History: 25 yo female with pelvic pain
Solution: Dermoid
The US images identify a complex cystic mass involving the right ovary. There are echogenic components likely to represent either calcification or fat. Other findings that can be seen on US is the "dermoid plug", or tip of the iceberg sign, the "dot-dash" sign related to hair in the mass, or fat-fluid levels in the cystic portions of the mass. Although the US findings are suggestive of the diagnosis, the CT findings of a mass in the right adnexa with fat, calcification, and soft tissue components are diagnostic.
A dermoid is a congenital benign germ cell tumor containing mature tissues from all 3 germ cell layer. There is typically a predominance of tissues from the ectodermal layer, explaining the prevelance of hair, teeth, and skin elements in the tumors. They are most frequently diagnosed in reproductive age females and are often quite soft and therefore not easily palpated on physical examination. A small minority of these tumors undergo malignant degeneration with the most frequent malignancy being squamous cell carcinoma. They can torse, resulting in an emergent process and they can rupture, resulting in a chemical peritonitis, although this is rare. They are usually surgically removed to avoid these uncommon, but severe complications.
The US images identify a complex cystic mass involving the right ovary. There are echogenic components likely to represent either calcification or fat. Other findings that can be seen on US is the "dermoid plug", or tip of the iceberg sign, the "dot-dash" sign related to hair in the mass, or fat-fluid levels in the cystic portions of the mass. Although the US findings are suggestive of the diagnosis, the CT findings of a mass in the right adnexa with fat, calcification, and soft tissue components are diagnostic.
A dermoid is a congenital benign germ cell tumor containing mature tissues from all 3 germ cell layer. There is typically a predominance of tissues from the ectodermal layer, explaining the prevelance of hair, teeth, and skin elements in the tumors. They are most frequently diagnosed in reproductive age females and are often quite soft and therefore not easily palpated on physical examination. A small minority of these tumors undergo malignant degeneration with the most frequent malignancy being squamous cell carcinoma. They can torse, resulting in an emergent process and they can rupture, resulting in a chemical peritonitis, although this is rare. They are usually surgically removed to avoid these uncommon, but severe complications.
CT Images
