Dermoid cyst differential diagnosis: Difference between revisions
Jump to navigation
Jump to search
Ahmed Younes (talk | contribs) No edit summary |
|||
Line 23: | Line 23: | ||
**Haemorrhagic [[ovarian cyst]] | **Haemorrhagic [[ovarian cyst]] | ||
**Pedunculated lipo[[leiomyoma]] of the [[uterus]] | **Pedunculated lipo[[leiomyoma]] of the [[uterus]] | ||
**Ovarian serous or mucinous [[cystadenoma]]/[[cystadenocarcinoma]] | **Ovarian serous or mucinous [[cystadenoma]]/[[cystadenocarcinoma]] | ||
{| | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |||
! colspan="2" rowspan="4" |Diseases | |||
| colspan="6" |'''Clinical manifestations''' | |||
! colspan="4" rowspan="2" |Para-clinical findings | |||
| colspan="1" rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Gold standard''' | |||
! rowspan="4" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Additional findings | |||
|- | |||
| rowspan="3" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Age of onset''' | |||
| colspan="3" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Symptoms''' | |||
! colspan="2" rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Physical examination | |||
|- | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Lab Findings | |||
! colspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Imaging | |||
! rowspan="2" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Immunohistopathology | |||
|- | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Pelvic/abdominal pain or pressure | |||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |Vaginal bleeding/discharge | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |GI dysturbance | |||
! colspan="1" rowspan="1" style="background: #4479BA; color: #FFFFFF; text-align: center;" |'''Fever''' | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Tenderness | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |CT scan/US | |||
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |MRI | |||
|- | |||
! colspan="14" style="background: #7d7d7d; color: #FFFFFF; text-align: center;" |Gynecologic | |||
|- | |||
| rowspan="14" style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Ovary|Ovarian]] | |||
| 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;" | | |||
*[[Women]] in [[Reproductive system|reproductive]] age (15 -45 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;" | | |||
* In [[Ultrasound|US]] we may see a >3 cm simple [[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|Theca lutein cysts]]<br><ref name="pmid2455880">{{cite journal |vauthors=Montz FJ, Schlaerth JB, Morrow CP |title=The natural history of theca lutein cysts |journal=Obstet Gynecol |volume=72 |issue=2 |pages=247–51 |date=August 1988 |pmid=2455880 |doi= |url=}}</ref><ref name="Southam1962">{{cite journal|last1=Southam|first1=Anna L.|title=Massive Ovarian Hyperstimulation with Clomiphene Citrate|journal=JAMA: The Journal of the American Medical Association|volume=181|issue=5|year=1962|pages=443|issn=0098-7484|doi=10.1001/jama.1962.03050310083018b}}</ref><ref name="NguyenReid1986">{{cite journal|last1=Nguyen|first1=K T|last2=Reid|first2=R L|last3=Sauerbrei|first3=E|title=Antenatal sonographic detection of a fetal theca lutein cyst: a clue to maternal diabetes mellitus.|journal=Journal of Ultrasound in Medicine|volume=5|issue=11|year=1986|pages=665–667|issn=02784297|doi=10.7863/jum.1986.5.11.665}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Women]] in [[reproductive]] age (15 -45 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;" | | |||
* Depends on the underlying [[etiology]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see bilaterally enlarged [[ovaries]] with multiple [[cysts]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Multiple bilateral [[cysts]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Theca interna cell [[Hyperplasia]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[History and Physical examination|History]]/<br>[[imaging]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It is associated with [[Hydatidiform mole|hydatidiform moles]], [[choriocarcinoma]], [[diabetes mellitus]] and [[clomiphene]] intake ([[ovulation]] induction) | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |Serous cystadenoma/carcinoma<br><ref name="JungLee20022">{{cite journal|last1=Jung|first1=Seung Eun|last2=Lee|first2=Jae Mun|last3=Rha|first3=Sung Eun|last4=Byun|first4=Jae Young|last5=Jung|first5=Jung Im|last6=Hahn|first6=Seong Tai|title=CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis|journal=RadioGraphics|volume=22|issue=6|year=2002|pages=1305–1325|issn=0271-5333|doi=10.1148/rg.226025033}}</ref><ref name="ImaiKiyozuka1990">{{cite journal|last1=Imai|first1=Shunsuke|last2=Kiyozuka|first2=Yasuhiko|last3=Maeda|first3=Hiroko|last4=Noda|first4=Tuneo|last5=Hosick|first5=Howard L.|title=Establishment and Characterization of a Human Ovarian Serous Cystadenocarcinoma Cell Line That Produces the Tumor Markers CA-125 and Tissue Polypeptide Antigen|journal=Oncology|volume=47|issue=2|year=1990|pages=177–184|issn=0030-2414|doi=10.1159/000226813}}</ref><ref name="pmid15087669">{{cite journal |vauthors=Malpica A, Deavers MT, Lu K, Bodurka DC, Atkinson EN, Gershenson DM, Silva EG |title=Grading ovarian serous carcinoma using a two-tier system |journal=Am. J. Surg. Pathol. |volume=28 |issue=4 |pages=496–504 |date=April 2004 |pmid=15087669 |doi= |url=}}</ref><ref name="pmid22405464">{{cite journal |vauthors=Li J, Fadare O, Xiang L, Kong B, Zheng W |title=Ovarian serous carcinoma: recent concepts on its origin and carcinogenesis |journal=J Hematol Oncol |volume=5 |issue= |pages=8 |date=March 2012 |pmid=22405464 |doi=10.1186/1756-8722-5-8 |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;" |– | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |– | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/– | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Elevated levels of [[CA-125|serum cancer antigen-125]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|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]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 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 | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Cyst]] wall consist of [[benign]]/[[malignant]] [[Fallopian tube|Fallopian]] [[Epithelium|epithelial]] layer | |||
*[[Psammoma body]] | |||
* We may see [[papillary]] projection inside the [[cyst]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Most common [[ovarian neoplasm]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mucinous cystadenoma]]/carcinoma<br><ref name="pmid9850171">{{cite journal |vauthors=Hoerl HD, Hart WR |title=Primary ovarian mucinous cystadenocarcinomas: a clinicopathologic study of 49 cases with long-term follow-up |journal=Am. J. Surg. Pathol. |volume=22 |issue=12 |pages=1449–62 |date=December 1998 |pmid=9850171 |doi= |url=}}</ref><ref name="pmid11075847">{{cite journal |vauthors=Lee KR, Scully RE |title=Mucinous tumors of the ovary: a clinicopathologic study of 196 borderline tumors (of intestinal type) and carcinomas, including an evaluation of 11 cases with 'pseudomyxoma peritonei' |journal=Am. J. Surg. Pathol. |volume=24 |issue=11 |pages=1447–64 |date=November 2000 |pmid=11075847 |doi= |url=}}</ref><ref name="JungLee2002">{{cite journal|last1=Jung|first1=Seung Eun|last2=Lee|first2=Jae Mun|last3=Rha|first3=Sung Eun|last4=Byun|first4=Jae Young|last5=Jung|first5=Jung Im|last6=Hahn|first6=Seong Tai|title=CT and MR Imaging of Ovarian Tumors with Emphasis on Differential Diagnosis|journal=RadioGraphics|volume=22|issue=6|year=2002|pages=1305–1325|issn=0271-5333|doi=10.1148/rg.226025033}}</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;" |– | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" |– | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/– | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Elevated levels of [[CA-125|serum cancer antigen-125]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see large simple [[cyst]] with [[septation]] | |||
* In [[mucinous cystadenocarcinoma]] we may see thickened internal [[septation]] with solid components inside the [[Cyst of urachus|cyst]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 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 | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Cyst]] wall consist of [[Columnar epithelia|columnar]] [[Endocervix|endocervical]] [[epithelium]] | |||
* We may see gelatinous [[mucin]] inside the [[cyst]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It may cause [[pseudomyxoma peritonei]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Endometrioma]]<br><ref name="pmid9848302">{{cite journal |vauthors=Mol BW, Bayram N, Lijmer JG, Wiegerinck MA, Bongers MY, van der Veen F, Bossuyt PM |title=The performance of CA-125 measurement in the detection of endometriosis: a meta-analysis |journal=Fertil. Steril. |volume=70 |issue=6 |pages=1101–8 |date=December 1998 |pmid=9848302 |doi= |url=}}</ref><ref name="KinkelFrei2005">{{cite journal|last1=Kinkel|first1=Karen|last2=Frei|first2=Kathrin A.|last3=Balleyguier|first3=Corinne|last4=Chapron|first4=Charles|title=Diagnosis of endometriosis with imaging: a review|journal=European Radiology|volume=16|issue=2|year=2005|pages=285–298|issn=0938-7994|doi=10.1007/s00330-005-2882-y}}</ref><ref name="de ZieglerBorghese2010">{{cite journal|last1=de Ziegler|first1=Dominique|last2=Borghese|first2=Bruno|last3=Chapron|first3=Charles|title=Endometriosis and infertility: pathophysiology and management|journal=The Lancet|volume=376|issue=9742|year=2010|pages=730–738|issn=01406736|doi=10.1016/S0140-6736(10)60490-4}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Women's College Hospital|Women]] in [[reproductive]] age (15 -45 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;" | | |||
*[[Iron deficiency anemia]] | |||
* Elevated levels of [[CA-125|serum cancer antigen-125]] | |||
* Increased levels of [[interleukin 1]], [[chemoattractant]] protein-1, and [[Interferon-gamma|interferon gamma]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Complex [[mass]] on [[Ultrasound|US]] | |||
* Increased [[Doppler ultrasound|Doppler]] flow because of increased vascularture | |||
* It may present with [[catamenial pneumothorax]], [[hemothorax]], and [[lung]] [[nodules]] in [[CT scan]]. | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* hyperintensity on T1-weighted images and a hypointensity on T2-weighted [[images]] | |||
* Powder burn [[hemorrhages]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Chocolate cyst]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Laparoscopy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It may cause [[infertility]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Teratoma]]<br><ref name="KawaiKano1992">{{cite journal|last1=Kawai|first1=Michiyasu|last2=Kano|first2=Takeo|last3=Kikkawa|first3=Fumitaka|last4=Morikawa|first4=Yoshimitsu|last5=Oguchi|first5=Hidenori|last6=Nakashima|first6=Nobuo|last7=Ishizuka|first7=Takao|last8=Kuzuya|first8=Kazuo|last9=Ohta|first9=Masahiro|last10=Arii|first10=Yoshitaro|last11=Tomoda|first11=Yutaka|title=Seven tumor markers in benign and malignant germ cell tumors of the ovary|journal=Gynecologic Oncology|volume=45|issue=3|year=1992|pages=248–253|issn=00908258|doi=10.1016/0090-8258(92)90299-X}}</ref><ref name="DunzendorferdeLAS MORENAS1999">{{cite journal|last1=Dunzendorfer|first1=Thomas|last2=deLAS MORENAS|first2=ANTONIO|last3=Kalir|first3=Tamara|last4=Levin|first4=Robert M.|title=Struma Ovarii and Hyperthyroidism|journal=Thyroid|volume=9|issue=5|year=1999|pages=499–502|issn=1050-7256|doi=10.1089/thy.1999.9.499}}</ref><ref name="OutwaterSiegelman2001">{{cite journal|last1=Outwater|first1=Eric K.|last2=Siegelman|first2=Evan S.|last3=Hunt|first3=Jennifer L.|title=Ovarian Teratomas: Tumor Types and Imaging Characteristics|journal=RadioGraphics|volume=21|issue=2|year=2001|pages=475–490|issn=0271-5333|doi=10.1148/radiographics.21.2.g01mr09475}}</ref><ref name="SabaGuerriero2009">{{cite journal|last1=Saba|first1=Luca|last2=Guerriero|first2=Stefano|last3=Sulcis|first3=Rosa|last4=Virgilio|first4=Bruna|last5=Melis|first5=GianBenedetto|last6=Mallarini|first6=Giorgio|title=Mature and immature ovarian teratomas: CT, US and MR imaging characteristics|journal=European Journal of Radiology|volume=72|issue=3|year=2009|pages=454–463|issn=0720048X|doi=10.1016/j.ejrad.2008.07.044}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 10-30 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 [[HCG]] and [[LDH]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see [[cystic]] [[adnexal]] [[mass]] with mural components and echogenic [[lesion]] due to [[calcification]] | |||
* The iceberg [[sign]] | |||
* Dot-dash pattern | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* We may see evidence of [[fat]] components | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* All three [[Germ layer|germ layers]] [[Cell (biology)|cell]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It may cause [[ovarian torsion]] | |||
* May content [[thyroid]] [[tissue]] and cause [[hyperthyroidism]] | |||
* In plane [[radiography]] we may see [[calcification]] due to the presence of [[tooth]] in the [[tumor]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Dysgerminoma]]<br><ref name="DganiShoham(Schwartz)1988">{{cite journal|last1=Dgani|first1=R.|last2=Shoham(Schwartz)|first2=Z.|last3=Czernobilsky|first3=B.|last4=Kaftori|first4=A.|last5=Borenstein|first5=R.|last6=Lancet|first6=M.|title=Lactic dehydrogenase, alkaline phosphatase and human chorionic gonadotropin in a pure ovarian dysgerminoma|journal=Gynecologic Oncology|volume=30|issue=1|year=1988|pages=44–50|issn=00908258|doi=10.1016/0090-8258(88)90044-3}}</ref><ref name="pmid8188914">{{cite journal |vauthors=Tanaka YO, Kurosaki Y, Nishida M, Michishita N, Kuramoto K, Itai Y, Kubo T |title=Ovarian dysgerminoma: MR and CT appearance |journal=J Comput Assist Tomogr |volume=18 |issue=3 |pages=443–8 |date=1994 |pmid=8188914 |doi= |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* in the second to third decade of life | |||
| 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 [[HCG]] and [[LDH]] | |||
*[[Hypercalcemia]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Multilobulated solid [[Mass|masses]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* We may see [[ovarian]] [[mass]] with septation which are hyperintense on T1 and hypo or isointense on T2 [[imaging]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Sheets fried egg appearance [[Cell (biology)|cells]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Same as [[male]] [[seminoma]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Yolk sac tumor]]<br><ref name="Yang2000">{{cite journal|last1=Yang|first1=Grace C.H.|title=Fine-needle aspiration cytology of Schiller-Duval bodies of yolk-sac tumor|journal=Diagnostic Cytopathology|volume=23|issue=4|year=2000|pages=228–232|issn=8755-1039|doi=10.1002/1097-0339(200010)23:4<228::AID-DC2>3.0.CO;2-M}}</ref><ref name="LevitinHaller1996">{{cite journal|last1=Levitin|first1=A|last2=Haller|first2=K D|last3=Cohen|first3=H L|last4=Zinn|first4=D L|last5=O'Connor|first5=M T|title=Endodermal sinus tumor of the ovary: imaging evaluation.|journal=American Journal of Roentgenology|volume=167|issue=3|year=1996|pages=791–793|issn=0361-803X|doi=10.2214/ajr.167.3.8751702}}</ref><ref name="TalermanHaije1974">{{cite journal|last1=Talerman|first1=A.|last2=Haije|first2=W. G.|title=Alpha-fetoprotein and germ cell tumors: A possible role of yolk sac tumor in production of alpha-fetoprotein|journal=Cancer|volume=34|issue=5|year=1974|pages=1722–1726|issn=0008-543X|doi=10.1002/1097-0142(197411)34:5<1722::AID-CNCR2820340521>3.0.CO;2-F}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Young [[children]] | |||
*[[Male]] [[infants]] | |||
| 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 levels of [[AFP]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see a combination of echogenic and hypoechoic components | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Ovarian mass]] with [[hemorrhagic]] areas | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Yellow appearance | |||
*[[Hemorrhagic]] | |||
* Schiller-Duval bodies ([[glomeruli]] like structures) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* The other name is [[Ovarian cyst|ovarian]] [[endodermal sinus tumor]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Fibroma]]<br><ref name="pmid13148256">{{cite journal |vauthors=MEIGS JV |title=Fibroma of the ovary with ascites and hydrothorax; Meigs' syndrome |journal=Am. J. Obstet. Gynecol. |volume=67 |issue=5 |pages=962–85 |date=May 1954 |pmid=13148256 |doi= |url=}}</ref><ref name="SivanesaratnamDutta1990">{{cite journal|last1=Sivanesaratnam|first1=V.|last2=Dutta|first2=R.|last3=Jayalakshmi|first3=P.|title=Ovarian fibroma - clinical and histopathological characteristics|journal=International Journal of Gynecology & Obstetrics|volume=33|issue=3|year=1990|pages=243–247|issn=00207292|doi=10.1016/0020-7292(90)90009-A}}</ref><ref name="AbadCazorla1999">{{cite journal|last1=Abad|first1=Antonio|last2=Cazorla|first2=Eduardo|last3=Ruiz|first3=Fernando|last4=Aznar|first4=Ismael|last5=Asins|first5=Enrique|last6=Llixiona|first6=Joaquin|title=Meigs' syndrome with elevated CA125: case report and review of the literature|journal=European Journal of Obstetrics & Gynecology and Reproductive Biology|volume=82|issue=1|year=1999|pages=97–99|issn=03012115|doi=10.1016/S0301-2115(98)00174-2}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* >50 y/o | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Pulling sensation in the [[groin]] | |||
| 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 levels of [[CA-125]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[CT scan]] we may see a unilateral [[mass]] with poor contrast enhancement | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Low signal intensity on T1 and T2 | |||
* We may see scattered hyperintense areas due to [[edema]] or [[cystic]] [[degeneration]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Spindle-shaped [[fibroblast]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It may cause [[Meigs syndrome]] ([[ovarian fibroma]], [[ascites]], and [[hydrothorax]]) | |||
* It may cause [[ovarian torsion]] | |||
* It may cause [[pleural effusion]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Thecoma]]<br><ref name="YaghoobianPinck1983">{{cite journal|last1=Yaghoobian|first1=Jahanguir|last2=Pinck|first2=Robert L.|title=Ultrasound findings in thecoma of the ovary|journal=Journal of Clinical Ultrasound|volume=11|issue=2|year=1983|pages=91–93|issn=00912751|doi=10.1002/jcu.1870110207}}</ref><ref name="LiZhang2012">{{cite journal|last1=Li|first1=Xinchun|last2=Zhang|first2=Weidong|last3=Zhu|first3=Guangbin|last4=Sun|first4=Congpeng|last5=Liu|first5=Qingyu|last6=Shen|first6=Yuechun|title=Imaging Features and Pathologic Characteristics of Ovarian Thecoma|journal=Journal of Computer Assisted Tomography|volume=36|issue=1|year=2012|pages=46–53|issn=0363-8715|doi=10.1097/RCT.0b013e31823f6186}}</ref><ref name="ProctorGreeley1951">{{cite journal|last1=Proctor|first1=Francis E.|last2=Greeley|first2=Joseph P.|last3=Rathmell|first3=Thomas K.|title=Malignant thecoma of the ovary|journal=American Journal of Obstetrics and Gynecology|volume=62|issue=1|year=1951|pages=185–192|issn=00029378|doi=10.1016/0002-9378(51)91109-X}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* >50 y/o | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | +/– | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Postmenopausal bleeding]] | |||
| 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;" | | |||
* In [[Ultrasound|US]] we may see non-specific [[ovarian]] [[mass]] | |||
* We may see evidence of [[endometrial hyperplasia]] due to increased level of [[estrogen]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Hyperintense on T2 | |||
* T1 intensity depends on the amount of [[fibrous tissue]] ([[fibrous tissue]] lead to hypointensity) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Lipid-laden [[Stromal cell|stromal cells]] with pale, vaculolated [[cytoplasm]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* We may see [[endometrial cancer]] as e result of hyper-[[Estrogen|estrogenism]] | |||
* We may see [[ovarian]] fibrothecoma (mixture of [[fibroma]] and [[thecoma]]) | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Granulosa cell tumour|Granulosa cell tumor]]<br><ref name="pmid17945423">{{cite journal |vauthors=Pectasides D, Pectasides E, Psyrri A |title=Granulosa cell tumor of the ovary |journal=Cancer Treat. Rev. |volume=34 |issue=1 |pages=1–12 |date=February 2008 |pmid=17945423 |doi=10.1016/j.ctrv.2007.08.007 |url=}}</ref><ref name="StenwigHazekamp1979">{{cite journal|last1=Stenwig|first1=Jan Trygve|last2=Hazekamp|first2=Johan The.|last3=Beecham|first3=Jackson B.|title=Granulosa cell tumors of the ovary. A clinicopathological study of 118 cases with long-term follow-up|journal=Gynecologic Oncology|volume=7|issue=2|year=1979|pages=136–152|issn=00908258|doi=10.1016/0090-8258(79)90090-8}}</ref><ref name="pmid9386298">{{cite journal |vauthors=Morikawa K, Hatabu H, Togashi K, Kataoka ML, Mori T, Konishi J |title=Granulosa cell tumor of the ovary: MR findings |journal=J Comput Assist Tomogr |volume=21 |issue=6 |pages=1001–4 |date=1997 |pmid=9386298 |doi= |url=}}</ref><ref name="pmid10227493">{{cite journal |vauthors=Ko SF, Wan YL, Ng SH, Lee TY, Lin JW, Chen WJ, Kung FT, Tsai CC |title=Adult ovarian granulosa cell tumors: spectrum of sonographic and CT findings with pathologic correlation |journal=AJR Am J Roentgenol |volume=172 |issue=5 |pages=1227–33 |date=May 1999 |pmid=10227493 |doi=10.2214/ajr.172.5.10227493 |url=}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 50-60 y/o | |||
| style="background: #F5F5F5; padding: 5px; text-align: center;" | + | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Postmenopausal bleeding]] | |||
| 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]] and [[Progesterone|progesteron]] | |||
* We may see [[inhibin]], [[calretinin]], and [[Ki-67]] on the surface of [[Granulosa cell|granulosa]] [[tumor]] [[Cell (biology)|cells]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see solid, [[cystic]], or multiloculated solid and [[cystic]] [[mass]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* We may see solid, [[Cystic Cytoplasm|cystic]], or multiloculated solid and [[cystic]] [[mass]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Call-Exner bodies]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[postmenopausal]] [[women]] may cause [[breast]] [[tenderness]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Sertoli-Leydig cell tumor|Sertoli-leydig cell tumor]]<br><ref name="LantzschStoerer2001">{{cite journal|last1=Lantzsch|first1=T.|last2=Stoerer|first2=S.|last3=Lawrenz|first3=K.|last4=Buchmann|first4=J.|last5=Strauss|first5=H.-G.|last6=Koelbl|first6=H.|title=Sertoli-Leydig cell tumor|journal=Archives of Gynecology and Obstetrics|volume=264|issue=4|year=2001|pages=206–208|issn=0932-0067|doi=10.1007/s004040000114}}</ref><ref name="JungRha2005">{{cite journal|last1=Jung|first1=Seung Eun|last2=Rha|first2=Sung Eun|last3=Lee|first3=Jae Mun|last4=Park|first4=Soo Youn|last5=Oh|first5=Soon Nam|last6=Cho|first6=Kyoung Sik|last7=Lee|first7=Eun Ju|last8=Byun|first8=Jae Young|last9=Hahn|first9=Seong Tai|title=CT and MRI Findings of Sex Cord–Stromal Tumor of the Ovary|journal=American Journal of Roentgenology|volume=185|issue=1|year=2005|pages=207–215|issn=0361-803X|doi=10.2214/ajr.185.1.01850207}}</ref> | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* 15 to 35 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;" | | |||
* Elevated [[serum]] [[testosterone]] level | |||
* Elevated [[alpha-fetoprotein]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* In [[Ultrasound|US]] we may see unilateral Well-defined hypoechoic [[lesion]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Low T2 signal intensity | |||
* areas of high signal intensity | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Lydig [[Cell (biology)|cells]] (Polygonal pink [[Cell (biology)|cells]] with [[eosinophilic]] [[cytoplasm]] | |||
*[[Sertoli cell|Sertoli cells]] (clear vacuolated [[cytoplasm]]) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* It may cause [[virilization]] [[Symptom|symptoms]] and [[amenorrhea]] | |||
|- | |||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Brenner tumor of ovary|Brenner tumor<br>]]<ref name="ShevchukFenoglio1980">{{cite journal|last1=Shevchuk|first1=Maria M.|last2=Fenoglio|first2=Cecilia M.|last3=Richart|first3=Ralph M.|title=Histogenesis of brenner tumors, I: Histology and ultrastructure|journal=Cancer|volume=46|issue=12|year=1980|pages=2607–2616|issn=0008-543X|doi=10.1002/1097-0142(19801215)46:12<2607::AID-CNCR2820461213>3.0.CO;2-Q}}</ref><ref name="OutwaterSiegelman1998">{{cite journal|last1=Outwater|first1=Eric K|last2=Siegelman|first2=Evan S|last3=Kim|first3=Bohyun|last4=Chiowanich|first4=Peerapod|last5=Blasbalg|first5=Roberto|last6=Kilger|first6=Alex|title=Ovarian Brenner tumors: MR imaging characteristics|journal=Magnetic Resonance Imaging|volume=16|issue=10|year=1998|pages=1147–1153|issn=0730725X|doi=10.1016/S0730-725X(98)00136-2}}</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;" |– | |||
| 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;" | | |||
:* In [[Ultrasound|US]] we may see hypoechoic solid [[Mass-to-charge ratio|mass]] and [[calcification]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Hypointense on T2 because of [[fibrous]] content | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Yellow/pale appearance | |||
*[[Transitional cell]] [[tumor]] (resembles [[Urinary bladder|bladder]]) | |||
* Coffee bean [[nuclei]] on [[H&E stain|H&E]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Biopsy]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* Most of the times it's an accidental finding | |||
|- | |||
| 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> | |||
===Spinal Dermoid Cysts=== | ===Spinal Dermoid Cysts=== |
Revision as of 17:19, 8 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]
- Pilar cysts (trichilemmal cyst)
- Acquired
- Intradermal
- Scalp is the most common site
- Steatocystoma multiplex
- Pilomatrixoma
- Encephalocele (when dermoid cysts appear on the medial aspect of the orbit)
- Ranula
- Vascular leiomyoma of the extracranial scalp
Ovarian Dermoid Cysts
- Ovarian dermoid cysts must be differentiated from the following:
- Haemorrhagic ovarian cyst
- Pedunculated lipoleiomyoma of the uterus
- Ovarian serous or mucinous cystadenoma/cystadenocarcinoma
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 | Follicular cysts [5] |
|
+/– | – | – | – | +/– |
|
|
| |||
Theca lutein cysts [6][7][8] |
|
+/– | – | – | – | +/– |
|
|
|
| |||
Serous cystadenoma/carcinoma [9][10][11][12] |
|
+/– | – | – | – | +/– |
|
|
| ||||
Mucinous cystadenoma/carcinoma [13][14][15] |
|
+/– | – | – | – | +/– |
|
|
|
| |||
Endometrioma [16][17][18] |
|
+ | + | +/– | – | + |
|
|
|
| |||
Teratoma [19][20][21][22] |
|
+/– | – | – | – | +/– |
|
|
| ||||
Dysgerminoma [23][24] |
|
+ | +/– | – | – | +/– |
|
|
|
||||
Yolk sac tumor [25][26][27] |
+ | – | – | – | + |
|
|
|
|
| |||
Fibroma [28][29][30] |
|
|
– | – | – | +/– |
|
|
|
| |||
Thecoma [31][32][33] |
|
+/– | – | – | – |
|
|
|
|
| |||
Granulosa cell tumor [34][35][36][37] |
|
+ | +/– | – | – |
|
| ||||||
Sertoli-leydig cell tumor [38][39] |
|
+/– | – | – | – | – |
|
|
|
| |||
Brenner tumor [40][41] |
|
+/– | – | – | – | – | – |
|
|
|
| ||
Krukenberg tumor [42][43] Spinal Dermoid Cysts
OthersDermoid cysts must also be differentiated from the following:[44]
References
|