A Rare Case of Huge Unilocular Autoamputated Extra-ovarian Dermoid Cyst

Abstract

Ovarian dermoid cysts are one of the commonest benign, pelvic tumours. However, presence of dermoid cysts at extraovarian locations is very rare. The extra-ovarian dermoid cysts can be of ovarian origin or may also originate from nonovarian sites like omentum, retroperitoneum, mediastinum, etc. We report one such rare case of extra-ovarian dermoid cyst observed in a 70-year-old postmenopausal woman at department of Gynaecology of our hospital. Her ultrasonographic observations showed a large well defined cystic lesion predominantly in the left adnexa extending into the midline with internal echoes within, which was later confirmed with MRI. Following this, she underwent a total abdominal hysterectomy with vertical midline incision. Intraoperatively, she was found to have a large tumour of 3.25kg (28cm x 26cm x 11cm) with adhesion to the omentum on its anterior upper and posterior aspects. The surface of the oval mass was smooth with few adherent lobules of fat in some areas. Its gross cut section showed a thick walled uniloculated cyst with yellow areas and thick creamy white fluid. Cyst wall had a bony hard area and two balls of hair were also noted in side. The pedicle of the tumour seen to arise from the left side broad ligament close to left ovary. Uterus was atretic with an intramural fibroid. The dermoid appears to be derived from its autoamputation from one of the pelvic organs; probably ovary. It is unique in its size and vastness occupying the major part of the lower half of the abdominal cavity.