
• When palpated, the dermoid does not cause pain.
• The skin over the cyst is not hyperemic, of a normal color, without ulcers, rashes, etc.
• If the dermoid is located on the head (skull), it may appear slightly sunken inward.
• A dermoid formation may not increase in size for a long time and may stop in size.
• In addition to being visible, a coccygeal dermoid can cause problems with urination and defecation (feces take on the appearance of a ribbon).
• Dermoid of the eye (eyeball, eyelid) can impair visual acuity.

A dermoid ovarian cyst in a girl may manifest itself with abdominal pain if the tumor grows to a large size. In addition, the picture of an "acute abdomen" is caused by torsion of the cyst stalk

Clinical symptoms of a dermoid tumor in a child usually appear only in case of an increase in the cyst, its inflammation, suppuration. Benign dermoids of a small size do not change the health of children for the worse and do not provoke functional disorders of internal organs. Rather, simple dermoids are a cosmetic, visible defect that bothers both the child and his parents. Any detected dermoid formation should be removed, despite the almost complete benignity of the tumor, there is a 1-2% risk of malignancy, that is, the dermoid growing into a malignant tumor.

Diagnosis of dermoid cyst in a child

Dermoids are diagnosed without difficulty due to their typical localization and because all germ cell tumors of this type have a characteristic consistency upon palpation. The only difficulty may be the precise determination of the tumor formation in the area of the brow and bridge of the nose, since anterior cerebral hernias are very similar to dermoids both visually and by palpation sensations. The difference between brain tumors is pain upon pressure and some bone defects of the skull revealed by X-ray. Lipomas are also very similar to dermoid cysts, but they are somewhat softer, more mobile and do not have such clear boundaries. Atheroma, which can be localized in the same areas as a dermoid cyst, shifts upon palpation, is mobile, and is fused with the skin.

The main stages involved in diagnosing a dermoid cyst in a child are:

• Collection of anamnestic information.
• General clinical examinations (examination, palpation).
• Specifying the location of the cyst.
• Clarification of the relationship between the tumor and nearby organs (are there any symptoms – digestive problems, vision problems, headaches, etc.).

Differentiation of dermoid from other neoplasms:

• bridge of the nose - with a hernia of the brain, which is characterized by asymmetry of the eyes, pulsation.
• neck - with medial and lateral congenital cysts that shift when swallowing.

1. Instrumental examination methods are possible – percutaneous puncture.
2. X-ray.
3. If indicated – computed tomography.
4. Angiography as indicated.
5. Ultrasound, which makes it possible to determine whether there is a connection between the dermoid and adjacent organs.

It should be noted that timely diagnosis of a dermoid cyst in a child allows not only to stop the process of its growth, but also to exclude all possible risks and complications - inflammation, including purulent, as well as the potential danger of developing into a malignant tumor.

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Treatment of dermoid cyst in a child

Treatment of almost all benign tumors is surgery. Small dermoid cysts are subject to observation, then at the first opportunity and in the absence of contraindications, the tumor is removed. Neither drug therapy, nor physiotherapy procedures, nor so-called folk methods are effective. Treatment of a dermoid cyst in a child should be carried out only surgically, no matter how much the parents resist it. Radical neutralization of the dermoid is necessary to avoid all sorts of risks, despite the fact that a mature teratoma - as a dermoid cyst is also called, is almost 99% benign neoplasm, there is a 1-1.5% risk of its development into cancer. In addition, the very content of the cyst does not allow it to be treated in any other way. There is no liquid or elements that can be absorbed in the cystic capsule, there are particles of the epidermis, bones, hair, fats and even elements of the teeth, all this just needs to be cut out.

In children, the operation is performed starting from the age of six months; if there are indications, removal can be performed at the age of one month, for example, in the case of a dermoid cyst of the coccyx.

Treatment of a dermoid cyst in a child may also involve long-term observation, in cases where the tumor is small, does not cause functional disorders, has stopped developing and is not a visible cosmetic defect. However, almost all doctors recommend removing the dermoid as early as possible, since during puberty, as a result of hormonal changes, the cyst can either increase in size or become inflamed and cause serious complications. Parents of the child should remember that a dermoid is a benign tumor, but any tumor has a risk of malignancy.

Removal of a dermoid cyst in a child

Dermoid removal surgery can be performed in a variety of ways, depending on the following factors:

• Age of the child.
• Hereditary factor.
• Localization of the cyst.
• Size of education.
• The condition of the dermoid is inflamed, purulent, uncomplicated.
• Presence or absence of contraindications.
• Evaluation of the risk ratio - surgery and possible complications in the development of a dermoid left under simple observation.

Removal of a dermoid cyst in a child can be performed both in a hospital and on an outpatient basis. The point of the surgical intervention is that the cyst is excised within the boundaries of healthy tissue. General (intubation) anesthesia is indicated for children under 6-7 years of age; for an older child, the cyst can be removed under local anesthesia. If the dermoid is small and its localization allows, then a gentle operation is performed with a small puncture or incision, through which the cyst is enucleated and removed along with the capsule. Then cosmetic sutures are applied, and the child is transferred to the ward.

If the dermoid formation has become inflamed, suppurated, and is accompanied by a clinical picture of "acute abdomen", and this may be the case with ovarian dermoid in girls or a retroperitoneal cyst, the operation is performed urgently. The purulent cyst is opened, excised, and then drainage is installed. The healing of surgical incisions in such cases takes longer, but the child can be discharged after a week.

Relapses are very rare and are associated with poor quality, incomplete removal of the capsule.

Removal of a dermoid cyst in a child is not a complicated, life-threatening or complication-causing operation. Parents' fears are more likely to be explained by anxiety for their baby and concerns about possible risks. The danger in such pathologies can be considered delay, refusal of surgical removal of the tumor, since the neoplasm has a potential risk of increasing in size during adolescence, disrupting the functions of internal organs, or developing into a malignant process.