Dermoid

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Dermoid

  1. 1. Ovarian dermoid<br />Benign mature cystic teratoma. Young women 20% of benign ovarian tumorsMostly unilateral (10 to 15% bilateral Elements of all three germ layers ( in ovarian dermoid especially ectodermic differentiation occurs ( lipid/ sebum/hair/ egg shell calcification). Organoid elements( 30%). Diametre , 10 cm Rarely >15cm.<br />Abdominal pain / pelvic pain – Only 15% have menstrual symptoms . Torsion is the most common complication. <br />MERCURY IMAGING INSTITUTE <br />SCO 172-173 SEC 9C CHANDIGARH<br />MERCURY IMAGING CENTRE <br />SCO 16-17 SEC 20D CHANDIGARH<br />
  2. 2. Radiology <br />Plain Radiograph – Calcification Fat floating ( sharp line is appreciated between two radioopacity of different attenuation. <br />USG : Reflective / echogenicdermoid plug / rokitansky nodule ( acute angle with the cyst ( acoustic shadowing). Fat fluid level , fluid –fluid level. D/D :Tubo-ovarian abscess / ectopic pregnancy / haemorrhagic cyst . MR : loss of T1W high signal on FaT SAT SEQUENCE . SALT –PEPPER APPEARANCE ( WATER / FAT INTERFACES).<br />
  3. 3. EDUCATION<br />HAEMORRHAGIC CYST VERSUS DERMOID CYST .<br /> On USG Echogenic / reflective focus with posterior acoustic shadow -----dermoid cyst.<br />Echogenic / reflective focus with through transmission -------haemorrhagic cyst.<br />
  4. 4. This case............................................................ <br />Clinical brief : 28 yr female Old case of PCOS . LMP : 20/07/2010. Pain Rt lower abdomen x 15days. USG ( 28/07/2010) : Echogenic mass in the Rt ovary ? dermoid cyst .<br />Focal well defined round area of altered MR signal is appreciated in the medulla of RT OVARY . The MR charcters of the lesion are ; Intermediate to hyperintense signal on TIw,T2w sequence. there is partial inversion on FATSAT sequence . No bloom appreciated on gradient sequence ( rules out chronic haemorrhage). Sharp hypointense line of demarcation appreciated between the rest of the medulla and mentioned lesion. The mentioned MR characters are corroborative with Heterogenous but predominantly fat signal of the lesion. No fluid-fluid level in the lesion. Note :Contralateral ovary was dedicatedly assessed and no similar natured lesion was appreciated in its cortex / medulla.Both the ovaries have multiple peripherally placed follicles corroborative with PCOD .<br />The mentioned RADIOLOGICAL findings are supportive of clinical and sonographic suspicion of ? Rt ovarian Dermoid with PCOD .<br />
  5. 5. T2W – INTERMEDIATE/ HYPERINTENSE SIGNAL INTENSITY LESION IN RT ovary <br />STRING OF PEARLS APPEARANCE –PCOD <br />
  6. 6. FIESTA FATSAT SEQUENCE- PARTIAL INVERSION <br />T1w- INTERMEDIATE /HYPERINTENSE<br />T2w - Intermediate / hyperintense<br /> STIR SEQUENCE- PARTIAL INVERSION <br />GRE- No intrasubstance bloom <br />
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  8. 8. POST OP ................................................. <br /> Yellowish cheesy material with single hair in the substance of the lesion was obtained. (Dermoid on inspection).<br /> ? IS THIS THE HAIR <br />

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