Chemical peritonitis: a rare complication of an iatrogenic ovarian dermoid cyst rupture

Laparoscopy is the standard method for the diagnosis and treatment of ovarian dermoid cysts, which represent 10% to 15% of all ovarian tumors. This procedure offers many advantages including less postoperative pain, lower risk of wound complication, early ambulation, and more rapid convalescence. The risk of adhesion formation also is reduced. However, in the case of an ovarian dermoid cyst, the laparoscopic approach could result in chemical peritonitis caused by the spilled contents of a ruptured dermoid cyst. We report a case of chemical peritonitis after rupture of an ovarian dermoid cyst during laparoscopy. Two operations were required, and medical treatment was not beneficial. We discuss a possible new medication for the treatment of this complication and compare this case with other recent reports.     

Spontaneous rupture of spinal dermoid cyst with disseminated lipid droplets in central canal and ventricles

Free fat in the ventricular space is a rare but well recognized complication of ruptured tumour of dermal origin. However, only 1 patient of spontaneous rupture of spinal dermoid tumour with disseminated fat in the central canal and ventricles has been described in the literature. The authors report an extremely rare case of ruptured intraspinal dermoid and passage of free fatty droplets via the patent central canal to the intracranial CSF space. The detailed clinical presentation, radiological findings, and review of the literature are presented. Despite being rarely reported, spinal dermoid cyst can rupture spontaneously, and free fat disseminate into the ventricles, and in extremely rare cases, fat can enter into the central canal. It is underlinerd that a prompt detection, with the help of MRI is essential in cases of spinal dermoid tumour cyst, with sudden deterioration in neurological condition, keeping in mind, the possibility of free fat in the central canal.     

Ovarian teratoma presenting as small bowel obstruction in an elderly lady-A case report

Teratomas of the ovary are of the mature or immature type. The mature variety is called dermoid cysts, which is the most frequent benign germ cell tumour of the ovary in the reproductive age group. They are usually asymptomatic until they reach a significant dimension.(1) Pressure effect, torsion and rupture of an ovarian cyst may present as an acute abdomen. A case is presented where an elderly lady presented with small bowel obstruction due to a very large, non-adherent to the intestine, dermoid cyst.     

The diagnosis of ruptured intracranial dermoid cysts

We present a case of a spontaneous asymptomatic rupture of an intracranial dermoid cyst with CT and MR images. The literature on the subject is reviewed. The potential associated complications are discussed.     

Ruptured intracranial dermoid cysts

BACKGROUND

Intracranial dermoid cysts are rare congenital neoplasms that are believed to arise from ectopic cell rests incorporated in the closing neural tube. The rupture of an intracranial dermoid cyst is a relatively rare event that typically occurs spontaneously. In the past it was believed that rupture is always fatal, a hypothesis that is not supported by more recently reported cases. The symptoms associated with rupture vary from no symptoms to sudden death.

METHODS

The present paper analyzes published cases of ruptured intracranial dermoid cysts in terms of their age profile and their clinical presentation and describes an additional case.

RESULTS

Analysis of published cases revealed headache (14 out of 44 patients; 31.8%) and seizures (13 out of 44 patients; 29.5%), to be the most common signs of rupture followed by, often temporary, sensory or motor hemisyndrome (7 out of 44 patients; 15.9%), and chemical meningitis (3 out of 44 patients; 6.9%).

CONCLUSION

Headache occurred primarily in younger patients (mean age 23.5 ± 9.3 years), whereas seizures primarily occurred in older patients (mean age 42.8 ± 11.3 years). The patients with sensory or motor hemisyndrome associated with rupture of an intracranial dermoid cyst showed a more homogeneous age distribution (mean age 38.4 ± 23.5 years).     

Ruptured intracranial dermoid cyst

Intradural dermoids are rare congenital tumors representing approximately 0.05% of all intracranial lesions. These benign tumors have a typical appearance on CT and MR due to their lipid components. The complication caused by rupture are the spillage of the fatty material into the cerebrospinal fluid. We report a case of a ruptured dermoid cyst showing fat/fluid levels in both side ventricles and fatty material in the subarachnoid space on CT and MR-imaging and the follow-up over four years after incomplete resection of the tumor.     

Kyste dermoïde intraorbitaire : un cas

Dermoid cysts account for 3–4 % of primary orbital tumors. The intraorbital location is relatively rare. The authors report a case of a 12-year-old male with an intraorbital dermoid cyst revealed by progressive right proptosis. The imaging aspects (CT scan and MRI) were consistent with intraconic dermoid cyst. The tumor was extirpated via a subfrontal approach. Histopathologic examination confirmed the diagnosis of dermoid cyst. The authors discuss the clinical symptoms, radiological aspects, and management.     

Atypical presentation of a dermoid cyst with porencephaly

We report a case of a dermoid cyst in the parasellar area associated with porencephaly. A 22-year-old man presented with headache and visual disturbance. Non-enhanced brain CT showed a high density mass in the parasellar area and a low density area in the left temporal lobe. On gadolinium-enhanced T1-weighted images, a partial rim enhancement was present in the parasellar region. A presumptive diagnosis of Rathke cleft cyst, craniopharyngioma, non-function pituitary adenoma, or germ cell tumor was considered. A left frontotemporal craniotomy was performed and the tumor was removed almost totally. The tumor was well-capsulated and contained whitish, milky debris. The histologic diagnosis was dermoid cyst. The temporal lobe lesion was porencephaly. The postoperative course was uneventful. Their most typical aspect is the presence of a low-density mass on CT, allowing an easy radiologic diagnosis of dermoid cyst containing lipids. Enhancement following contrast administration is uncommon. The hyperdensity may be related to the high protein content of the lesion. The hyperdense aspect of the lesion on CT, and the presence of rim enhancement made the radiologic diagnosis of a dermoid cyst difficult in this case. A case of dermoid cyst associated with porencephaly has not yet been reported in the literature.     

Epidural hematoma secondary to a rupture of a synovial cyst.

BACKGROUND CONTENT: With modern advances in imaging studies, synovial cysts are becoming more evident as a common component of erosive lumbar degenerative disc disease causing spinal stenosis and radiculopathy. Whereas hemorrhage can occur inside the cyst and is reported, rupture causing epidural hematoma is a rare complication and finding of this disorder. PURPOSE: To report a rare clinical presentation of a synovial cyst and spinal stenosis, where rupture of the cyst leads to an early cauda equina syndrome. STUDY DESIGN: Case report with a review of literature. METHODS: Clinical history, physical findings, and magnetic resonance imaging studies of a patient with an intraspinal synovial cyst at L4-5 1 week before a sudden worsening of symptoms are reported. RESULTS: A case report is presented of a male with a known synovial cyst at L4-5, presenting initially with neurogenic claudication. This patient developed sudden worsening of symptoms with bilateral lower extremity pain, weakness, and radiculopathy with difficult voiding. The patient had developed an epidural hematoma, secondary to rupture of a synovial cyst, documented at surgical decompression. CONCLUSIONS: Although synovial cyst associated with erosive facet and erosive degenerative disc disease are common, rupture of the cyst is not. A case report of a ruptured synovial cyst leading to an early cauda equina syndrome is presented. This case illustrates the spectrum of clinical features and presentations possible with spinal stenosis complicated by lumbar synovial cyst formation.     

Intra-axial CNS dermoid cyst

Intracranial dermoid cysts are rare tumors. They constitute 0.3% of intracranial tumors. These are commonly seen in the midline and sylvian area. Intraaxial lesions are extremely rare. We report the case of a 35-years-old female with a large intraaxial dermoid cyst, which was reported as oligodendroglioma on imaging studies done preoperatively, but was confirmed to be a dermoid cyst intra-operatively and on histopathological examination; thus highlighting a diagnostic dilemma. Patient did well post operatively and there is no recurrence in the one year follow-up. To conclude, dermoid cysts are rare benign tumors, and intraaxial lesions are still rarer. Complete surgical excision may become difficult due to adherence to nerves and vessels.     

Delayed ischemic deficit after resection of a large intracranial dermoid: case report and review of the literature

OBJECTIVE AND IMPORTANCE: A unique case of delayed ischemic deficit after resection of a large intracranial dermoid is presented. CLINICAL PRESENTATION: A 23-year-old woman, 36 hours after the uneventful gross total resection of a large intracranial dermoid cyst, slowly developed a progressive mixed aphasia and right hemiparesis. Magnetic resonance imaging and magnetic resonance angiography revealed small infarcts of the left putamen and temporal-occipital junction and a vasospastic tapering of the left M1 segment. INTERVENTION: Angiography confirmed severe vasospastic tapering of the left M1 and M2 segments. Endovascular treatment successfully restored flow in the left superior division. However, the initial attempt at low-pressure dilation of the inferior division led to vessel rupture. Seven months after reoperation for emergent trapping of the M1 segment, the patient made an excellent recovery, with only mild right-hand incoordination. CONCLUSION: Ruptured dermoid cysts are a risk for early and delayed cerebral ischemia, and endovascular treatment of dermoid-encased vessels may carry a higher risk for rupture.     

Congenital intracranial frontotemporal dermoid cyst presenting as a cutaneous fistula

BACKGROUND: Intracranial extension and a cutaneous sinus tract are rarely seen with craniofacial dermoid cysts, with few cases reported in the literature. METHODS: We report a case of a 1-year-old girl who was initially seen with a cutaneous fistula of the frontotemporal region, which revealed an intracranial dermoid cyst. RESULTS: The patient underwent a right lateral orbitotomy by a bicoronal approach. The cyst was seated within the lateral orbital wall, with intracranial extension through the temporal and sphenoidal bones to the dura of the temporal lobe. Histopathologic analysis confirmed the diagnosis of a dermoid cyst. CONCLUSIONS: Craniofacial dermoid cysts may be associated with a cutaneous sinus tract and/or intracranial extension. Failure to recognize and promptly treat these lesions may lead to a progressive skeletal distortion and/or recurrent infection with a potential for meningitis or cerebral abscess. Therefore, detailed CT and MRI scans are mandatory before surgical treatment of any cutaneous fistula in the head and neck region.     

Adult onset tethered cord syndrome associated with intradural dermoid cyst. A case report

STUDY DESIGN: A case report and a review of literature. OBJECTIVES: To describe a rare case of adult onset tethered cord syndrome associated with intradural dermoid cyst. SETTING: General Orthopedics, Japan. METHODS: A 50-year-old woman was referred to us because of right leg pain and pollakiuria. Neurological examinations and radiological assessments including myelography, computerized tomography scan and Magnetic resonance image were carried out. We diagnosed it as the adult onset tethered cord syndrome associated with an intradural cystic lesion. RESULTS: The cystic lesion was totally removed following laminectomy from L5 through S4. Histologically, the tumor was diagnosed as a dermoid cyst. CONCLUSIONS: Intradural dermoid could produce adult onset tethered cord syndrome, but it was not reported in the English literatures to our knowledge.     

Secondary pan-hypophysitis caused by rupture of Rathke's cleft cyst: case report]

We report a case of secondary hypophysitis caused by rupture of Rathke's cleft cyst. A 30-year-old woman was admitted to our hospital with complaints of polyuria and left visual acuity impairment. These symptoms were preceded by aseptic meningitis one month prior to admission. An MRI on admission showed a suprasellar cystic mass and a swelling pituitary stalk. The mass was partially resected via the transsphenoidal approach. Pathological diagnosis was adeno- and neuro-hypophysitis and ruptured Rathke's cleft cyst. These findings strongly suggested that the hypophysitis was caused by rupture of Rathke's cleft cyst. After the operation, the patient's visual acuity improved with steroid administration. An MRI performed 5 months after the operation showed marked reduction of the mass. To our knowledge, there have been only 5 reports of secondary hypophysitis caused by ruptured Rathke's cleft cyst.     

Intramedullary inclusion cysts of the cervicothoracic junction. Report of two cases in adults and review of the literature

Intramedullary inclusion cysts are extremely rare within the rostral spinal cord. In this case report the authors outline the clinical features and surgical treatment of one dermoid cyst and one epidermoid cyst of the cervicothoracic junction. The authors also include a relevant literature discussion regarding the treatment and the embryological origin of these lesions.     

Intramedullary epidermoid cysts

Intramedullary inclusion cysts are extremely rare within the rostral spinal cord. In this case report the authors outline the clinical features and surgical treatment of one dermoid cyst and one epidermoid cyst of the cervicothoracic junction. The authors also include a relevant literature discussion regarding the treatment and the embryological origin of these lesions.     

Comparison of superior eyelid incision and directly over the lesion incision to brow dermoid cyst excision

A superior eyelid incision and a directly over the lesion incision to access lateral brow dermoid cysts were compared in terms of cosmetic results, operating time, complication, recurrence, and cyst rupture. From February 2004 to March 2008, 27 patients underwent excision of lateral brow dermoid cyst lesions. Dermoid cyst excision was performed using a directly over the lesion incision in 14 patients and 13 patients via a superior eyelid incision. Both incision scars were very good in adult patients, but the aesthetic results of the superior eyelid incision were judged to be better in children. The parents were satisfied in both groups. We suggest the using of the upper eyelid crease incision in children.     

Dermal sinus and dermoid cyst revealed by abscess formation in posterior fossa. Report of 2 pediatric cases and review of the litterature

Cranial dermal sinus, usually associated with dermoid cyst, is the persistance of an abnormal embryonal communication between the skin and the central nervous system. It may be the source of intracranial infection, most often a meningitis and rarely an abscess formation. Two cases of little girls (18 months and 2 years) having dermal sinus with dermoid cyst revealed by cerebellar abscess formations are reported. In the first case there were multiple cerebellar abscesses with hydrocephalus leading to a raised intracranial pressure. In the second case there was an abscess formation adjacent to the dermoid cyst. CT scan showed cysts and abscesses but MRI, achieved in the second case, was useful in demonstrating the sinus tract as well as the associated cyst and abscess. The two patients underwent a posterior fossa surgery with antibiotic therapy. In the first case abscess drainage and ventricular external drainage were necessary before sinus and cyst excision. Two months after surgery the two patients were neurologically intact and developping well. Surgery with total excision of dermal sinus and dermoid cyst, even sometimes difficult, must be preferred to the simple abscess drainage and antibiotic therapy.     

Bladder fistula of an ovarian dermoid cyst

We report a case of right ovarian dermoid cyst fistulized in the bladder and revealed by recurrence urinary infections. The diagnostic has not been conformed but 5 years after the urinary first manifestations. The cystoscopy has been a cardinal importance but the right seat of the lesion has been determined only during laparotomy. This unusual complication of ovarian dermoid cyst must call the practitioner's attention to urinary symptoms with a pelvic tumour. Moreover, the left ovary agenesis and the young patient's age have constrained the surgeon to preservative method. The functional efficiency of this method has been proved by the periods recovery, 5 months later.     

Variant type of teratoma appearing as a primary solid dermoid tumor in the rectum: Report of a case

We report herein the rare case of a 39-year-old woman found to have a primary solid dermoid tumor in the rectum. The patient presented after noticing a small amount of anal bleeding, and physical examination revealed a walnutsized hard tumor, palpable in the anterior rectum, located about 9 cm from the anal verge. Morphologic examinations revealed a polypoid lesion with some hair surrounded by rectal mucosa, and four biopsy specimens from the lesion showed normal squamous epithelium. The tumor, which measured 2.5×2.1×1.3 cm, was removed by endoscopic polypectomy. Microscopically, the tumor was diagnosed as a solid dermoid tumor without a cyst, a variant type of mature teratoma or dermoid cyst. Since 1914, only 12 such cases, including ours, have been reported in Japan. The clinical features and diagnostic and therapeutic methods applied thereto are discussed.