Dermoid cyst in a child

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

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

Surgeons have revealed the following statistical pattern, which is characteristic of the contents of the dermoid cyst in children: 

• Ectoderm is 100% dermoid.
• Mesodermal elements - 90% of cysts.
• Endoderm - 70% of dermoids.

Dermoid formations in children are localized where the embryonic cavities, the so-called "gill" slits, must merge: 

• head (eyes, nose, mouth, nasolabial folds, ears, back of the neck, neck),
• sternoclavicular joints, 
• sacrum, 
• testicles, 
• testicles, 
• mediastinum,
• the brain (rarely).

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

[1], [2], [3]

Causes of a dermoid cyst in a child

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

1. The most popular theory is the "shifted blastomeres", according to which the germ cells, having separated, retain their immobility and do not divide until the onset of an unfavorable moment provoking the factor. 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 liquid in the cavity. The dermoid contains parts of all three germ layers, the earlier the blastomeres are separated, the more variants of the elements in the contents of the cyst. Thus, it is believed that the reasons for the formation of a dermoid tumor are associated with a violation of intrauterine development at the earliest stage - embryogenesis. The violation of differentiation of embryonic cells, separation of the elements of the three embryonic layers into atypical zones for them is one of the most obvious, studied causes of the appearance of dermoids.

Embryonic-cell tumors are not found often and are detected either at the age of 2-3 years, or in the pubertal period, when the body of the child is experiencing rapid hormonal changes.

2. There is also a theory about the genetic, hereditary factor, moreover, 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. For the zygote - (stem new cell) diploid chromosome set and the same number of chromatids (23) from the father and mother are needed. In addition, maternal and paternal genes must undergo genomic imprinting, that is, some of them must leave their "trace". When this stage is missed and the process is broken, the mother's chromosomes predominate, in a pathological sense. By laboratory, with the help of molecular innovations, the "maternal" factor in the formation of dermoid tumors was revealed, which according to statistics is most often diagnosed in girls.

The causes of the dermoid cyst in a child, as well as dermoids in adults, continue to be studied, difficulties in combining the versions and determining one etiologic base are associated with a positive factor - dermoids are rare.

[4], [5], [6], [7], [8]

Dermoid cyst in a newborn

Dermoids in newborn babies are a consequence of disturbed embryogenesis, when all three embryonic leaves separate their cells into an uncharacteristic, atypical for them zone (fusion of "sacral", embryonic cavities).

The 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 such a percentage: 

• The sacrococcygeal teratoma is 37-38%
• Newborn girls, ovaries - 30-31% 
• Head - 10-12% 
• The mediastinum region is 4-5% 
• The retroperitoneal location is 9-10% 
• Other zones - 3-4%

In general, dermoids are formed in girls, 4 times more often than in boys.

Since the dermoid cyst in the newborn is most often formed in the sacrum, between the anus and the coccyx, traumatic hemangioma can develop in the process of childbirth in the place of neoplasm. Also one of the complications is that the coccygeal dermoid is predominantly detected in girls, while the tumor can fill the pelvic area, but without damage or damage to the bone tissue. It should be noted that 90% of such teratomas are determined in utero, when a pregnant woman undergoes ultrasound examination between 22-1 and 34-1 weeks. Ultrasound or MRI shows an excessively enlarged uterus, and the fetus has a homogeneous mass in the region of the sacrum. With large fetal cysts, maternity delivery is indicated with caesarean section to avoid possible complications such as cyst rupture.

Features that have a dermoid cyst in a newborn, depending on localization: 

1. The testicular dermoid in newborn boys is almost 100% benign, unlike mature ovarian teratosis in girls. It should also be noted that such education is very rare, and most likely due to a hereditary factor. The cyst contains sebaceous, fatty and epidermal components, cartilage, bone elements in surgical practice has not yet been found. The dermoid cyst is detected practically from the first week after birth, less often it is found at the age of one and a half years. Usually the dermoid develops and grows very slowly, it is observed and operated as soon as possible, when it reaches the age of 2-3 years. An organ-saving operation is performed, the outcome and the forecast are 100% safe. 
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 squeezes nearby organs, the child reacts accordingly - constantly cries, the stomach is strained. The dermoid is well defined by palpation, then by ultrasound. The operation is indicated only in case of large tumors, small cysts are to be observed. 
3. Dermoid of the oral cavity or teratoma of pharynx (polyp) is a benign formation that can be seen right from the first week of birth. This 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 region, in the epignatus zone - the throat. Small dermoids of the mouth are operated upon reaching a child of three years of age, large cysts can be removed earlier, as 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 usually dermoid cysts grow slowly, and their development is asymptomatic. Indication for examination for cystic education may be congenital abnormalities of the newborn, endocrine disorders, other abnormalities, revealed during the pre-natal period. 
5. The dermoid ovarian cyst in girls is also diagnosed at a later age. In newborns, this disease occurs without clinical manifestations. A possible sign may be an atypical increase in the belly and crying of the child. In such cases, the child is examined for diseases of the digestive and pelvic organs. 
6. The sacrococcygeal dermoid is determined during the pre-natal stage, and is clearly visible right after birth. Clinical symptoms directly depend on the location of the cyst - external or internal. The external cyst is usually larger in size, it can even interfere with the delivery process. The tumor, located in the middle between the buttocks, is most often soldered to the coccyx, when the external cyst develops pressure on the rectum and defecation is violated, urination is incontinence of urine and feces. The coccygeal dermoid is treated only surgically, and as soon as possible due to the rather high risk of inflammation, suppuration and malignancy (overgrowth in a malignant tumor). If there are no strict contraindications, the operation is performed from 2 months of age.

It should be noted that the dermoid cyst in a newborn is a very rare phenomenon, so benign tumors of the sacrum occur in a ratio of 1 to 26-27.000 births. Dermoid formations are considered benign tumors and have a fairly favorable prognosis when they are removed in a timely manner.

[9], [10], [11]

Symptoms of a dermoid cyst in a child

Like other benign tumors, dermoid formations most often do not appear for a long time with clinical signs. Symptoms of a dermoid cyst in a child either appear in the newborn period, when they are visually conspicuous, or are detected with an increase, inflammation, suppuration, pressure on nearby organs. The clinical picture of dermoids is associated with localization, cyst size, and also the age of the child. Most often, dermoid neoplasms are located in the region of the head (eyes, nose, ears, superciliary, mouth, neck, neck), clavicle, coccyx, rarely in the mediastinum, retroperitoneum. Also, the dermoid can be localized to the ovaries or testicles.

Symptoms of a dermoid cyst in a child can be as follows: 

• Children of the first year of life have dense, elastic formations in one of the above places.
• The tumor has a rounded shape.
• The dermoid cyst is felt dense, elastic.
• The cyst does not have a dense connection to the skin, it is not soldered to it.
• With palpation, the dermoid does not cause painful sensations.
• Skin over the cyst is not hyperemic, the usual shade, without ulceration, rashes and so on.
• If the dermoid is located on the head (skull), it may look slightly depressed inwards.
• Dermoid formation may not increase for a long time, stop in size.
• The dermoid of the tailbone, in addition to being visible, can cause a violation of urination and defecation (the fecal masses become a ribbon).
• The dermoid of the eye (eyeball, eyelid) can disrupt the clearness of vision.

The dermoid ovarian cyst in a girl can manifest abdominal pain if the tumor grows to large sizes. In addition, the picture of the "acute abdomen" is caused by the torsion of the cyst's legs

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

Diagnosis of a dermoid cyst in a child

Dermoids are diagnosed without difficulty due to their typical localization and because all germinogenic formations of this type are characteristic for consistency during palpation. The only difficulty is the precise definition of tumor formation in the zone of the brow and nose, since the anterior cerebral hernias are very similar both visually and palpation sensations to dermoids. Difference of brain formations is pain at pressing and some bone defects of the skull, revealed on the x-ray. Also on dermoid cysts are very similar lipomas, but they are somewhat softer, more mobile and do not have such clear boundaries. Atheroma, which can be localized in the same zones as the dermoid cyst, is displaced, palpated, mobile, soldered to the skin.

The main stages that involve the diagnosis of a dermoid cyst in a child: 

• Collection of anamnestic information.
• General clinical studies (examination, palpation).
• Specification of the area of the cyst.
• Clarification of the connection of the tumor with nearby organs (whether there are symptoms - indigestion, vision, headaches, and so on).

Differentiation of the dermoid with other neoplasms:

• nose - with a hernia of the brain, which is characterized by asymmetry of the eyes, pulsation.
• neck - with middle and lateral congenital cysts, which are displaced when swallowed.

1. Possible instrumental methods of examination - percutaneous puncture.
2. X-ray.
3. According to the indications - computed tomography.
4. Angiography according to indications.
5. Ultrasound, which makes it possible to find out whether there is a connection of the dermoid with the adjacent organs.

It should be noted that the 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 growing into a malignant tumor.

[12], [13], [14], [15]

Treatment of a dermoid cyst in a child

Treatment of virtually all benign formations is an operation. Small dermoid cysts are subject to observation, then at the first opportunity and absence of contraindications, the tumor is removed. No medication, no physiotherapy, or so-called alternative methods are effective. Treatment of a dermoid cyst in a child should be carried out only surgically, no matter how much parents resist. Radical neutralization of the dermoid is necessary in order to avoid all possible risks, in spite of the fact that the mature teratoma is also called the dermoid cyst, it is almost 99% benign, there is 1-1.5% of the danger of its growth into cancer. In addition, the very content of the cyst does not allow it to be treated in any other way. In the cystic capsule there is no liquid or elements that can be resorbed, there are particles of the epidermis, hair bones, fats and even the elements of the teeth, all this needs only 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, with the dermoid tailbone cyst.

Treatment of a dermoid cyst in a child can consist of long-term observation, in the case when the tumor is small, do not cause functional disorders, stopped development and is not a visible cosmetic defect. Nevertheless, almost all doctors recommend removing the dermoid as early as possible, as in the pubertal period, as a result of hormonal changes, the cyst may either increase or inflame and provoke serious complications. Parents of the child need to remember that the dermoid is a benign tumor, but any tumor has a risk of malignancy.

Removal of a dermoid cyst in a child

The operation to remove the dermoid can be performed in various ways, it all depends on such factors: 

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

Removal of a dermoid cyst in a child can be carried out both in a hospital and outpatient settings. The meaning of surgical intervention is that the cyst is excised within the boundaries of a healthy tissue. Children under the age of 6-7 years are shown a general (intubation) anesthesia, a child older than a cyst can be removed under local anesthesia. If the dermoid is small and its location allows, a gentle operation is performed with a small puncture or incision through which the cyst is removed and removed together with the capsule. Next, cosmetic sutures are applied, and the child is transferred to the ward.

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

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

Removal of a dermoid cyst in a child is not difficult, life-threatening or complicating surgery. Parents' fears are more likely to be explained by anxiety for their baby and fears about possible risks. The danger in such pathologies can be considered delay, failure to promptly remove the tumor, since the tumor has the potential to increase in the adolescent period, disrupt the functions of internal organs, or develop into a malignant process.