Multiple dermoid cysts of omentum.
A Mazumdar, K Vaiphei, GR Verma
Department of Surgery and Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India., India
Department of Surgery and Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Dermoid cyst of the omentum is an extremely rare condition. We report a case of multiple dermoid cysts of omentum in a 50 years old woman. The aetiopathogenesis, clinical presentation and relevant literature is briefly reviewed.
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Mazumdar A, Vaiphei K, Verma G R. Multiple dermoid cysts of omentum. J Postgrad Med 1997;43:41-2
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Mazumdar A, Vaiphei K, Verma G R. Multiple dermoid cysts of omentum. J Postgrad Med [serial online] 1997 [cited 2021 Apr 10 ];43:41-2
Available from: https://www.jpgmonline.com/text.asp?1997/43/2/41/411
Omental cysts are seldom diagnosed prior to surgery, because of their rarity. Only few cases of omental dermoid cyst have been described in literature. We present a case in which two dermoid cysts were present in the greater omentum. The malignant potential of the cyst warrants awareness.
A 50 yr old female was admitted with a slowly growing abdominal mass and occassional pain for 20 years. There was no history of trauma to abdomen, bladder or bowel dysfunction or any gynaecological problem. On abdominal examination there was a mass of 12x12 cm size situated in the umbilical, right lumbar and right iliac fossa region. The mass was smooth, non tender, fluctuant, mobile in all directions and had well defined margins. It was not moving with respiration. There was no free fluid or other intraabdominal lump. Per-rectal and systemic examination were normal. Haematological, biochemical investigations and chest radiography were normal. Abdominal radiography showed soft tissue mass in the centre with areas of calcification in it. Ultrasound revealed a large cystic mass of homogenous echotexture with multiple calcific density contents. Computerised tomography showed a large cystic mass with areas of fat density and calcific foci within it [Figure:1]. At exploratory laparotomy two cysts were present in the omentum. The larger one measured 12x10 cm while the smaller one measured 4x2 cm. The larger cyst was adherent to the urinary bladder. Complete excision of both the cysts was done. Ovaries were normal. Cut section of the specimen showed earthy pultaceous material, tufts of hair, cartilage and bony spicules. Histopathology of the cyst wall showed epidermal lining with lamellated keratin in the lumen and a prominent granular layer. In addition the wall also showed osteoid fibro-collagenous tissue, bone formation and cystic spaces lined by pseudostratified columnar epithelium.
The first case of dermoid cyst of the omentum was described by Meckel in 1815. In 1928 Mumey et al had reported 15 cases. Till 1983 Kearney et al had reported another 12 cases. Although the exact etiology is not known but the proposed hypothesis is that the primitive germ cells get trapped in the omentum during the embryological development as they migrate from yolk sac to the urogenital ridge giving rise to omental dermoid cyst. An alternative mechanism is that the cyst actually originate in the ovary but later gets detached and implants in the omentum. Cyst may also arise from supernumerary ovary located in the omentum.
Dermoid cyst of omentum produce no pathognomic symptoms. The patient usually complaints of vague pain, abdominal swelling or symptoms produced due to pressure on adjacent structures. In most cases omental teratomas are composed of mature tissue element and behave in a clinically benign fashion. Short duration, rapid progress & presence of ascites may predict the malignant potential of the cyst. Roentgenogram and CT scans are helpful pre-operative investigations. But the final diagnosis is made oly after laparotomy and subsequent pathological examination. Treatment is entirely surgical and prognosis is good.
Walker AR, Putnam TC. Omental, mesenteric and retroperitoneal cyst. A clinical study of 33 new cases. Ann Surg 1973; 178:13-19.|
|2||Vanek VW, Phillips AK. Retroperitoneal, mesenteric and omental cyst. Arch Surg 1984; 119:838-842.|
|3||Kearney MS. Synchronus benign teratomas of the greater omentum and ovary. Case Report. Br J Obstet Gynaec 1983; 90:676-679.|
|4||Mummey N. Dermoid cyst of greater omentum. Am J Surg 1928; 5:56-60.|
|5||Printz JL, Choate SW, Townees PL. The embryology of supernumery ovaries. Obstet Gynaecol 1973; 41:246-252.