Fetal Ovarian Dermoid Cyst

Shanti Shetty, Sanjeev Mani, Alpana Karnik, Veena Louzado, Nikhil CunhaBandra Holy Family Hospital

Mumbai

Antenatal ultrasound - Cystic structure in the left adnexal region

Lesion is separate from the urinary bladder

Lesion reveals anechoic fluid content with echogenic dependant debris

USG Findings

• A transabdominal ultrasound scan was performed for growth and measurements.

• Single viable IUP at 38w 3d.• Placenta location - anterior• Amniotic fluid - Normal• Presentation of fetus - cephalic• There is a relatively large ( 67 x 72 mm) cystic structure in

the left adnexal region, in close relation to the urinary bladder, free from the stomach and the urinary bladder. It reveals anechoic fluid content with echogenic debris that sediments towards the dependant part.

Differential diagnosis

• Fetal ovarian dermoid cyst• Twisted ovarian cyst

Discussion• Dermoid cysts are the most common ovarian neoplasms• They appear in the late 2nd/ 3rd trimester• Their sizes range from small to 40 cm• They are usually unilateral but upto 15% are bilateral• Dermoid cysts contain fatty, sebaceous material, hair, cartilage,

bone and teeth.• They demonstrate as a completely cystic mass, a cystic mass with

an echogenic mural nodule reperesenting a dermoid plug, high amplitude echoes shadowing or a complex mass with internal septation.

• The term ‘Tip of the iceberg’ refers to a mixture of matted hair and sebum producing a ill-defined acoustic shadowing that obscures the posterior wall of the lesion.

Management

• Continous ultrasound monitoring of antenatally detected ovarian dermoid cysts is recommended

• Induction of labour is considered if fetal lung maturity is established

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