Summary: Sonographic images demonstrate
a complex ovarian mass with a large mural echogenic component, multicystic
component with echogenic bands, and distal acoustic shadowing consistent with
an ovarian dermoid.
Sonographic images demonstrate a complex ovarian mass with a large mural echogenic component, multicystic component with echogenic bands, and distal acoustic shadowing consistent with an ovarian dermoid.
Ovarian dermoids are the most common germ cell neoplasm and most commonly excised
ovarian neoplasm. Dermoids comprise a number of histologic types of tumors, all of which contain mature or immature tissues of germ cell origin. They
typically contain mature tissues of ectodermal (skin, brain), mesodermal (muscle, fat), and endodermal (mucinous or ciliated epithelium) origin.
Dermoids have a variety of appearances on ultrasound (US). Three manifestations occur
most commonly.2 The most common manifestation is a cystic lesion
with a densely echogenic tubercle (Rokitansky nodule) projecting into the cyst
lumen. The second is a diffusely or partially echogenic mass with the echogenic
area usually demonstrating sound attenuation. The third consists of multiple
thin, echogenic bands caused by hair in the cyst cavity. Manifestation 2 and 3
are demonstrated in this case. Differential considerations on US include a blood
clot within a hemorrhagic cyst, which can appear echogenic, echogenic bowel, or
endometrioma. On computed tomography, fat attenuation within a cyst, with or
without calcification in the wall, is diagnostic
Ovarian dermoid can be associated with complications including rupture, most commonly
torsion, or malignant degeneration (rare). The growth rate of a dermoids is
estimated to be approximately 1.67 mm per year or 1 cm per 6 years. They can be
managed either expectantly or surgically. The risks of expectant management are
small. Close follow-up without intervention should always be considered to
preserve ovarian function and future fertility. Factors in deciding surgical
intervention include symptoms, age, parity > 2, past history of ovarian
cyst, bilateral cysts, and large cyst size.3
- Outwater EK, Siegelman ES, Hunt JL. Ovarian teratomas: Tumor types and imaging characteristics. Radiographics.
- Hoo WL, Yazbek J, Holland T, Mavrelos D,& et al. Expectant management of ultrasonically diagnosed
ovarian dermoid cysts: Is it possible to predict outcome?. Ultrasound Obstet Gynecol. 2011;36:235-240.
- O’Neil KE, Cooper AR. The approach to ovarian dermoids in adolescents and young women.
J Pediatr Adolesc Gynecol. 2011;24:176-180.