Dermoid cyst

Dermoid cyst, dermoid (dermoid) is a benign formation, from the group of choristomas (teratomas). A cavity cyst is formed as a result of the displacement of undifferentiated elements of the germ layers under the skin and includes parts of the ectoderm, hair follicles, pigment cells, sebaceous glands.

Dermoids, mature teratomas are formed when embryonic development (embryogenesis) is disrupted and are formed along the lines of developing parts of the fetus's body, embryonic connections, folds, where there are all the conditions for the separation and accumulation of germ layers.

Most often, a dermoid cyst is localized on the scalp, in the eye socket, in the oral cavity, on the neck, in the ovaries, in the retroperitoneal and pelvic area, pararectal tissue, less often a dermoid is formed in the kidneys and liver, in the brain. Dermoid teratoma is usually small in size, but can reach 10-15 centimeters or more, has a round shape, most often one chamber, which contains parts of undeveloped hair follicles, sebaceous glands, skin, bone tissue, crystallized cholesterol. The cyst develops very slowly, is not expressed by specific symptoms, and is characterized by a benign, favorable course. However, a large dermoid can disrupt the functions of nearby organs due to pressure on them, in addition, up to 8% of diagnosed dermoid cysts become malignant, that is, they develop into epithelioma - squamous cell carcinoma.

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Causes of Dermoid Cyst

The etiology and causes of dermoid cysts are still being studied, and doctors are mainly guided by several hypotheses. It is believed that dermoids are formed as a result of a violation of embryogenesis, when some elements of all three folia embryonal - embryonic layers - are preserved in the ovarian stroma. The neoplasm develops at any age, the causes of dermoid cysts that provoke its growth have not yet been established. However, versions of traumatic, hormonal factors have been clinically confirmed, that is, a dermoid can develop as a result of a blow, damage to the peritoneum, or during hormonal changes - puberty, menopause. The hereditary factor is not yet considered statistically confirmed, although geneticists continue to study the phenomenon of failure in embryonic development and its connection with the formation of cysts.

The history of studying the etiology and pathogenesis of dermoid formations began in the 19th century with veterinary medicine, when the famous animal doctor Leblen began studying a cyst filled with hair follicles found in the brain of a horse. Later, the description of dermoid cysts became widespread in "human" medicine, doctors began to closely study benign neoplasms consisting of residual elements of amniotic bands. According to current data, dermoid cysts account for about 15% of all cystic formations and are etiologically explained by the generally accepted theory of impaired embryogenesis in three variants.

The following common causes of dermoid cysts are identified:

• Separation of germ layer cells and their accumulation in tissue separation zones at the embryonic stage (2-8 weeks).
• Separation of the blastomere at the earliest stage – during division of the egg, subsequently from the separated blastomere the elements of the three embryonic layers are formed.
• Bigerminal (bigerminale) version – a violation of the initial stages of division of the zygote (fertilized egg) or pathology of the development of the twin embryo.

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Pregnancy and dermoid cyst

As a rule, the first pregnancy and dermoid cyst are detected simultaneously, that is, the dermoid can be detected during an ultrasound examination of a pregnant woman. If the mature teratoma is small, its size does not exceed 10 centimeters, the neoplasm is subject to observation, surgery, including laparoscopy, is not performed. A dermoid cyst that does not interfere with the functions of nearby organs and does not grow during pregnancy is removed after childbirth or during a cesarean section.

It is believed that pregnancy and dermoid cysts are quite compatible with each other; according to statistics, among the total number of benign formations on the ovaries, dermoids account for up to 45% and only 20% of them are removed during the period of gestation.

A dermoid cyst most often does not affect the fetus and the pregnancy process itself, but hormonal changes and organ displacement can provoke its growth and cause complications - torsion, strangulation, rupture of the cyst. They try to remove a complicated dermoid cyst laparoscopically, but not earlier than 16 weeks. A special case is a large cyst, its torsion or strangulation, as a result of which necrosis and the clinic of "acute abdomen" develop, such a neoplasm is removed urgently.

It is also necessary to debunk a myth that is very popular among pregnant women: a dermoid cyst does not resolve in principle - under any circumstances. Neither pregnancy, nor folk or medicinal remedies are able to neutralize a dermoid, so if the cyst did not interfere with bearing a child, it will still have to be removed after childbirth.

Most often, a gentle, minimally invasive method is used to remove dermoids – laparoscopy; the transvaginal method is used less often.

Symptoms of a dermoid cyst

As a rule, a small dermoid does not manifest itself clinically, this is due to its slow development and localization. Basically, the symptoms of a dermoid cyst begin to be noticeable when the formation grows more than 5-10 centimeters, suppurates, becomes inflamed or provokes pressure on neighboring organs, less often it manifests itself as a cosmetic defect. Most often, the symptoms of a dermoid cyst are visible if the neoplasm is localized on the scalp, it is difficult not to notice, especially in children. In other cases, a dermoid is diagnosed during a random or routine examination or during an exacerbation, suppuration, or torsion of the cyst.

• Dermoid ovarian cyst. A neoplasm larger than 10-15 centimeters shifts or causes pressure on nearby organs, manifesting itself as constant pulling, aching pain in the lower abdomen. The abdominal cavity is tense, the abdomen is enlarged, the digestion process is disrupted, urination becomes more frequent. An inflamed, purulent cyst can provoke an increase in body temperature, severe abdominal pain, torsion or rupture of the cyst is clinically manifested by symptoms of "acute abdomen".
• In the initial stage of development, pararectal dermoid does not manifest itself with specific signs. The symptoms of a dermoid cyst are more noticeable if the cyst begins to press on the lumen of the rectum, causing difficulties and pain during defecation. A characteristic sign is ribbon-like feces.
• A dermoid cyst of the mediastinum develops asymptomatically and can be detected on an X-ray during a routine or random examination. The clinical picture is noticeable only when the tumor presses on the pericardium, trachea, lungs, or provokes a percutaneous fistula. There is persistent shortness of breath, dry cough, cyanosis of the skin, transient tachycardia, and, if the tumor is large, a cyst protrudes on the anterior chest wall.

What does a dermoid cyst look like?

It is easiest to describe the external formation, although internal cysts differ little from external ones - in terms of the consistency of the contents, its composition and the density of the capsule, they are almost identical to each other.

A classic dermoid is a cavity surrounded by a dense capsule, ranging in size from a small pea to 15-20 centimeters. As a rule, a dermoid formation consists of one chamber (cavity) filled with dense or soft contents of keratinized parts, sweat glands, hair follicles, sebaceous elements, epidermal particles, and bone. Dermoid cysts grow very slowly, but their growth can only be stopped by surgery; the cyst never resolves or decreases in size. Over the past ten years, cases of malignancy of dermoids have become more frequent, especially if they are localized in the pelvic organs or in the peritoneum.

What does a dermoid cyst look like? It depends on where it is located:

• Head area:
  • Bridge of the nose.
  • Eyelids.
  • Lips (soft tissues of the mouth).
  • Neck (under the lower jaw).
  • Nasolabial folds.
  • Back of the head.
  • Ocular tissue, periorbital region.
  • Ears.
  • Nasopharynx (in the form of dermoid polyps).
  • Rarely - the temple area.
• Other parts of the body, internal organs:
  • Stomach.
  • Buttocks.
  • Ovaries.
  • Anterior mediastinum.

A dermoid formation can form on bone tissue, then it looks like a small concave pit with clear edges. Dermoids are also very similar to atheromas, but unlike them, they are denser and not fused with the skin, more mobile and have clear boundaries.

Dermoid cyst of the ovary

Dermoid cyst of the ovary is considered a benign neoplasm, which can become malignant only in 1.5-2% of all diagnosed cases. Mature teratoma, formed in the ovarian tissue, looks like a dense capsule with contents of embryonic elements - fatty, sebaceous tissue, hair particles, bone, keratinized inclusions. The consistency of the capsule is quite dense, surrounded by a jelly-like liquid, the size of the cyst can be from a few centimeters to 15-20 cm. The etiology of dermoid cysts is unclear, but most likely associated with pathological embryogenesis at the stage of organ formation in the embryo. In addition, mature teratoma develops and increases to a formation visible on ultrasound during hormonal changes - during puberty or menopause. Dermoid ovarian cyst is diagnosed during routine examinations, registration for pregnancy, according to statistics it accounts for 20% of all cysts and up to 45% of all benign tumors of the female body. The course of the disease, as well as the prognosis, is favorable, the cyst is treated only by surgery.

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Dermoid cyst of the brow ridge

Mature teratoma of the brow is a congenital neoplasm of connective tissue that is diagnosed at an early age. Dermoid cyst of the brow deforms the soft tissues of the face, localizing in the area of the bridge of the nose, above the eyebrows, in the middle of the forehead closer to the nose, on the bridge of the nose.

The clinical picture of a dermoid of the maxillofacial area is always non-specific by sensations, but visually clear by observations. A dermoid cyst of the brow ridge is one of the most easily diagnosed neoplasms, since it has a typical location, is defined as an external deformation of the face in the early stages, usually in infancy. Often, a dermoid can be very small and unmanifested, and begins to develop rapidly during puberty, this is especially typical for boys. The cyst is mobile to the touch, not fused with the skin, sweaty, clearly defined and practically painless upon palpation. Pain can occur as a signal of inflammation, suppuration of the cyst, in such cases the surrounding skin is also inflamed, and the body reacts to the infection with general symptoms - from fever to nausea, dizziness and weakness.

A dermoid cyst must be removed surgically; if this is not done in a timely manner, the dermoid can deform the bone tissue of the bridge of the nose and form not only a cosmetic defect, but also internal pathological changes in the brain and nasopharynx.

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Dermoid cyst of the eye

Dermoid or choristoma of the eye is a benign neoplasm, most often of congenital etiology. Dermoid cyst of the eye is localized in the upper part of the orbit - in the upper lateral section, and manifests itself as a tumor of varying size in the upper eyelid area. Much less often, dermoid is located in the middle of the corners of the eyes, and is almost never found on the lower eyelid. Dermoid cyst of the eye is not accidentally called epibulbar, since in 90% of cases it is localized above the eyeball (epibulbaris) - in the cornea, sclera, and on the eyeball, extremely rarely - on the cornea.

A benign dermoid of the eye has a round shape, looks like a dense, fairly mobile capsule, not fused with the skin, the cyst stalk is directed towards the bone tissues of the orbit. The formation develops asymptomatically in terms of discomfort, it is painless, however, increasing in size, it can provoke a pathological anomaly - microphthalmos or a decrease in the size of the eye, abmlyopia - various visual impairments in a normal eye that are not corrected by glasses ("lazy" eye).

Dermoid cyst of the eye is formed in the initial stage of embryogenesis, in the period up to the 7th week, the neoplasm is a cluster of tissue rudiments in the form of a capsule with cystic contents of dermal, hair particles. These hairs are often visible on the surface of the cyst and interfere not only with vision, but are also a rather unpleasant cosmetic defect.

As a rule, dermoid choristomas of the eye are diagnosed at an early age due to their visual obviousness, the only slight difficulty is the differentiation of dermoid and atheroma, hernia of the brain. Dermoid is characterized by its asymptomatic nature and is never accompanied by dizziness, nausea and other cerebral symptoms. In addition, X-ray reveals a dermoid "root" in bone tissue with clear edges.

Treatment of dermoid cysts of the eye is most often surgical, especially in the case of epibulbar types of cysts; the prognosis is favorable in 85-90% of cases, however, surgical intervention can somewhat reduce visual acuity, which can be corrected later with the help of additional therapy, contact lenses or glasses.

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Dermoid cyst of the conjunctiva

A dermoid cyst of the conjunctiva is a lipodermoid, lipodermoid, so named because, unlike a typical cyst, it does not have a capsule and consists of lipid, fatty tissue, covered in stroma. In fact, this is a conjunctival lipoma of congenital, poorly understood etiology, closely associated with pathology, atrophy of the muscle that raises the upper eyelid (levator), as well as with a change in the location of the lacrimal gland. Most likely, this is explained by an intrauterine irritant factor affecting the embryo.

A dermoid cyst of the conjunctiva is considered a benign choristoma and accounts for 20-22% of all diagnosed eye tumors. Most often, lipodermoid is detected in children at an early age due to its obvious localization and combination with other eye anomalies. During a pathogenetic study or biopsy, fatty elements, sweat gland particles, and less often hair follicles are usually found in a dermoid. Due to the fact that the contents and the formation itself have a lipophilic structure, a dermoid cyst tends to grow into the cornea to its deepest layers. A dermoid cyst of the conjunctiva looks like a mobile, fairly dense tumor under the upper eyelid on the outside of the eye slit. The size of a dermoid can vary, from millimeter parameters to several centimeters, when the formation covers the eye and the lacrimal gland.

The dermoid develops very slowly, but steadily progresses, occasionally penetrating even beyond the orbit of the eyeball up to the temple area. When palpated and pressed, a large dermoid easily moves deep into the orbital area.

As a rule, a biopsy is not required to clarify the diagnosis, and dermoid conjunctiva is treated only surgically. In this case, doctors try to minimize the risk of damage to the conjunctiva to avoid eversion or shortening of the eyelid.

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Dermoid cyst on the eyelid

Most often, a dermoid cyst on the eyelid is localized outside or inside the upper skin fold and looks like a round formation of dense consistency, ranging in size from a small pea to 2-3 cm in diameter. As a rule, the skin of the eyelid is not inflamed, the eyelid itself can maintain normal mobility if the dermoid is small and grows slowly. Cysts on the eyelids are rarely bilateral, the dermoid is located in the lateral, less often in the medial part of the eyelid and is easily palpated as a tumor limited by a capsule, elastic, painless, quite mobile.

It is quite easy to diagnose a dermoid cyst of the eyelid, as it is visible to the naked eye, a biopsy is rarely prescribed for clinical symptoms similar to those of a brain hernia. If the formation does not fit when palpated, does not go deep, there is no dizziness, nausea or headache, and radiography of the cyst shows its clear contours, then the dermoid can be considered definite and subject to surgical treatment.

Usually, the cyst is detected at an early age of up to 2 years and is subject to regular monitoring, since it develops extremely slowly and indications for immediate surgery are not urgent. If there is no sharp increase, limited eyelid mobility, ptosis of 2-4 degrees, there is no pressure on the eyeball or optic nerve, a dermoid cyst on the eyelid is operated on at a later age, starting from 5-6 years, the intervention is carried out under general anesthesia in a hospital setting. The course of dermoid development is benign in 95% of cases, the cyst stops growing as soon as the eye stops growing and, in fact, it is only a cosmetic defect. However, there is a small risk of malignancy and the possibility of tumor progression (no more than 2%), so almost all ophthalmologists recommend removing the dermoid at the earliest opportunity.

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Dermoid cyst of the orbit

An orbital cyst, which is diagnosed as dermoid, can develop over decades and begins to grow rapidly during hormonal storms - during puberty, pregnancy and menopause. However, most often, a dermoid orbital cyst is determined at the age of up to 5 years and accounts for up to 4.5-5% of all eye neoplasms.

The tumor is formed from undifferentiated epithelial cells that accumulate near the junction of bone tissues, the cyst is localized under the periosteum. The formation is round in shape, often yellowish in color due to secreted cholesterol crystals from the inner wall of the capsule. Lipid elements, hair particles, and sebaceous glands can be found inside. Most often, the dermoid is located in the upper quadrant inside the eye orbit, without causing displacement of the eyeball (exophthalmos), if the cyst is localized outside, it causes exophthalmos of the eyeball down and inward.

A dermoid cyst of the orbit develops asymptomatically, complaints may concern only swelling of the upper eyelid and some discomfort when blinking. The formation may also be located deep in the orbit, such a cyst is diagnosed as a Kronlein cat-shaped cyst or a retrobulbar dermoid cyst. With such localization, the tumor provokes exophthalmos, the apple is displaced to the side opposite to the location of the cyst. In such situations, the patient may complain of a feeling of distension in the orbit, pain and dizziness.

The diagnosis of orbital dermoid is not difficult, it is immediately differentiated from cerebral hernia or atheroma, in which the tumor visually increases during inhalation, bending and other physical efforts. In addition, atheromas and hernias are characterized by a slowdown in pulsation when pressing, since the cyst cavity is penetrated by vessels, which is not the case with a dermoid with dense contents. A clarifying and confirmatory diagnostic method is computed tomography, which visualizes the localization, shape and clear contours of the cyst.

Orbital dermoid is treated with surgery, which is performed according to indications in the case of rapid tumor progression, the risk of suppuration, or in connection with visual impairment.

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Dermoid cyst above the eyebrow

A benign neoplasm in the eyebrow area is most often a dermoid, that is, a congenital cyst filled with embryonic elements. The etiology of dermoids has not been fully studied, but there is a theory accepted by many doctors that speaks of a violation of embryogenesis, when in the early period of embryo formation parts of the ectoderm are displaced and separated. Over time, these elements are grouped and encapsulated by the epithelial membrane. Inside the cyst, you can find parts of the sebaceous and sweat glands, keratinized elements, hair follicle cells, and bone tissue. The cyst also contains a jelly-like lipid fluid and cholesterol crystals.

Surgeons claim that the arch area is the most typical place for a dermoid cyst above the eyebrow to choose. The size of the formation varies from millimeter parameters to 3-5 centimeters in diameter, the older the person, the larger the dermoid, which increases in parallel with the growth of the head.

A dermoid cyst above the eyebrow is removed at the age of 5-6 years, before that it is observed and left alone. If the formation does not cause harm, does not interfere with visual functions, does not suppurate, it can be left under observation for longer. However, due to possible inflammation as a result of bruises, head injuries, concomitant infectious diseases and in order to exclude the risk of degeneration into a malignant tumor, the dermoid should be removed at the first opportunity and under favorable conditions. The course and prognosis of dermoid cysts are usually favorable, relapses after surgery are rare if the cyst was not completely removed.

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Dermoid cyst on the face

The favorite place that a dermoid cyst chooses for its location is the face and head.

A dermoid cyst on the face and head can develop in the following areas:

• The edge of the eye.
• Orbital cyst (orbital cyst).
• Hairy area of the head.
• Brow area.
• Eyelids.
• Whiskey.
• Nose.
• Oral cavity (floor).
• Lips.
• Nasolabial folds.
• Ears.
• Neck (under the lower jaw).

A dermoid cyst on the face develops and grows very slowly, often over decades. Patients seek help from a surgeon only in the case of its rapid enlargement and obvious cosmetic defect, less often in situations when the cyst suppurates or becomes inflamed. Very rarely, the neoplasm causes functional disorders, most often this happens with a cyst of the oral cavity - talking and even eating becomes difficult.

Palpation of the cyst does not cause painful sensations if the tumor is small, but as it grows, it can become inflamed, especially when localized in the middle of the floor of the mouth, in the area of the hyoid bone or in the chin area. Cysts of this type seem to bulge under the tongue, interfering with its work (it rises).

Dermoids on the face are subject to surgical treatment, as a rule, it is indicated at the age of 5 years, not earlier. The operation is performed in a hospital setting under general anesthesia, taking into account the patient's health condition and the size and localization of the cyst. The course of the disease is favorable, relapses are extremely rare.

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Dermoid cyst of the angle of the eye

Dermoid of the corner of the eye is considered a completely benign formation and differs from other types of cysts in its favorable course and prognosis.

A dermoid cyst of the corner of the eye can be quite small in size - from a millet grain to quite obvious, visually manifested formations of 4-6 centimeters. The main danger of a dermoid on the eyes is the potential for deep growth and a small percentage of malignancy (up to 1.5-2%). Also, the external localization and access to the cyst provokes the danger of its injury, inflammation and suppuration.

If the dermoid located in the corner of the eye does not interfere with vision, does not interfere with the development of the eye socket, eyelids, does not provoke ptosis, it is observed and not treated until the age of 5-6 years. A cosmetic defect at an early age is not an absolute indication for surgery, although in the future it cannot be avoided. In addition, surgical intervention is contraindicated in the presence of chronic diseases, cardiac pathologies, since radical treatment involves the use of general anesthesia.

In cases of cyst growth, its enlargement, excision is performed, especially when amblyopia (visual impairment) develops. Treatment should not be delayed, since a dermoid cyst of the angle of the eye can grow further and affect nearby tissues of the eyeball, eyelid. Complications and relapses are possible, as after any other surgery, but their risk is minimal and does not compare with the obvious benefit of dermoid removal.

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Dermoid cyst of the coccyx

The dermoid of the sacrococcygeal region, due to its constant enlargement, provokes deviation of the coccyx and the appearance of symptoms similar to epithelial coccygeal tract.

Previously, these diagnoses were identical and treated in the same way, currently in clinical practice the diseases are differentiated and there are various definitions - coccygeal dermoid cyst, coccygeal fistula, pilonidal sinus, etc. There are no significant differences in the diagnosis, but in their etiological features these formations are still different, although the true causes of coccygeal dermoids have not yet been established.

Dermoid cyst of the coccyx, etiology.

In clinical practice, two versions of the development of dermoids in the sacrococcygeal region are accepted:

• Epithelial dermoid cyst is formed as a congenital, embryonic defect caused by incomplete degenerative formation (reduction) of the ligaments and muscle tissue of the tail.
• Coccygeal dermoid develops due to pathological embryonic abnormalities and separation of growing hair follicles that penetrate the subcutaneous tissue of the coccygeal region.

Interestingly, statistical data show almost zero percentage of dermoid cysts in the coccygeal bone in representatives of the Negroid race, and a large percentage in representatives of Arab countries and residents of the Caucasus. Dermoid cysts in the coccyx are diagnosed mainly in men, women suffer from it three times less often.

The localization of the dermoid is typical - in the middle of the intergluteal line ending in the subcutaneous tissue of the coccyx with a frequent opening in the form of a fistula (epithelial tract).

This course ensures constant release of the cyst contents, and blockage leads to its inflammation and infection. Particles of hair, fat or sebaceous gland elements are found in the cyst contents.

A dermoid cyst of the coccyx is characterized by suppuration, which provokes obvious clinical manifestations. An uncomplicated dermoid cyst of the coccyx can develop asymptomatically for years, rarely manifesting itself in transient pain during long periods of sedentary work. Suppuration provokes an increase in body temperature, pulsating pain, a person cannot sit, bend over, squat.

Coccyx dermoid is treated only by a radical method - surgery, with the help of excision of the epithelial tract, scars and possible fistulas at the same time. Most often, surgical intervention is performed under local, local anesthesia when the cyst is in remission, without suppuration. Further treatment involves taking antibiotics, sanitizing the coccyx area, local anesthesia.

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Dermoid cyst on the head

A dermoid is a cyst-like formation with a capsule and contents of hair elements, sebaceous glands, fats, bone tissue, keratinized particles, and scales. A dermoid cyst on the head is the most common localization of benign formations of congenital etiology. The internal and external walls of the cyst are most often similar in structure to the skin and consist of normal dermal layers - the epidermis, epithelium.

The typical arrangement of dermoids on the head is as follows:

• Upper eyelids.
• Corners of the eyes.
• The bridge of the nose or the brow ridge area.
• Lips.
• Ears.
• Nasolabial folds.
• Back of the head.
• Neck.
• Submandibular region.
• Floor of the oral cavity.
• Eye socket, conjunctiva of the eye.
• Rarely - the cornea of the eye.

Since a dermoid cyst on the head is formed as a result of impaired embryogenesis in the areas of embryonic grooves and branches, it is most often located in three areas:

• Mandibular zone.
• Periorbital zone.
• Perinasal region.
• Less often, dermoids are localized on the floor of the oral cavity, in the tissues of the neck, temples, in the area of the chewing muscles, and on the cheeks.

Dermoids of the head, like all other benign congenital cysts, develop slowly and gradually, they can maintain their small size for many years, without clinical manifestations and without causing any discomfort, except cosmetic. Treatment of dermoid cysts of the head is performed surgically, in a hospital setting under general anesthesia. The course and outcome of the operation are favorable, relapses are possible only in the case of a combination of dermoids with other tumor or inflammatory processes, as well as with incomplete excision of the cyst.

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Dermoid cyst on the neck

Dermoid cyst on the neck belongs to the group of congenital mature teratomas. The cavity of the cystic formation is filled with contents characteristic of a dermoid - hair follicles, keratinized scales, fatty, sebaceous elements, skin particles. Most often, dermoids of the neck are localized in the sublingual region or in the area of the thyroglossal canal. Geneticists studying the etiology of dermoids claim that neck cysts are formed in the period up to the 5th week of embryonic development, when the thyroid gland and tongue are formed.

A dermoid cyst on the neck is visible almost immediately after the birth of the child, but small formations may remain unnoticed due to typical infantile folds. The cyst develops very slowly and does not bother the child, does not cause painful sensations. Pain may occur in the case of inflammation of the formation or its suppuration. Then the first sign appears - difficulty swallowing food, then intermittent breathing appears.

A dermoid cyst of the neck, located in the area of the hyoid bone, causes deformation of the skin, is visible to the naked eye, in addition, the cyst can be hyperemic and have an opening in the form of a fistula.

Dermoids of the neck are treated with surgery, which is performed at the age of 5-7 years, earlier surgical intervention is possible only in emergency conditions - the risk of malignancy, acute inflammatory process or dysfunction of swallowing, breathing. Treatment of this type of cyst is complex, the operation is performed under general anesthesia and can have complications due to the close location of the cyst and many functionally important muscles.

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Dermoid cyst of the brain

Among all brain tumors, dermoid is considered the safest and most treatable.

A dermoid cyst of the brain is formed at the earliest stages of embryogenesis, when skin cells, the purpose of which is to form the face, enter the spinal cord or brain. The etiology of all dermoids is not fully clarified, but its congenital nature does not cause doubts among doctors. It should also be noted that dermoid formations are most often localized on the surface of the head, but not in the brain itself, such cases are diagnosed extremely rarely, mainly in boys under 10 years of age.

The typical localization chosen by a dermoid cyst of the brain is the cerebellopontine angle or midline structures.

Symptomatically, the cyst may not manifest itself for quite a long time; pain and cerebral manifestations in the form of dizziness, nausea, and impaired coordination are rare in the case of a sharp growth of the tumor or its proliferation, suppuration.

The only treatment method is surgical, the method is determined depending on the location and size of the cyst. Endoscopy or craniotomy can be used. The outcome is usually favorable, the rehabilitation period is also rarely accompanied by complications. Dermoid of the brain is operated no earlier than 7 years for urgent indications.

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Pararectal dermoid cyst

A pararectal dermoid cyst is a mature teratoma that contains elements of keratinized particles, hair, elements of sebaceous and sweat secretions, skin, and cholesterol crystals. The etiological causes of pararectal dermoids are not specified, but they are believed to be associated with embryonic developmental defects when the germ layers begin to separate into a place that is not typical for organ formation.

Clinically, a pararectal dermoid cyst is visible as a rounded convex formation, painless to the touch. Such a dermoid quite often spontaneously breaks through, forming a fistula or even an abscess. Unlike a coccygeal dermoid, a pararectal cyst opens into the perineum or rectum.

Most often, a dermoid is diagnosed during a routine rectal examination using palpation or in the case of suppuration, inflammation. In addition to palpation, a rectoscopy and fistulography are performed. It is believed that a coccygeal dermoid and a pararectal cyst are similar in symptoms, so they need to be differentiated, in addition, it is necessary to exclude rectal tumors, which are often combined with dermoids.

Pararectal formations are more prone to malignancy than benign cysts localized in other areas, so early diagnosis and timely surgery are necessary conditions for minimizing the risk.

Dermoid cyst in a child

Dermoid cysts in children are usually detected very early, in 60-65% of cases in the first year of life, in 15-20% in the second year, and extremely rarely at a later date. Such early detection of benign cysts is associated with embryonic, dysontogenetic etiology, that is, the formations are formed at the intrauterine stage and are visible almost immediately after birth.

Fortunately, a dermoid cyst in a child is rare; among all benign childhood neoplasms, it accounts for no more than 4%.

A dermoid in children is an organoid cyst consisting of tissues of various structures and organs. Hair follicles, bone particles, nails, teeth, skin, and sebaceous glands can be found in the capsule. Cysts develop slowly but constantly and can be localized on the head, in the eye area, coccyx, and in internal organs - in the ovaries, brain, and kidneys. Accordingly, a dermoid cyst can be external or internal. Cysts increase in size without causing clinical symptoms, but all of them are subject to excision after the age of 5-7 years, as they are potentially dangerous in terms of disruption of the functions of nearby organs, and there is also a risk of their development into malignant tumors (1.5-2% of cases).

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Can a dermoid cyst go away?

The myth that dermoids can disappear on their own should be debunked. The question of whether a dermoid cyst can dissolve can be considered unreasonable, because the very content of the formation indicates that lipid elements, particles of teeth, skin, bone parts, hair in principle cannot disappear and dissolve in the body.

Of course, many try folk methods, postponing the operation, especially if it concerns a child. However, we must admit the fact - dermoids never dissolve with either drug treatment or herbal treatment.

Can a dermoid cyst dissolve? Definitely not. Unlike other types of cysts, such as follicular cysts, dermoids consist of a very dense capsule with contents that only need to be cut out, just like a bad tooth, and are not capable of disappearing on their own at the behest of magic spells or herbal poultices. Dermoids may not require surgery if they do not interfere with the functioning of other organs and systems and the cosmetic defect does not cause an acute desire to neutralize it. However, it is necessary to recall the risk of malignancy, that is, the potential for a dermoid cyst to develop into cancer, including squamous cell cancer. Therefore, radical excision of the cyst is the only way to get rid of it forever.

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Recurrence of dermoid cyst

Dermoids are treated only by surgery, as a rule, the outcome of the operation is favorable in 95% of cases. However, there are complications, including relapse of the dermoid cyst. This is possible under the following circumstances and conditions:

• Severe inflammation and suppuration of the cyst.
• Evacuation of purulent contents into nearby tissues when a cyst ruptures.
• Incomplete excision of a dermoid when its location is unclear or when it has grown strongly into nearby tissues.
• Incomplete removal of the cyst capsule due to deterioration of the patient's condition during surgery.
• During laparoscopy, the cysts are large.
• When there is insufficient drainage of purulent contents.

As a rule, relapse of a dermoid cyst is rare, more often the operation is performed with minimal risk and trauma, the sutures are almost invisible and dissolve quickly. Radical excision of the cyst is indicated only if the cyst has frozen in development, or after inflammation is in a stage of stable remission.

Treatment of dermoid cyst

Dermoids are subject to surgical treatment; as a rule, excision of such cysts is performed from the age of 5-7 years and at a later period.

Treatment of a dermoid cyst involves excision within the healthy tissues, and less frequently the adjacent area is also excised to neutralize possible complications. Surgery is performed under both general and local anesthesia, for example, in the case of a coccygeal dermoid.

If the formation is small in size, treatment of a dermoid cyst does not exceed half an hour; more complex procedures are required for large purulent cysts.

Also, a long-term operation is suggested for a dermoid cyst of the brain.

Today, medical technologies are so advanced that after the intervention, the patient can practically forget about the operation on the second day; laser methods for removing cysts, endoscopy, and laparoscopy are especially effective.

In addition, surgeons strive to minimize injuries to nearby tissues, to apply such masterly cosmetic sutures that even during facial surgery the patient forgets after a while that he once had a cosmetic defect in the form of a dermoid. The operation consists of opening the cyst, evacuating the cystic contents and draining the cavity if it becomes purulent. Deep excision of the capsule is also possible to prevent cyst recurrence. Treatment of a dermoid cyst has a favorable outcome and is considered one of the safest in surgical practice.

Laparoscopy of dermoid cyst

Laparoscopy has long been popular due to its low trauma and effectiveness. Currently, laparoscopy of a dermoid cyst is the gold standard in surgical practice, which is used to excise a dermoid of any size, even a maximum of up to 15 centimeters.

During laparoscopy, the incisions are practically bloodless, as surgeons use electric, laser instruments and ultrasound. All this together allows not only to control the process well, but also to simultaneously seal the damaged tissues with the incisions, treating their edges. Laparoscopy of a dermoid cyst is especially effective during ovarian surgery, as any woman strives to preserve her reproductive function and, indeed, after six months, conception is quite possible and will not cause any complications. In addition, the laparoscopic method is also good in a cosmetic sense, because postoperative scars are practically invisible and dissolve within 2-3 months without a trace.

The only area where laparoscopy may not be appropriate is the brain, especially if the dermoid is located in a hard-to-reach place. Then craniotomy is inevitable, but even with such surgical intervention the prognosis is quite favorable.

Dermoid cyst removal

Removal of a dermoid cyst is possible only by surgical means, the choice of which depends on the location of the neoplasm, its size, the patient’s health condition and other factors.

As a rule, dermoid removal is performed no earlier than the age of five, when the organism is already able to withstand both local and general anesthesia.

If the cyst contains purulent contents, it is removed only after anti-inflammatory treatment and transition to the stage of stable remission. When the formation develops slowly and without inflammation, the removal of the dermoid cyst is carried out on a planned basis using conventional surgery or laparoscopic method.

The cyst is opened, its contents are scraped out, and the doctor ensures that all elements are evacuated without a trace to avoid relapses, and the same is done with the cyst capsule. Excision of the capsular walls is important, especially if the cyst has grown deep into nearby tissues. The surgical intervention is performed within the boundaries of healthy tissues and lasts from 15 minutes to several hours in the case of intervention in the brain (trepanation).

For small dermoids located on the coccyx or head area (epidermal cysts), local anesthesia is possible, but small children who are not capable of long-term stay in surgical conditions are subject to general anesthesia.

Removal of a dermoid cyst is not only desirable, but mandatory, given the risk of suppuration, dysfunction of many organs due to an increase in the dermoid, and also due to the risk of malignancy, albeit low - only up to 2%.

Treatment of dermoid cysts with folk remedies

Unlike other diseases that can be treated with phototherapy and alternative methods, treating a dermoid cyst with folk remedies is a myth. Apart from wasting time and increasing the risk of suppuration, inflammation and transformation of the cyst into a malignant tumor, such treatment will not bring anything else.

Dermoids are treated only by surgery, which is usually low-traumatic and effective. Lotions, compresses, decoctions, spells and other methods will not help, this is a fact that is not even disputed. No matter how much a person would like to avoid surgery, especially if we are talking about a child, it will have to be done, because the dermoid is simply not able to dissolve due to its embryonic contents, consisting of hair, fat, sebaceous elements, bone particles. Treatment of dermoid cysts with folk remedies will not replace a truly effective method - surgery.