What has hair, teeth, yellow gooey fluid, and likes to call your ovaries home? No, this is not a bad joke or a fictional character in a fantasy novel. It’s a dermoid cyst, and it’s pretty common in women under the age of 30. Dermoids, also affectionately known in the medical world as ovarian germ cell tumors or mature cystic teratomas, comprise about 25% of all ovarian cysts. The large majority are benign (phew!) but can be quite pesky and occasionally painful.
What makes them so notable is not whom they affect but how they affect them. Let’s take a quick trip back to Bio 101. In our body, we have three types of tissue: endoderm, mesoderm, and ectoderm. These big three make up the basis of every organ in our body, including our skin. Mature cystic teratomas (nickname deromids) are comprised of all of these three cell types. Hence, they have the ability to be whatever or whoever they want. That’s why when they are removed and opened, you can see anything from hair to teeth to nerve tissue to fat cells.
Just like their Houdini-like abilities to transform into everything and anything, they are often invisible when it comes to pain. Many women find they have dermoids totally by accident on an ultrasound for something else or during a physical exam.
Symptoms in general are a side effect of size. The larger the dermoid, the more likely you will have pain, pressure, cramping, etc. Occasionally, dermoids will present with acute pain, nausea/vomiting, and a trip to the operating room. This is called ovarian torsion. When cysts take up residence in the ovaries, the size of the ovary can increase substantially. The bigger an ovary, the more apt it is to twist.
Very rarely, a dermoid cyst will make itself known by rupturing, that is, opening up. When it does this, that yuck fluid escapes its “jail” and has now leaked all over your pelvis/abdomen. This can be pretty painful and almost certainly requires a surgery to do a major clean out. Your body can react very strongly to this unwelcome substance, and unless treated ASAP, major scar tissue and other serious issues can occur.
When dermoids say cheese to our camera (the ultrasound), they have a very characteristic smile. This is a good thing because it allows us to be pretty confident in what we are dealing with. Once it is confirmed, or as close to confirmed as we can get, a treatment plan is devised. Depending on the size (and symptoms) of the cyst, surgery may be recommended. Most of the time these cysts can be removed with the aid of a laparoscope (a.k.a. camera) and a few small incisions.
This minimally invasive approach allows women to come in and go home within a few hours. While the ovary is almost always left inside in women who still have babies and pregnancy on their brain, for women who are done with the baby thinking, it is ok to remove the entire ovary. Make sure that you discuss the surgical approach and strategy with your doctor before going in. You want to make sure that you are on the same page!
Although most are benign, there is a small subset of ovarian germ cell tumors that are bad (a.k.a. can cause cancer). The names of these are definitely going to be foreign, but we will make a quick intro in case you should run into them in a dark alley. They include dysgerminonams, yolk sac tumors, and mixed germ cell tumors. Luckily, most of us will never ever meet them ourselves or know anyone who will encounter them. However, if you do, make sure you see a GYN who specializes in ovarian cancer (a.k.a. GYN oncologists). Rare ovarian tumors are their bread and butter; they know the best surgery approaches, the best medical treatments, and the best way to tackle this problem.
You may have to travel to see them (not every town/city has one in their zip code), but it’s worth the trip. They may save your ovary, save your fertility, and most importantly, save your life.
When you hear the word cyst, you probably mutter a curse word and ask what does this mean?! And then, when it is followed up by “and it looks like it may have hair, teeth, and yellow stuff,” (and no it is NOT a baby) your psyche gets even more psyched out. But don’t despair. Although dermoids are sort of disgusting to look at, they are not divas to deal with. They are fairly easy to remove, almost always benign, and come back in only about 4% of cases. Find a good doctor who knows what they are doing, and your dermoid doesn’t stand a chance!