Dermoid cyst differential diagnosis: Difference between revisions

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**Pedunculated lipo[[leiomyoma]] of the [[uterus]]
**Pedunculated lipo[[leiomyoma]] of the [[uterus]]
**Ovarian serous or mucinous [[cystadenoma]]/[[cystadenocarcinoma]]
**Ovarian serous or mucinous [[cystadenoma]]/[[cystadenocarcinoma]]


{|
{|
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! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Gynecologic
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Gynecologic
|-
|-
| rowspan="14" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovary|Ovarian]]
| rowspan="15" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovary|Ovarian]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cyst|Dermoid cyst]]<br><ref name="pmid20505067">{{cite journal |vauthors=Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R |title=Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement |journal=Radiology |volume=256 |issue=3 |pages=943–54 |date=September 2010 |pmid=20505067 |doi=10.1148/radiol.10100213 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
*[[Women]] in [[Reproductive system|reproductive]] age (20 -30 y/o)
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  +/–
| style="background: #F5F5F5; padding: 5px;" |
* High level of [[estrogen]] +/–
| style="background: #F5F5F5; padding: 5px;" |
* [[cyst]] with no internal echo and with posterior acoustic enhancement
| style="background: #F5F5F5; padding: 5px;" |
* simple [[cyst]] with no internal echo or [[septa]]
| style="background: #F5F5F5; padding: 5px;" |
* NA
| style="background: #F5F5F5; padding: 5px;" |
*[[History and Physical examination|History]]/<br>[[imaging]]
| style="background: #F5F5F5; padding: 5px;" |
* It is associated with [[hyperestrogenism]] and [[endometrial hyperplasia]]
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cyst|Follicular cysts]]<br><ref name="pmid20505067">{{cite journal |vauthors=Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R |title=Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement |journal=Radiology |volume=256 |issue=3 |pages=943–54 |date=September 2010 |pmid=20505067 |doi=10.1148/radiol.10100213 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovarian cyst|Follicular cysts]]<br><ref name="pmid20505067">{{cite journal |vauthors=Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R |title=Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement |journal=Radiology |volume=256 |issue=3 |pages=943–54 |date=September 2010 |pmid=20505067 |doi=10.1148/radiol.10100213 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
| style="background: #F5F5F5; padding: 5px;" |
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|-
|-
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Krukenberg tumor]]<br><ref name="pmid8626898">{{cite journal |vauthors=Kim SH, Kim WH, Park KJ, Lee JK, Kim JS |title=CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors |journal=J Comput Assist Tomogr |volume=20 |issue=3 |pages=393–8 |date=1996 |pmid=8626898 |doi= |url=}}</ref><ref name="pmid17076540">{{cite journal |vauthors=Al-Agha OM, Nicastri AD |title=An in-depth look at Krukenberg tumor: an overview |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=11 |pages=1725–30 |date=November 2006 |pmid=17076540 |doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 |url=}}</ref>
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Krukenberg tumor]]<br><ref name="pmid8626898">{{cite journal |vauthors=Kim SH, Kim WH, Park KJ, Lee JK, Kim JS |title=CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors |journal=J Comput Assist Tomogr |volume=20 |issue=3 |pages=393–8 |date=1996 |pmid=8626898 |doi= |url=}}</ref><ref name="pmid17076540">{{cite journal |vauthors=Al-Agha OM, Nicastri AD |title=An in-depth look at Krukenberg tumor: an overview |journal=Arch. Pathol. Lab. Med. |volume=130 |issue=11 |pages=1725–30 |date=November 2006 |pmid=17076540 |doi=10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2 |url=}}</ref>
| style="background: #F5F5F5; padding: 5px;" |
* >55 y/o
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  +/–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |  +/–
Based on underlying [[malignancy]]
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px; text-align: center;" |–
| style="background: #F5F5F5; padding: 5px;" |
* In case of [[Metastasis|metastatic]] [[Gastrointestinal cancer|GI cancers]] we may see [[iron deficiency anemia]] (IDA)
| style="background: #F5F5F5; padding: 5px;" |
* Mostly bilateral, complex ovarian [[lesion]]
* In [[CT scan]] we may see evidence of concurrent [[malignancy]] in other [[organs]]
| style="background: #F5F5F5; padding: 5px;" |
* Mostly bilateral, complex [[Ovary|ovarian]] [[lesion]] with solid components
* Internal hyperintensity on T1 and T2 weighted [[Mri|MR]] [[images]] because of [[Mucin 17|mucin]]
* Evidence of concurrent [[malignancy]] in other [[organs]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Mucin]]-secreting [[signet cell]]
| style="background: #F5F5F5; padding: 5px;" |
*[[Imaging]]/<br>[[biopsy]]
|}


===Spinal Dermoid Cysts===
===Spinal Dermoid Cysts===

Latest revision as of 12:47, 10 October 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Soujanya Thummathati, MBBS [2]

Overview

Dermoid cyst must be differentiated from teratoma, as well as other common benign tumors that develop in the head and neck, ovaries, or spine (such as pilar cysts, steatocystoma, pilomatrixoma, encephalocele, vascular malformations, lipoleiomyoma, pilonidal cyst, and lipoma).[1][2][3][3][4]

Differential Diagnosis

Head and Neck

Dermoid cysts of head and neck must be differentiated from the following:[1][2]

Ovarian Dermoid Cysts


Diseases Clinical manifestations Para-clinical findings Gold standard Additional findings
Age of onset Symptoms Physical examination
Lab Findings Imaging Immunohistopathology
Pelvic/abdominal pain or pressure Vaginal bleeding/discharge GI dysturbance Fever Tenderness CT scan/US MRI
Gynecologic
Ovarian Dermoid cyst
[5]
+/– +/–
  • cyst with no internal echo and with posterior acoustic enhancement
  • NA
Follicular cysts
[5]
+/– +/–
  • In US we may see a >3 cm simple cyst with no internal echo and with posterior acoustic enhancement
  • NA
Theca lutein cysts
[6][7][8]
+/– +/–
Serous cystadenoma/carcinoma
[9][10][11][12]
  • >55 y/o
+/– +/–
  • In US we may see simple or multiloculated cyst
  • In serous cystadenocarcinoma we may see papillary projection inside the cyst
  • In serous cystadenocarcinoma we may see ascites
  • We may see a simple cyst with beak sign, hypointense on T1 and hyperintense on T2
  • We may see some Solid malignant components inside the cyst with intermediate signal on T1 and T2
Mucinous cystadenoma/carcinoma
[13][14][15]
  • >55 y/o
+/– +/–
  • Stained glass appearance due to variable signal intensity on T1 and T2
  • The more mucin we have, there is more intensity on T1
  • and less intensity on T2
Endometrioma
[16][17][18]
+ + +/– +
  • hyperintensity on T1-weighted images and a hypointensity on T2-weighted images
  • Powder burn hemorrhages
Teratoma
[19][20][21][22]
  • 10-30 y/o
+/– +/–
  • We may see evidence of fat components
Dysgerminoma
[23][24]
  • in the second to third decade of life
+ +/– +/–
  • We may see ovarian mass with septation which are hyperintense on T1 and hypo or isointense on T2 imaging
  • Sheets fried egg appearance cells
Yolk sac tumor
[25][26][27]
+ +
  • High levels of AFP
  • In US we may see a combination of echogenic and hypoechoic components
  • Yellow appearance
  • Schiller-Duval bodies (glomeruli like structures)
Fibroma
[28][29][30]
  • >50 y/o
  • Pulling sensation in the groin
+/–
  • In CT scan we may see a unilateral mass with poor contrast enhancement
  • Low signal intensity on T1 and T2
Thecoma
[31][32][33]
  • >50 y/o
+/–
Granulosa cell tumor
[34][35][36][37]
  • 50-60 y/o
+ +/–
Sertoli-leydig cell tumor
[38][39]
  • 15 to 35 y/o
+/–
  • In US we may see unilateral Well-defined hypoechoic lesion
  • Low T2 signal intensity
  • areas of high signal intensity
Brenner tumor
[40][41]
  • >55 y/o
+/–
  • Hypointense on T2 because of fibrous content
  • Most of the times it's an accidental finding
Krukenberg tumor
[42][43]
  • >55 y/o
+/– +/–

Based on underlying malignancy

Spinal Dermoid Cysts

Others

Dermoid cysts must also be differentiated from the following:[44]

References

  1. 1.0 1.1 Ohta N, Watanabe T, Ito T, Kubota T, Suzuki Y, Ishida A; et al. (2012). "A case of sublingual dermoid cyst: extending the limits of the oral approach". Case Rep Otolaryngol. 2012: 634949. doi:10.1155/2012/634949. PMC 3465894. PMID 23056976.
  2. 2.0 2.1 Dermoid cyst. Wikipedia. https://en.wikipedia.org/wiki/Dermoid_cyst Accessed on February 4, 2016.
  3. 3.0 3.1 3.2 Sharma M, Mally R, Velho V (2013). "Ruptured conus medullaris dermoid cyst with fat droplets in the central canal [corrected]". Asian Spine J. 7 (1): 50–4. doi:10.4184/asj.2013.7.1.50. PMC 3596585. PMID 23508636.
  4. Intracranial dermoid cyst. Radiopaedia.org. http://radiopaedia.org/articles/intracranial-dermoid-cyst-1 Accessed on February 5, 2016.
  5. 5.0 5.1 Levine D, Brown DL, Andreotti RF, Benacerraf B, Benson CB, Brewster WR, Coleman B, Depriest P, Doubilet PM, Goldstein SR, Hamper UM, Hecht JL, Horrow M, Hur HC, Marnach M, Patel MD, Platt LD, Puscheck E, Smith-Bindman R (September 2010). "Management of asymptomatic ovarian and other adnexal cysts imaged at US: Society of Radiologists in Ultrasound Consensus Conference Statement". Radiology. 256 (3): 943–54. doi:10.1148/radiol.10100213. PMID 20505067.
  6. Montz FJ, Schlaerth JB, Morrow CP (August 1988). "The natural history of theca lutein cysts". Obstet Gynecol. 72 (2): 247–51. PMID 2455880.
  7. Southam, Anna L. (1962). "Massive Ovarian Hyperstimulation with Clomiphene Citrate". JAMA: The Journal of the American Medical Association. 181 (5): 443. doi:10.1001/jama.1962.03050310083018b. ISSN 0098-7484.
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  9. Jung, Seung Eun; Lee, Jae Mun; Rha, Sung Eun; Byun, Jae Young; Jung, Jung Im; Hahn, Seong Tai (2002). "CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis". RadioGraphics. 22 (6): 1305–1325. doi:10.1148/rg.226025033. ISSN 0271-5333.
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  42. Kim SH, Kim WH, Park KJ, Lee JK, Kim JS (1996). "CT and MR findings of Krukenberg tumors: comparison with primary ovarian tumors". J Comput Assist Tomogr. 20 (3): 393–8. PMID 8626898.
  43. Al-Agha OM, Nicastri AD (November 2006). "An in-depth look at Krukenberg tumor: an overview". Arch. Pathol. Lab. Med. 130 (11): 1725–30. doi:10.1043/1543-2165(2006)130[1725:AILAKT]2.0.CO;2. PMID 17076540.
  44. Intracranial dermoid cyst. Radiopaedia.org. http://radiopaedia.org/articles/intracranial-dermoid-cyst-1 Accessed on February 5, 2016.


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