Parasitic dermoid cyst coexisting with absence of an adnexa

aog˙1125 aogs2011.cls March 23, 2011 17:5

AOG aog˙1125 Dispatch: March 23, 2011 CE:

Journal MSP No. No. of pages: 1 PE: Lorna Faith

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LETTER TO THE EDITOR

Parasitic dermoid cyst coexisting with absence of an adnexa

Sir,We would like to call attention to a case of a 29-year-old woman,

nullipara, who arrived at the Obstetrics, Gynecology and Phys-iopathology of Human Reproduction Unit, Maternal and NeonatalDepartment of the Policlinico Hospital of Palermo, complaining ofpain in the lower abdominal zone, dyspareunia and pollakisuria, forthe previous two months. No previous surgery and/or pathologywere recorded. The pain was described as strong and discontinu-ous, located mainly in the right side, with radiation to the right leg.Menstrual cycle was regular but dysmenorrheic. CA-125 was mildlyQ1elevated at 40 (normal range 0–35units/ml). Pelvic examination re-vealed a regular uterus and the presence of a pelvic mass, presumablypertaining to the right ovary. Ultrasonography showed an enlargedcystic mass with diffuse, low-level internal echoes, measuring 6cmin diameter, which seemed to be located in the right adnexal region.A right ovary was not identified.

Doppler scanning showed a benign vascular pattern. A cystoscopyshowed regular mucosa. A diagnosis of right ovarian cyst, probablydermoid, was made.

Elective laparoscopy was carried out, showing a normal uterusand left adnexa. A bulky cyst (6cm×5cm) adherent to the anteriorabdominal wall was seen near the bladder, without connections tointernal genital organs. The cyst was surrounded by thin, filmy ad-hesions and supplied by a slight vascularization which could easilybe removed (Figure 1). Careful exploration showed absence of the

Figure 1. Parasitic dermoid cyst adherent to the anterior abdominalwall.

right adnexa. The cyst was removed and an endobag used to mini-mize spillage; sebaceous material and hair were found in the mass.Histology revealed a mature cystic teratoma with no residual ovarianelements. There were also tubal fragments with foci of dystrophiccalcification.

This unusual case could be explained by autoamputation andreimplantation of an ovarian teratoma to the abdominal wall. Ab-sence of the right adnexa lends credence to this. In subacute orchronic torsion, the tumour may become adherent to adjacent struc-tures, forming a new collateral circulation. Infrequently, the tumourcompletely detaches from its pedicle, resulting in a parasitic dermoidcyst (1). These lesions are very rare, usually found by chance, and forthis reason the incidence is unknown. The most common sites arethe omentum (2) and the retro-uterine pouch (3). The right adnexaappears to be more frequently involved, possibly because the sig-moid colon protects the left adnexa from torsion (4). In the absenceof an adnexa, or with a visibly reduced ovary, along with a symp-tomatology as described above, we would remind surgeons of theimportance of a careful exploration of the entire abdominal–pelviccavity for possible parasitic teratoma.

Gaspare Cucinella1, Roberta Granese1,2, Renato Venezia1,Donatella Mangione1, Gloria Calagna1 and Antonino Perino1

1Department of Obstetrics and Gynecology, University Hospital‘Paolo Giaccone’, Palermo, and 2Department of Obstetrics and

Gynecology, University Hospital ‘Gaetano Martino’, Messina, Italy.

Address for correspondenceRoberta Granese,

Department of Obstetrics and Gynaecology,University Hospital ‘Gaetano Martino’,

v. Consolare Valeria, 98125 Messina, ItalyE-mail: [email protected]

DOI: 10.1111/j.1600-0412.2011.01125.x

References

1. Kearney MS. Synchronous benign teratomas of the greater

omentum and ovary. Case report. Br J Obstet Gynaecol. 1983;

90:676.

2. Peterson WF, Prevost EC, Edmunds FT, Hundley JM, Morris FK.

Benign cystic teratomas of ovary: a clinical study of 1007 cases with a

review of literature. Am J Obstet Gynecol. 1955;70:368–82.

3. Barlett CE, Khan A, Pisal N. Parasitic dermoid cyst managed

lapaoscopically in a 29-year-old woman: a case report. J Med Case

Rep. 2009;3:63.

4. Peh WC, Chu FS, Lorentz TG. Painful right iliac fossa mass caused

by a migrating left ovary. Clin Imaging. 1994;18:199–202.

C© 2011 The AuthorsActa Obstetricia et Gynecologica Scandinavica C© 2011 Nordic Federation of Societies of Obstetrics and Gynecology 1


Query

Q1 Author: please write CA-125 in full.



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