Dermoid cyst in a kidney is rarely seen. We report a case of intrarenal dermoid cyst which mimics malignant renal tumour and discuss the dilemma in managing this disease.
Intra-axial dermoid cysts are rare intracranial space occupying lesions, more so in the pediatric age group. Dermoid cysts account for about 0.2 to 1.8% of all intracranial tumors and are commonly located in the cisternal spaces, mainly in the cerebellopontine angle and parasellar cisterns. A purely intra-axial position as reported in this paper is quite exceptional.
A case of benign cystic teratoma, sufficiently large to present as an abdominal mass with pressure signs on the right ureter in a two-year old child is presented, the lowest age in this country recorded.
A study of 207 benign ovarian tumors seen at the University Hospital, Kuala Lumpur between 1968 and 1975 was made to evaluate the clinical features that might be useful in the preoperative differentiation of mucinous cystadenoma, serous cystadenoma, and cystic teratoma of the ovary. This study indicated that the pertinent information included the mean age of the patient, the marital and menstrual status, and the estimated tumor size. The racial background was an additional factor in serous cystadenoma. Features like parity, the location of the tumor, and ABO blood group pattern were of no value in the preoperative differentiation.
Mediastinal mature cycstic teratomas are rare germ cell tumors most commonly found in the anterior mediastinum, and constitute about 3-12% of all mediastinal tumors. They grow slowly and are usually diagnosed incidentally. This is a rare presentation of a young lady with mediastinal mature cystic teratoma (dermoid cyst) presenting with chronic cough and haemoptysis.
Dermoid cysts are anatomic embryonic abnormalities that are rarely seen in the oral cavity. Histologically, they are further classified as epidermoid, dermoid or teratoid. We report a case in which an 18- year-old girl who developed an epidermoid cyst presenting as a large sublingual swelling occupying the entire floor of the mouth causing snoring and speech difficulty. We emphasized on the clinical steps in achieving an accurate diagnosis, possible differential diagnosis, necessary imaging techniques and management of epidermoid cyst.
Paediatric germ cell tumor is composed of various neoplasms which exhibit capricious clinical presentation and histological features depending on the age and the area of presentation. Yolk sac tumor is an extremely rare malignant tumor of embryonic origin which usually arises from the gonads. Its manifestation in the head and neck region is extremely rare. Here, we report a rare case of the malignant transformation of mature teratoma into yolk sac tumor of the neck in an infant. Diagnosis was confirmed following histopathological examination of the neck mass along with marked increase of the serum alpha-fetoprotein. The child unfortunately succumbed prior to chemotherapy. We highlight the challenge we faced in diagnosing and managing this rare entity. We would also like to recommend serial monitoring of serum alpha-fetoprotein in all patients with mature teratoma to detect malignant transformation early.
Juxtafacet cyst of the spine is a rare occurrence. Reports have described them as synovial cysts; ganglion cysts; extradural cysts as well as degenerative cysts of the spine. Patients may present with radicular pain, motor deficits, sensory disturbances, cauda equina syndrome and even myelopathy. Lumbar juxtafacet cysts may be confused clinically with prolapsed intervertebral discs or other conditions involving nerve root compression such as arachnoid cysts, ependymal cysts, dermoid cysts or teratomatous cysts. In the case of the juxtafacet cyst, surgical excision is usually curative. We report a case of spinal synovial juxtafacet cyst found intraoperatively in a case that was preoperatively diagnosed as prolapsed intervertebral disc. Synovial juxtafacet cyst of the spine should be considered as one of the differential diagnoses in patients, especially in older patients, presenting with nerve root compression.
A 62-year-old lady presented with a six-month history of swelling of the left upper eyelid, resulting in mild mechanical ptosis. Clinical assessment suggested a provisional diagnosis of dermoid cyst. The lesion was excised and histology revealed nodular deposits of amorphous eosinophilic material surrounded by lymphocytes and plasma cells. Special histochemistry and immunoperoxidase stain results showed deposition of amyloid, non-AA type. The lesion recurred 6 months later.
Torsion of ovarian tumors occurred predominantly in the reproductive age group. The majority of the cases presented in pregnant (22.7%) than in non-pregnant (6.1%) women. The major presenting symptom was pain but an abdominal mass was palpable in 79.4% of cases. Torsion was more common on the right ovary and 50% were gangrenous at laparotomy. Most of the tumors were benign cystic teratomas. Only 8.7% of the tumors were malignant.
Collision tumor consists of two tumors occurring in the same organ without intermixture of the two cell types. The most common type of collision tumor in ovary is between teratoma and surface epithelial tumor. A 38-year-old woman presented with complained of lower abdominal pain and tightness, and a solid partially cystic left ovarian mass with minimal ascites was detected. Left salpingo-oophorectomy was performed. The ovarian mass measured 15 × 12 × 7 cm with a pedunculated mass on its surface which measured 6 × 2.5 × 2.5 cm. Histologically, it was a collision tumor of fibroma and mature cystic teratoma. Fibroma becomes more edematous as their size increases, which is frequently accompanied by the escape of increasing quantities of fluid from the tumor surfaces. Ascites is often detected when the fibroma is more than a diameter of 10 cm. It is important to identify the different components of a collision tumor for proper management.
An infected pre-auricular sinus presenting as a post-auricular swelling is commonly misdiagnosed as an infected dermoid or sebaceous cyst. It may even mimic a mastoid abscess leading to further unwarranted investigations and interventions. We present a case of a 25-year-old Malay man who was initially diagnosed with recurrent infected dermoid cyst. At presentation, a right post-auricular inflamed swelling was noted with an overlying old incision and drainage scar. An auricular pit was found at the crus of helix. Using a blunt probe inserted along the sinus tract pus was drained without the need for further surgical incision. Six weeks after the acute episode, patient underwent excision of the pre-auricular sinus with no evidence of recurrence at three months follow up. Awareness by the attending physician of this ‘variant type’ of pre-auricular sinus at patient’s first presentation may negate the need for unnecessary incision and drainage which may subsequently impact the outcome of surgical excision and reduce the risk of recurrence.
Teratomas of anterior mediastinum are rare. They are often slow growing, asymptomatic, and detected incidentally on chest imaging. Mycobacterium abscessus (M. abscessus) is an acid-fast bacillus that is classified as a pathogenic "rapid growing" non-tuberculous mycobacteria. It is an uncommon cause of human pathology, which may cause skin and soft tissue infection after skin injury following inoculation, minor trauma, and surgery. Here, we present an unusual case of benign cystic teratoma mimicking recurrent pleural effusion, which was subsequently complicated by M. abscessus infection following thoracotomy. Cystic teratoma is rare, but it needs to be considered whenever clinical and investigative work-up fails to provide a convincing diagnosis. A combined clinical, radiological, surgical, and histopathological assessment is important to arrive at the correct diagnosis. Rapidly growing mycobacteria needs to be included in the differential diagnosis of patients with non-resolving infected post-thoracotomy wound and who do not respond to broad-spectrum antibiotics.
Teratomas are neoplasms characterised by an abnormal growth of tissues derived from the three germinal layers. The term 'teratoma' is derived from the Greek root 'teratos', meaning monster. Germ cells develop in the embryo and subsequently become the cells that make up the reproductive system. During fetal development, these cells follow a midline path and descend into the pelvis as ovarian cells or the scrotal sac as testicular cells. The presence of germ cells in extragonadal sites is because of the failure of these cells to migrate along the urogenital ridge. Therefore, teratomas occur in order of decreasing frequency in the ovaries, testes, anterior mediastinum, retroperitoneum, sacrococcygeal region and cranium.Liver teratomas are very rare; of the 25 hepatic teratomas described in the literature, only five have occurred in adults. The majority of the cases were in female children below the age of three, mostly arising in the right lobe of liver.We report a case of an adult male with benign mature teratoma arising in the left lobe of liver, compressing the common bile duct and causing obstructive jaundice.
Mature cystic teratoma is the commonest ovarian germ cell tumour which accounts for 70% of all benign ovarian neoplasms in the reproductive age groups. Being a pluripotent germ cell tumour, mature cystic teratoma has at least two out of three mature embryonic germ cell components: ectoderm, mesoderm and endoderm. The presence of multiple cystic spaces within the tumour wall, also known as pneumatosis cystoides-like appearance is rarely described but a characteristic feature in cystic teratoma of the ovary. Currently, there is little information concerning the mechanism of its formation. Herein, we described an unusual case of ovarian mature cystic teratoma in a 31-year-old pregnant female with multiple sieve-like areas resembling pneumatosis cystoides of the intestine. Macroscopic and histological examination of the ovary revealed features diagnostic of mature cystic teratoma. Intriguingly, multiple cystic spaces of variable sizes were found within the cyst wall histologically. They were lined partially or completely by foamy histiocytes and foreign body type multinucleated giant cells, exhibiting strong CD68 immunoreactivity. Vascular endothelial markers (CD31 and CD34) and epithelial marker (cytokeratin AE1/AE3) were negative. A diagnosis of mature cystic teratoma with pneumatosis cystoides-like feature was rendered. The patient was discharged well with no signs and symptoms of early labour. The etiopathogenesis of this intriguing histological feature is briefly discussed in this article.
Porto-spleno-mesenteric vein thrombosis is a rare, life-threatening condition of extrahepatic portal venous
system thrombosis. We report a rare case of a 49-year-old lady with late presentation of acute portal vein
thrombosis in a non-cirrhotic liver with an incidental finding of left adnexal teratoma. She presented with a
one-week history of severe abdominal pain associated with vomiting and diarrhea. She gave no history of prior
risk for venous thromboembolism or liver diseases. Physical examination revealed a tender mass extending from
suprapubic to left iliac fossa. Abdominal computed tomography scans showed a well-defined fat-containing left
adnexal mass, likely a benign teratoma, with no involvement of surrounding structures or calcification. There
was evidence of porto-splenic-mesenteric vein thrombosis with liver infarction, bowel and splenic ischemia.
Management of the extensive thrombosis causing multi-organ failure includes resuscitation, supportive care
and treatment of thrombosis. Treatment options include early anticoagulation and if feasible, thrombolysis.