Cecal dermoid masquerading dermoid cyst of ovary: a case report and review of the literature

Abstract

Background: The ovary is the most common site of occurrence of mature cystic teratomas (dermoid cysts). These are the most common ovarian germ cell tumor in the reproductive age group, accounting for 10-20% of all ovarian neoplasms, with a 1-2% risk of malignancy. A cecal dermoid cyst is a rare entity with only ten cases having been reported so far, eight of which could be retrieved as the rest were reported in different languages. None of these cases were managed laparoscopically. Here we present the first case of cecal dermoid managed laparoscopically.

Case presentation: A 35-year-old nulliparous Indian Hindu woman presented with complaints of on and off abdominal pain for 10 months. The abdominal examination revealed a well-defined mass of about 10 × 5 cm size, palpable in the right iliac fossa. On sonography, it was suggestive of a right-sided ovarian dermoid cyst. The lesion measured 10 × 7 × 5 cm on a contrast-enhanced computed tomogram (CT) scan. It was well defined and hypodense and located in the right lower abdomen. The ovarian tumor markers were normal. On laparoscopy, the uterus, bilateral tubes, and ovaries were found to be healthy. The cyst was seen arising from the right medial wall of the cecum at the ileocecal junction, which was excised laparoscopically. Histopathological study revealed it to be a mature cystic teratoma.

Conclusion: Ovarian mature cystic teratoma commonly has an indolent course and can present with palpable abdominal mass, pain, or vomiting due to complications like torsion, hemorrhage, or infection. Alternatively, these cysts can be asymptomatic and incidentally detected. Clinicians should be aware of the variety of presentations of dermoid cysts of the bowel as well as mesentery. The exact location of the teratoma eluded us till the laparoscopy despite adequate imaging including a contrast-enhanced CT scan having been performed preoperatively. We are reporting this as it is a rare entity, and this knowledge will help gynecologists and surgeons make an appropriate surgical decision.

Keywords: Case report; Cecal neoplasm; Cecum; Dermoid cyst; Mature cystic teratoma.

Fig. 1

Ultrasonography image showing a well-defined cystic and solid lesion with areas of calcification

Fig. 2

Well-defined hypodense focal lesion in the right lower abdomen and upper pelvis

Fig. 3

Intraoperative image showing bilateral healthy ovaries

Fig. 4

Intraoperative images showing the cyst arising from the cecum

Fig. 5

Histopathology showing the squamous epithelium with the presence of a pilosebaceous unit in the subepithelium (hematoxylin and eosin, ×100). The inset showing keratin flakes with stratified squamous epithelium (×4 magnification)