Ovarian dermoid

Benign mature cystic teratoma. Young women 20% of benign ovarian tumors Mostly unilateral (10 to 15% bilateral Elements of all three germ layers ( in ovarian dermoid especially ectodermic differentiation occurs ( lipid/ sebum/hair/ egg shell calcification). Organoid elements( 30%). Diametre , 10 cm Rarely >15cm.Abdominal pain / pelvic pain – Only 15% have menstrual symptoms . Torsion is the most common complication.

MERCURY IMAGING INSTITUTE SCO 172-173 SEC 9C CHANDIGARHMERCURY IMAGING CENTRE SCO 16-17 SEC 20D CHANDIGARH

Radiology

• Plain Radiograph – Calcification Fat floating ( sharp line is appreciated between two radioopacity of different attenuation.

• USG : Reflective / echogenic dermoid plug / rokitansky nodule ( acute angle with the cyst ( acoustic shadowing). Fat fluid level , fluid –fluid level. D/D :Tubo-ovarian abscess / ectopic pregnancy / haemorrhagic cyst . MR : loss of T1W high signal on FaT SAT SEQUENCE . SALT –PEPPER APPEARANCE ( WATER / FAT INTERFACES).

EDUCATIONHAEMORRHAGIC CYST

VERSUS DERMOID CYST .

On USG Echogenic / reflective focus with posterior acoustic shadow -----dermoid cyst.

Echogenic / reflective focus with through transmission -------haemorrhagic cyst.

This case............................................................

• Clinical brief : 28 yr female Old case of PCOS . LMP : 20/07/2010. Pain Rt lower abdomen x 15days. USG ( 28/07/2010) : Echogenic mass in the Rt ovary

? dermoid cyst .• Focal well defined round area of altered MR signal is appreciated in the

medulla of RT OVARY . The MR charcters of the lesion are ; Intermediate to hyperintense signal on TIw,T2w sequence. there is partial inversion on FATSAT sequence . No bloom appreciated on gradient sequence ( rules out chronic haemorrhage). Sharp hypointense line of demarcation appreciated between the rest of the medulla and mentioned lesion. The mentioned MR characters are corroborative with Heterogenous but predominantly fat signal of the lesion. No fluid-fluid level in the lesion. Note : Contralateral ovary was dedicatedly assessed and no similar natured lesion was appreciated in its cortex / medulla.Both the ovaries have multiple peripherally placed follicles corroborative with PCOD .

• The mentioned RADIOLOGICAL findings are supportive of clinical and sonographic suspicion of ? Rt ovarian Dermoid with PCOD .

T2W – INTERMEDIATE/ HYPERINTENSE SIGNAL INTENSITY LESION IN RT ovary

STRING OF PEARLS APPEARANCE –PCOD

T1w- INTERMEDIATE /HYPERINTENSE

T2w - Intermediate / hyperintense

GRE- No intrasubstance bloom

STIR SEQUENCE- PARTIAL INVERSION

FIESTA FATSAT SEQUENCE- PARTIAL INVERSION

POST OP ...............................................

.. Yellowish cheesy material

with single hair in the substance of the lesion was obtained.

(Dermoid on inspection).

? IS THIS THE HAIR