Dermoid cyst on the face of a child. Dermoid cyst of the brow ridge

Cysts are quite common in children. It may have different locations, sizes and contents. There are many types of cysts, with the dermoid cyst most commonly seen in children. Doctors often encounter a brain cyst in a child, a disease that frightens parents very much. Let's look at why a cyst occurs in a child's head, why it is dangerous, and what treatment methods exist.

Brain cyst

Brain cysts in children are being diagnosed more and more often. Experts say that nowadays about 40% of newborns are born with this pathology. It is a hollow formation that is filled with liquid. Such a cyst replaces a dead area of the brain. It is interesting that often a person lives his whole life without knowing about this pathology. For many, the tumor is discovered accidentally during a computed tomography or magnetic resonance imaging scan. At the same time, in some cases, in the absence timely treatment the cyst causes the development of a serious illness or even death.

Kinds

Depending on the cause of formation, the following types of brain cysts are distinguished:

Choroid plexus cysts. These formations are considered normal variants if they are formed during the period of intrauterine development of the child. In this case, they do not pose a danger to the baby’s health and disappear on their own. It is much worse if choroid plexus cysts appeared after birth, which is associated with illnesses the mother suffered during pregnancy. Most often, their development is provoked by the herpes virus.
Arachnoid cyst. It is a formation that occurs between the layers of the arachnoid (arachnoid) membranes of the brain and is filled cerebrospinal fluid. In most cases this type cysts are diagnosed in boys. A congenital arachnoid cyst in a child is formed as a result of a violation of intrauterine development. An acquired cyst may appear after infectious and inflammatory diseases.
Subependymal cyst. The reason for the formation of this cyst is said to be lack of blood circulation in the brain. Because of this, oxygen deficiency develops in the brain tissues, and they die, and in their place a cyst cavity is formed. This is enough serious pathology, which requires constant monitoring by a doctor.

Symptoms

Small formations usually do not manifest themselves in any way. Enlargement of a cyst located in the brain primarily leads to increased intracranial pressure.

In children of the first year of life, the growth of the cyst is accompanied by such manifestations as constant worry, lethargy, frequent regurgitation, poor coordination of movements, convulsions. Depending on the location of the formation, an increase in its size can lead to paralysis and seizures. As a result, there is a violation of the physical and mental development of the baby.

In older children, an enlarged cyst in the occipital region provokes disruption of the functioning of the optic nerve. Symptoms of this condition include double vision, flashes of light, fog or spots in the field of vision. When the cerebellum is compressed by a cyst, the child experiences dizziness, tinnitus, an unsteady gait, and often morning sickness and vomiting.

Diagnostics

Diagnosis of a cyst in a child of the first year of life, whose fontanel has not yet closed, can be done by ultrasound. For older children, computed tomography or magnetic resonance imaging is used.

Treatment

Treatment of cysts is necessary if they grow. If these formations do not increase in size or cause painful symptoms, experts only recommend constant monitoring by a doctor.

Therapy for this disease can be conservative or radical. Drug treatment involves the use of drugs that can eliminate the causes of cyst formation. These medications include drugs that resolve adhesions and restore blood supply. In the case of an infectious cause of cyst formation, the child is prescribed antiviral, antibacterial and immunomodulatory drugs.

Radical therapy is a surgical intervention that can be performed using endoscopy, cyst shunting and craniotomy.

Dermoid cyst

A dermoid cyst is a benign formation that contains particles of the dermis, epidermis, sebaceous glands, hair follicles and hair. Its size can vary from the size of a pea to walnut. In both adults and children, a dermoid cyst can be located in the temporal region, lower part of the neck, scalp, on the inner or outer edge of the orbit, floor of the mouth and in the sacral area. Sometimes it is diagnosed in the ovaries in girls and testicles in boys.

Dermoid cyst is congenital. It is formed due to improper fusion of various tissues during the period of intrauterine development of the fetus.

Symptoms

As a rule, dermoid cysts are characterized by an asymptomatic course. Only upon reaching big size they become visible. Most frequent complications Such formations may suppurate. And only in 8% of cases these cysts turn from benign to malignant.

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Various skin or subcutaneous nodules may be detected in the infant. These are cysts, most of which are benign and go away on their own. But some formations pose a danger to the child and must be differentiated as early as possible.

A cyst is a closed capsule or sac-like formation filled with liquid, semi-solid or gaseous contents. A cyst in infants occurs in tissues and can affect any part of the body. Cysts range in size from microscopic to large.

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Cyst in an infant: causes

Cyst infant may be caused by:

genetic conditions;
various types of infections;
malfunction in the organs of the developing embryo;
defects in cells;
chronic inflammatory conditions.

Types of childhood cysts

Benign cysts are caused by clogged air ducts and other natural body secretions. However, some cysts in children are tumors or form within tumors. They indicate potential danger and indicate cancer in children.

There are three most dangerous cysts:

Dermoid or epidermoid cyst.
Gill cleft cyst.
Keratocyst.

Dermoid and epidermodal cysts in infants

These are the types mainly benign formations, differ in localization:

A dermoid cyst in an infant is a congenital lesion of the lower layer of skin, which is usually distributed along the line of embryonic fusion of facial processes or in the neural axis.
An epidermoid cyst in an infant is formed in top layer skin and usually consists of epidermal tissue and debris.

Found in newborns or small children. It is predominantly localized near the face and scalp (near the fontanel, upper lateral forehead, lateral eyelid), as well as the chin area, although damage can occur anywhere on the scalp, face, spinal axis, or bone.

Dermoid and epidermoid cysts, which degenerate into cancer, can penetrate under the skin or deep into the bone.

Causes:

These cysts develop during pregnancy. They form when skin cells or elements such as hair follicles, sweat or sebaceous glands, penetrate the skin.

Dermoid and epidermoid cysts are almost always present at birth but may go unnoticed until injury occurs.

Symptoms:

Signs vary depending on location:

Scalp cysts are usually painless, mobile, and slowly increase in size. Skin around the cyst normal color. Complications include infection and inflammation.
In an infant, a cyst in the bone is a little harder and less mobile. A cyst in the cranial cavity can penetrate the brain.

Diagnostics :

Most lesions of the scalp, as well as, can be diagnosed on medical examination, sometimes with the help of visualization tools.

Injuries involving the skull usually require the use of X-rays, or less commonly computed resonance imaging or magnetic resonance imaging, to ensure there is no penetration of the brain.

Treatment :

Due to the possibility of penetration into the skull, it is recommended surgical removal. The operation is a simple one. Most children can return home the next day and resume daily activities, including bathing (after 2-3 days).

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Gill cleft cyst in infants

Gill cleft anomaly is formed in children from tissues inside the neck. Cysts are usually located near the anterior edge of the sternocleidomastoid muscle, which is a muscle in the neck that extends near the mastoid (jaw) bone across the collarbone and sternum.

These types of disorders and childhood oncology are often related to each other, since they form malignant formations. However, such diseases respond well to treatment and have a favorable prognosis.

Causes :

Gill cleft anomaly develops during embryonic development, when the structures and tissues that form the neck and throat grow abnormally. They form pockets containing foreign cells. The gill cleft cyst is lined with skin and lymph cells containing fluid that is secreted from them.

Symptoms:

Gill cleft disorders are not very noticeable and each child experiences them differently. But common symptoms include:

a small induration mainly on one side of the neck at the anterior edge of the sternocleidomastoid muscle;
a small hole in the skin through which mucus or other fluid leaks near the anterior edge of the sternocleidomastoid muscle.

Diagnostics :

A branchial cleft cyst in an infant is diagnosed by physical examination. However, cancers are detected using the following procedures:

computed tomography uses a combination of x-rays and computer technology to produce a horizontal, or axial, image;
biopsy is a procedure for taking tissue samples for examination under a microscope.

Treatment :

Determined based on the level of deviation and clarification of the following features:

child's age, general condition health and medical history;
degree of violations;
expectations from therapy.

Treatment may include surgery for mass removal, as well as complex application antibiotics.

Keratocyst

This cyst in a baby A rare, mostly benign tumor, but capable of developing an aggressive form of cystic tumor, which often affects the lower jaw.

It is mostly asymptomatic, but swelling of the jaw is sometimes observed.

The final diagnosis is made based on histological analysis performed under a microscope.

Treatment :

wide or local surgical excision;
removal of the cyst along with its capsule;
performing curettage (tissue scraping);
peripheral ostectomy (removal of part of the bone tissue) after curettage and/or enucleation.

A dermoid cyst or dermoid is a cyst-shaped tumor with a wall of connective tissue. On the outside this formation is smooth, and on the inside it is rough, and the inner layer is similar in structure to skin and includes the cuticle, stratified epithelium, it contains hair, sebaceous and sweat glands, as well as fatty inclusions.

Most often, dermoids are located on the upper or inner edge of the orbit, temporal region, scalp, lower neck, floor of the mouth and manubrium of the sternum.

Symptoms of a dermoid cyst

Externally, dermoid cysts are dense, round formations with clear boundaries, they are painless and not fused to the skin, and their sizes range from half to four centimeters in diameter. This formation tends to increase. When the dermoid is localized on the bone part, a flat fossa with a protruding edge is formed.

Dermoid must be correctly distinguished from atheroma; you should know that atheroma is a softer formation that is always fused to the skin. In addition, during examination, the doctor always differentiates dermoid from lipoma, hygroma, fibroma, lymphadenitis and midline cyst neck.

Most dangerous complication A dermoid cyst may become suppurated, and the cyst must be opened and drained.

Treatment of dermoid cyst

There are no other treatment methods, only surgical intervention is used. In this case, the membrane of the dermoid cyst should be completely removed. If in young children this operation is performed under anesthesia, then after seven years it occurs under local anesthesia.

Often used method of operation through a small puncture , while the operation time does not exceed a quarter of an hour, and there are no traces, scars or stitches left after the operation. Thanks to the use of modern technology and the use of cosmetic sutures, the child can go home in a couple of hours and completely forget about the operation in two or three days.

Cysts are very often located in the retrorectal space, which makes their diagnosis and identification difficult. As the rectum grows and becomes compressed, signs of this disease begin to appear. A sluggishly progressive difficulty in defecation begins to be noted, which then manifests itself in the release of feces in the form of a ribbon. However, this condition does not cause unnecessary suffering to the child; no pain is observed. Pain still occurs. In this case, the cyst can independently open outward or into the intestinal lumen, which leads to persistent internal or external fistulas, and they are not easy to distinguish from chronic paraproctitis.

Tumor diagnosis

In simple cases, diagnosis is not particularly difficult. Usually a finger is enough rectal examination, allowing to identify a swelling of greater or lesser hardness between the coccyx and the rectum, as well as a decrease in the lumen of the latter. TO indirect sign The presacral dermoid includes skin punctate funnels above the coccyx in the intergluteal fold.

Dermoid cysts of the peri-rectal tissue should be removed routinely, and complicated cysts can be operated on only after the acute inflammation has been eliminated.

In this case, intubation anesthesia is performed, while the child is on the operating table - with his legs down on his stomach. An incision is made in the skin and tissue along the edge of the sacrum, and the coccygeal-anal ligament is intersected at the tip of the coccyx. Ligating the branches of the middle sacral artery approaches the cyst, after which the actual removal begins. To prevent intestinal injury through anus introduce forefinger and with its help the cyst is separated. Then, under visual control, separate back wall cysts from the anterior surface of the sacrum. Next comes the back and side walls, and finally the cyst is completely removed.

A dermoid cyst in a child, as well as in an adult, is a benign organoid tumor formation. Dermoids, or as they are also called, mature teratomas, are diagnosed in 10-11% of children with soft tissue neoplasms.

The cyst is a dense capsule of connective tissue filled with embryonic elements - parts of the endoderm, exoderm and mesoderm. A dermoid cyst may contain particles of sweat and sebaceous glands, bone and hair inclusions, and skin flakes.

Surgeons have identified the following statistical pattern, which is characteristic of the contents of dermoid cysts in children:

Ectoderm – 100% dermoids.
Mesodermal elements – 90% of cysts.
Endoderm – 70% dermoids.

Dermoid formations in children are localized where the embryonic cavities, the so-called “gill” slits, should connect:

head (eyes, bridge of the nose, oral cavity, nasolabial folds, ears, back of the head, neck),
sternoclavicular joints,
sacrum,
testicles,
testicles,
mediastinum,
brain (rare).

A dermoid cyst in a child, as a rule, rarely develops to a large size, since it is detected in the first year of life. The tumor is considered benign; inflammation or suppuration occurs in rare cases.

Causes of dermoid cyst in a child

The etiology of the formation of dermoid tumors has not yet been clarified. Among medical specialists studying the nature of the cause of a dermoid cyst in a child, there are also other versions; today there are more than 15 of them.

The most popular theory is “displaced blastomeres”, according to which the germ cells, having separated, remain immobile and do not divide until the onset of an unfavorable moment, a provoking factor. Due to the fact that the displaced blastomeres have no connection with the body, they begin to encapsulate and form a dense pseudocyst. Indeed, dermoids are not cysts in the classical sense of this formation, since their contents are more similar to a tumor - there is no fluid in the cavity. The dermoid contains parts of all three germ layers; the earlier the blastomeres are separated, the more variants of elements in the contents of the cyst. Thus, it is believed that the causes of the formation of a dermoid tumor are associated with disruption of intrauterine development at the earliest stage - embryogenesis. Impaired differentiation of embryonic cells, separation of elements of the three germ layers into atypical zones is one of the most obvious, studied reasons for the appearance of dermoids.

Embryonic cell tumors are not common and are detected either before the age of 2-3 years, or in puberty when rapid hormonal changes occur in the child’s body.

There is also a theory about a genetic, hereditary factor, moreover, on the maternal side. According to this version, pathological parthenogenesis (self-activation) is the cause of the formation of dermoid tumors. This theory is also called the “zygote” theory. For a zygote (new stem cell), a diploid chromosome set and the same number of chromatids (23 each) from the father and mother are needed. In addition, maternal and paternal genes must undergo genomic imprinting, that is, some of them must leave their “trace.” When this stage is skipped and the process is disrupted, the mother's chromosomes predominate, and in a pathological sense. In the laboratory, with the help of molecular innovations, a “maternal” factor was identified in the formation of dermoid tumors, which, according to statistics, are most often diagnosed in girls.

The causes of dermoid cysts in children, as well as dermoids in adults, continue to be studied; difficulties in combining versions and determining one etiological basis are associated with a positive factor - dermoids are quite rare.

Dermoid cyst in a newborn

Dermoids in newborn babies are a consequence of disrupted embryogenesis, when all three germ layers separate their cells into an uncharacteristic, atypical zone for them (fusion of “sacral” embryonic cavities).

Dermoid cyst in a newborn (teratoma neonatus, cysta dermoidea) is detected in 22-24.5% of all cases of diagnosed tumors and is most often localized in the following percentage:

Sacrococcygeal teratoma – 37-38%
Newborn girls, ovaries – 30-31%
Head – 10-12%
Mediastinal area – 4-5%
Retroperitoneal localization – 9-10%
Other zones – 3-4%

Mostly, dermoids form in girls, 4 times more often than in boys.

Since a dermoid cyst in a newborn most often forms in the area of the sacrum, between the anus and the coccyx, during childbirth a traumatic hemangioma may develop at the site of the neoplasm. Also, one of the complications is that coccygeal dermoid is predominantly detected in girls, and the tumor can fill the pelvic area, but without damage or disruption of bone tissue. It should be noted that 90% of such teratomas are determined in utero, when the pregnant woman undergoes ultrasound examination between 22-1 and 34-1 weeks. An ultrasound or MRI shows an overly enlarged uterus, and a homogeneous mass is visible in the fetal sacrum. For large fetal cysts, obstetrics by cesarean section is indicated to avoid possible complications such as cyst rupture.

Features that a dermoid cyst has in a newborn, depending on the location:

Testicular dermoid in newborn boys is almost 100% benign, in contrast to mature ovarian teratomas in girls. It should also be noted that such formation is very rare, and is most likely associated with a hereditary factor. The cyst contains sebaceous, fatty and epidermal components; cartilage and bone elements have not yet been encountered in surgical practice. A dermoid cyst is detected almost from the first week after birth, less often it is detected before the age of one and a half years. Usually the dermoid develops and grows very slowly, it is observed and operated on as early as possible, upon reaching 2-3 years of age. Organ-saving surgery is performed, the outcome and prognosis are 100% good.
Dermoid formations of the retroperitoneal space are also detected before the age of one year. Most often, such teratomas are formed in girls, the tumor can be quite large - up to 4-5 centimeters, it compresses nearby organs, the child reacts accordingly - he constantly cries, his stomach is tense. Dermoid is easily identified by palpation and then by ultrasound. Surgery is indicated only in the case of large tumors; small cysts are subject to observation.
Oral dermoid or pharynx teratoma (polyp) is a benign formation that is visible immediately from the first week of birth. Such a dermoid is localized in the upper dome of the pharynx and consists of a capsule with various contents (rudimentary particles, elements of embryonic tissue). The cyst can be located in the jaw area, in the epignatus area - the pharynx. Small oral dermoids are operated on when the child reaches the age of three; larger cysts can be removed earlier, since the risk of complications is much higher than the risks associated with surgery.
Cerebral dermoids are very rare in newborns and are usually diagnosed at a later age. This is due to the fact that dermoid cysts usually grow slowly and their development is asymptomatic. Indications for examination for cystic formation can be congenital pathologies newborn, endocrine disorders, other abnormalities identified during the prenatal period.
Dermoid ovarian cysts in girls are also diagnosed at a later age. In newborns, this disease occurs without clinical manifestations. Possible signs may include an atypically enlarged abdomen and the baby crying. In such cases, the child is examined for diseases of the digestive and pelvic organs.
The sacrococcygeal dermoid is determined in utero and is clearly visible immediately after birth. Clinical symptoms directly depend on the location of the cyst - external or internal. External cyst, as a rule, larger in size, it can even interfere with the birth process. The tumor, located in the middle between the buttocks, is most often fused to the coccyx; with an external-internal cyst, pressure appears on the rectum and defecation and urination are impaired - urinary and fecal incontinence. Coccygeal dermoid can only be treated surgically, and as early as possible due to the relatively high risk inflammation, suppuration and malignancy (development into malignant tumor). If not strict contraindications, the operation is performed from 2 months of age.

It should be noted that a dermoid cyst in a newborn is a very rare phenomenon, since benign tumors of the sacrum occur in only a ratio of 1 to 26-27,000 births. Dermoid formations are considered benign tumors and have a fairly favorable prognosis if they are removed in a timely manner.

Symptoms of a dermoid cyst in a child

Like other benign tumors, dermoid formations most often long time do not appear clinical signs. Symptoms of a dermoid cyst in a child are either detected in the newborn period, when they are visually noticeable, or are determined by enlargement, inflammation, suppuration, and pressure on nearby organs. The clinical picture of dermoids is related to the location, size of the cyst, as well as the age of the child. Most often, dermoid tumors are located in the head (eyes, bridge of the nose, ears, eyebrows, mouth, neck, back of the head), collarbone, coccyx, and less often in the mediastinum, retroperitoneum. Dermoid can also be localized in the ovaries or testicles.

Symptoms of a dermoid cyst in a child may be as follows:

In children of the first year of life, there are dense, elastic formations in one of the above places.
The tumor has a round shape.
The dermoid cyst is dense and elastic to the touch.
The cyst does not have a tight connection with the skin and is not fused to it.
On palpation, the dermoid does not cause painful sensations.
The skin over the cyst is not hyperemic, of a normal color, without ulcerations, rashes, and so on.
If the dermoid is located on the head (skull), it may appear slightly pressed inward.
Dermoid formation may not enlarge for a long time, stay in size.
The coccyx dermoid, in addition to being visible, can cause problems with urination and defecation (stool takes on the appearance of a ribbon).
Dermoid of the eye (eyeball, eyelid) can interfere with clarity of vision.

A dermoid ovarian cyst in a girl can manifest itself abdominal pain if the tumor grows to a large size. In addition, the picture " acute abdomen» causes torsion of the cyst pedicle

Clinical symptoms of a dermoid tumor in a child usually appear only in the case of enlargement of the cyst, its inflammation, and suppuration. Small benign dermoids do not change the health status of children for the worse and do not provoke functional disorders internal organs. Rather, simple dermoids are a cosmetic, visible defect that bothers both the child and his parents. Any identified dermoid formation should be removed, despite the almost complete benignity of the tumor, there is a 1-2% risk of malignancy, that is, the dermoid developing into a malignant tumor.

Diagnosis of dermoid cyst in a child

Dermoids are diagnosed without difficulty because of their typical localization and because all germinal formations of this type are characterized by consistency upon palpation. The only difficulty may be precise definition tumor formation in the area of the eyebrow and bridge of the nose, since anterior cerebral hernias are very similar both visually and in palpation sensations to dermoids. The difference between the brain formations is pain when pressing and some bone defects of the skull revealed on x-ray. Lipomas are also very similar to dermoid cysts, but they are somewhat softer, more mobile and do not have such clear boundaries. Atheroma, which can be localized in the same areas as the dermoid cyst, moves during palpation, is mobile, and is fused to the skin.

The main stages involved in diagnosing a dermoid cyst in a child:

Collection of anamnestic information.
Are common clinical researches(examination, palpation).
Specification of the cyst location area.
Clarification of the connection between the tumor and nearby organs (are there any symptoms - indigestion, vision, headaches, etc.).

Differentiation of dermoid from other neoplasms:

the bridge of the nose – with a herniated brain, which is characterized by asymmetry of the eyes and pulsation.
neck - with middle and lateral congenital cysts, which are displaced during swallowing.

Instrumental methods of examination are possible - percutaneous puncture.
X-ray.
According to indications - computed tomography.
Angiography according to indications.
Ultrasound, which makes it possible to find out whether the dermoid is connected to adjacent organs.

It should be noted that timely diagnosis of a dermoid cyst in a child allows not only to stop the process of its growth, but also to eliminate all possible risks and complications - inflammation, including purulent, as well as the potential danger of developing into a malignant tumor.

Treatment of dermoid cyst in a child

The treatment of almost all benign tumors is surgery. Small dermoid cysts are subject to observation, then the tumor is removed as soon as possible and in the absence of contraindications. Not drug therapy, neither physiotherapeutic procedures nor the so-called traditional methods are not effective. Treatment of a dermoid cyst in a child should only be carried out surgically, no matter how the parents resist it. Radical neutralization of the dermoid is necessary to avoid all sorts of risks, despite the fact that a mature teratoma, also called a dermoid cyst, is almost 99% benign, there is a 1-1.5% risk of it developing into cancer. In addition, the very content of the cyst does not allow it to be treated in any other way. In the cystic capsule there is no liquid or elements that can be absorbed; there are particles of the epidermis, hair bones, fats and even elements of teeth; all this just needs to be cut out.

In children, the operation is performed starting from six months of age; if there are indications, removal can be performed at the age of one month, for example, with a dermoid cyst of the coccyx.

Treatment of a dermoid cyst in a child may also involve long-term observation, in cases where the tumor is small in size, does not cause functional impairment, has stopped developing and is not a visible cosmetic defect. However, almost all doctors recommend removing the dermoid as early as possible, since during puberty as a result hormonal changes the cyst can either enlarge or become inflamed and cause serious complications. Parents of the child need to remember that dermoid is a benign tumor, but any tumor has a risk of malignancy.

Removal of a dermoid cyst in a child

Dermoid removal surgery can be performed different ways, it all depends on the following factors:

Child's age.
Hereditary factor.
Localization of the cyst.
Education size.
The condition of the dermoid is inflamed, purulent, uncomplicated.
The presence or absence of contraindications.
Assessment of the risk ratio between surgery and possible complications in the development of dermoid left under simple observation.

Removal of a dermoid cyst in a child can be carried out both in a hospital and in outpatient setting. The point of surgery is that the cyst is excised within the boundaries of healthy tissue. General (intubation) anesthesia is indicated for children under 6-7 years of age; for an older child, the cyst can be removed under local anesthesia. If the dermoid is small and its localization allows, then a gentle operation is performed with a small puncture or incision, through which the cyst is enucleated and removed along with the capsule. Next are superimposed cosmetic stitches, and the child is transferred to the ward.

If the dermoid formation is inflamed, suppurates, accompanied by clinical picture"acute abdomen", and this can be with ovarian dermoid in girls or a retroperitoneal cyst, the operation is performed in urgently. The purulent cyst is opened, excised, then drainage is placed. The healing of surgical incisions in such cases takes longer, but after a week the child may be discharged.

Relapses are very rare and are associated with insufficient quality, incomplete removal of the capsule

Removing a dermoid cyst in a child is not a complex, life-threatening or complication-causing operation. Parents' fears are more likely explained by concern for their baby and concerns about possible risks. The danger in such pathologies can be considered delay, refusal to surgically remove the tumor, since the tumor has a potential risk of enlarging in adolescence, disrupting the functions of internal organs, or developing into a malignant process.

Dermoid cyst, dermoid (dermoid) is a benign formation, from the group of choristomas (teratomas). A cavitary cyst is formed as a result of displacement of undifferentiated elements of the germ layers under the skin and includes parts of the ectoderm, hair follicles, pigment cells, and sebaceous glands.

Dermoids, mature teratomas are formed when embryonic development (embryogenesis) is disrupted and are formed along the lines of developing parts of the fetal body, embryonic joints, folds, where there are all the conditions for separation and accumulation of germ layers.

Most often, a dermoid cyst is localized on the skin of the head, in the eye socket, in the oral cavity, on the neck, in the ovaries, in the retroperitoneal and pelvic zone, in the perirectal tissue; less often, the dermoid is formed in the kidneys and liver, in the brain. Dermoid teratoma is usually small in size, but can reach 10-15 centimeters or more, has a round shape, most often one chamber, which contains parts of undeveloped hair follicles, sebaceous glands, skin, bone tissue, and crystallized cholesterol. The cyst develops very slowly, is not expressed by specific symptoms, and has a benign, favorable course. However, a large dermoid can disrupt the functions of nearby organs due to pressure on them; in addition, up to 8% of diagnosed dermoid cysts become malignant, that is, they develop into epithelioma - squamous cell carcinoma.

Causes of dermoid cyst

The etiology and causes of dermoid cysts are still being studied, and doctors are generally guided by several hypotheses. It is believed that dermoids are formed as a result of a violation of embryogenesis, when some elements of all three folia embryonal - germ layers are preserved in the ovarian stroma. The neoplasm develops at any age; the causes of the dermoid cyst that provoke its growth have not yet been established. However, clinically confirmed versions of traumatic, hormonal factors, that is, a dermoid can develop as a result of a blow, damage to the peritoneum, or during a period of hormonal changes - puberty, menopause. The hereditary factor is not yet considered statistically confirmed, although geneticists continue to study the phenomenon of failure in embryonic development, and its connection with the formation of cysts.

The history of studying the etiology and pathogenesis of dermoid formations began in the 19th century with veterinary medicine, when famous doctor, using animals, Leblen took up the study of filled hair follicles cyst found in the horse's brain. Subsequently, the description of dermoid cysts became widespread in “human” medicine; doctors began to seriously study benign neoplasms consisting of residual elements of amniotic constrictions. According to current data, dermoid cysts occupy about 15% of all cystic formations and are etiologically explained by the generally accepted theory of impaired embryogenesis in three variants.

The following are common causes of dermoid cysts:

Separation of cells of the germ layers and their accumulation in zones of tissue separation at the embryonic stage (2-8 weeks).
Separation of the blastomere at the very early stage - during egg division; subsequently, elements of three germ layers are formed from the separated blastomere.
Bigerminal version is a violation of the initial stages of division of the zygote (fertilized egg) or pathology of the development of the twin embryo.

Pregnancy and dermoid cyst

As a rule, the first pregnancy and the dermoid cyst are detected simultaneously, that is, the dermoid can be detected during an ultrasound scan of a pregnant woman. If the mature teratoma is small, its size does not exceed 10 centimeters, the neoplasm is subject to observation, surgery, including laparoscopy, is not performed. A dermoid cyst, which does not disrupt the functions of nearby organs and does not grow during pregnancy, is removed after childbirth or during a cesarean section. sections.

It is believed that pregnancy and a dermoid cyst go well together; according to statistics, among the total number of benign formations on the ovaries, dermoids occupy up to 45% and only 20% of them are removed during the gestation period.

A dermoid cyst most often does not affect the fetus and the pregnancy process itself, however, hormonal changes and displacement of organs can provoke its growth and cause complications - torsion, strangulation, rupture of the cyst. They try to remove a complicated dermoid cyst laparoscopically, but not earlier than 16 weeks. A special case is the large size of the cyst, its torsion or strangulation, as a result of which necrosis develops and the clinic of “acute abdomen”, such a neoplasm is removed urgently.

You should also debunk the myth, which is very popular among pregnant women, that a dermoid cyst does not resolve in principle - under any circumstances. Neither pregnancy, nor folk or medications are not able to neutralize the dermoid, so if the cyst did not interfere with bearing a child, it will still have to be removed after childbirth.

Most often, when removing dermoids, a gentle, minimally invasive method is used - laparoscopy; the transvaginal method is used less frequently.

Symptoms of a dermoid cyst

As a rule, small dermoid does not manifest clinically; this is due to its slow development and localization. Basically, the symptoms of a dermoid cyst begin to be noticeable when the formation grows more than 5-10 centimeters, suppurates, becomes inflamed or provokes pressure on neighboring organs, and less often manifests itself in the form of a cosmetic defect. Most often, the symptoms of a dermoid cyst are visible if the tumor is localized on the scalp; it is difficult to miss, especially in children. In other cases, dermoid is diagnosed during a random or routine examination or during exacerbation, suppuration, or torsion of the cyst.

Ovarian dermoid cyst. A neoplasm larger than 10-15 centimeters moves or causes pressure on nearby organs, manifesting itself as constant pulling, aching pain in the lower abdomen. The abdominal cavity is tense, the abdomen is enlarged, the digestion process is disrupted, and urination becomes more frequent. An inflamed, purulent cyst can cause an increase in body temperature, severe pain in the abdomen, torsion or rupture of the cyst is clinically manifested by symptoms of an “acute abdomen.”
Pararectal dermoid initial stage development does not manifest itself with specific signs. Symptoms of a dermoid cyst are more noticeable if the cyst begins to put pressure on the lumen of the rectum, causing difficulty and pain during bowel movements. Characteristic sign- ribbon-shaped feces.
A mediastinal dermoid cyst develops asymptomatically and can be detected on x-ray during a routine or random examination. The clinic is noticeable only when the neoplasm puts pressure on the pericardium, trachea, lungs, or provokes a percutaneous fistula. Persistent shortness of breath, dry cough, cyanosis of the skin, transient tachycardia appear, with large sizes tumors - a bulging cyst on the anterior wall of the chest.

What does a dermoid cyst look like?

It is easiest to describe the external formation, although internal cysts are not much different from external ones - in terms of the consistency of the contents, its composition and the density of the capsule, they are almost identical to each other.

A classic dermoid is a cavity surrounded by a dense capsule, ranging in size from a small pea to 15-20 centimeters. As a rule, a dermoid formation consists of one chamber (cavity) filled with dense or soft contents from keratinized parts, sweat glands, hair follicles, sebaceous elements, particles of epidermis, bone. Dermoid cysts grow very slowly, but their growth can only be stopped by surgery; the cyst never resolves or decreases in size. Over the past ten years, cases of malignancy of dermoids have become more frequent, especially if they are localized in the pelvic organs or in the peritoneum.

What does a dermoid cyst look like? It depends on its location:

Head area:
- Bridge of the nose.
- Eyelids.
- Lips ( soft fabrics mouth).
- Neck (under the lower jaw).
- Nasolabial folds.
- Back of the head.
- Fiber of the eye, periorbital region.
- Nasopharynx (in the form of dermoid polyps).
- Rarely – temple area.
Other body parts, internal organs:
- Stomach.
- Buttocks.
- Ovaries.
- Anterior mediastinum.

A dermoid formation can form on bone tissue, then it looks like a small concave pit with clear edges. Also, dermoids are very similar to atheromas, but unlike them they are denser and not fused to the skin, they are more mobile and have clear boundaries.

Ovarian dermoid cyst

Ovarian dermoid cyst is considered a benign neoplasm, which can become malignant only in 1.5-2% of all diagnosed cases. A mature teratoma, forming in the ovarian tissues, looks like a dense capsule with contents of embryonic elements - adipose, sebaceous tissue, particles of hair, bone, keratinized inclusions. The consistency of the capsule is quite dense, surrounded by a jelly-like liquid, the size of the cyst can be from several centimeters to 15-20 cm. The etiology of dermoid cysts is unclear, but is most likely associated with pathological embryogenesis at the stage of organ formation in the embryo. In addition, a mature teratoma develops and increases to a formation visible on ultrasound during the period of hormonal changes - in puberty or during menopause. Ovarian dermoid cyst is diagnosed during routine examinations, registration for pregnancy; according to statistics, it accounts for 20% of all cysts and up to 45% of all benign tumors female body. The course of the disease is the same as the prognosis - favorable, the cyst can only be treated operationally.

Dermoid cyst of the brow ridge

Mature teratoma of the eyebrow is a congenital neoplasm of connective tissue that is diagnosed at an early age. Dermoid cyst brow ridge deforms the soft tissues of the face, localizing in the bridge of the nose, above the eyebrows, in the middle of the forehead closer to the nose, on the back of the nose.

The clinic of dermoid of the maxillofacial zone is always non-specific in sensations, but visually clear from observations. Dermoid cyst of the brow ridge is one of the most easily diagnosed neoplasms because it has typical location, is defined as external facial deformation on early stages usually in infancy. Often the dermoid can be very small and undeveloped, and begins to develop rapidly during puberty, this is especially true for boys. The cyst is mobile to the touch, not fused to the skin, sweaty, clearly defined and practically painless on palpation. Pain can occur as a signal of inflammation, suppuration of the cyst, in such cases the surrounding skin is also inflamed, and the body reacts to infection general symptoms– from elevated temperature body to the point of nausea, dizziness and weakness.

A dermoid cyst must be removed surgically; if this is not done in a timely manner, the dermoid can deform the bone tissue of the bridge of the nose, and form not only cosmetic defect, but also internal pathological changes in the brain, nasopharynx.

Dermoid cyst of the eye

Dermoid or choristoma of the eye is benign neoplasm, most often of congenital etiology. The dermoid cyst of the eye is localized in the upper part of the orbit - in the superolateral section, and manifests itself as a tumor different sizes in the zone upper eyelid. Much less often, dermoid is located in the middle of the corners of the eyes; they are practically not found on the lower eyelid. It is no coincidence that the dermoid cyst of the eye is called epibulbar, since in 90% it is localized above the eyeball (epibulbaris) - in the cornea, sclera, and on the apple, extremely rarely - on the cornea.

A benign dermoid of the eye has a round shape, looks like a dense, rather mobile capsule, not fused to the skin, the stalk of the cyst is directed towards the bone tissues of the orbit. The formation develops asymptomatically in the sense of discomfort, it is painless, however, increasing in size, it can provoke pathological anomaly– microphthalmia or reduction in eye size, abmlyopia – various visual impairments in normal eye, not corrected by glasses (“lazy” eye).

A dermoid cyst of the eye is formed in the initial stage of embryogenesis, in the period up to the 7th week; the neoplasm is an accumulation of tissue primordia in the form of a capsule with cystic contents of dermal and hair particles. This hair is often visible on the surface of the cyst and interferes not only with vision, but is also a rather unpleasant cosmetic defect.

As a rule, dermoid choristomas of the eye are diagnosed at an early age due to their visual clarity; the only slight difficulty is the differentiation of dermoid and atheroma, brain herniation. Dermoid is characterized by its asymptomatic nature and is never accompanied by dizziness, nausea and other brain symptoms. In addition, x-rays reveal a dermoid “root” in the bone tissue with clear edges.

Treatment of dermoid cysts of the eye is most often surgical, especially for epibulbar types of cysts; the prognosis is favorable in 85-90% of cases, however, surgical intervention can slightly reduce visual acuity, which is subsequently corrected with the help of complementary therapy, contact lenses or glasses.

Dermoid cyst of the conjunctiva

A dermoid cyst of the conjunctiva is a lipodermoid, so named because, unlike a typical cyst, it does not have a capsule and consists of lipid, adipose tissue covered in stroma. In fact, this is a conjunctival lipoma of congenital little-studied etiology, closely associated with pathology, atrophy of the levator muscle upper eyelid(levator), as well as with a change in the location of the lacrimal gland. Most likely this is explained by an intrauterine irritating factor affecting the embryo.

Conjunctival dermoid cyst is considered a benign choristoma and accounts for 20-22% of all diagnosed eye tumors. Most often, lipodermoid is detected in children at an early age due to its obvious localization and combination with other eye anomalies. During a pathogenetic study or biopsy, fatty elements, particles of sweat glands, and, less often, hair follicles are usually found in the dermoid. Due to the fact that the contents and the formation itself have a lipophilic structure, the dermoid cyst tends to grow into the cornea to its deepest layers. A dermoid cyst of the conjunctiva looks like a mobile, fairly dense tumor under the upper eyelid on the outside of the palpebral fissure. The size of the dermoid can vary, from millimeter parameters to several centimeters, when the formation closes the eye and the lacrimal gland.

Dermoid develops very slowly, but progresses steadily, occasionally penetrating even beyond the orbit of the eyeball up to the temple area. With palpation and pressure, a large dermoid easily moves deeper into the orbital area.

As a rule, a biopsy is not required to clarify the diagnosis, and conjunctival dermoid is treated only by surgery. At the same time, doctors try to minimize the risk of damage to the connective membrane in order to avoid eversion or shortening of the eyelid.

Dermoid cyst on the eyelid

Most often, a dermoid cyst on the eyelid is localized outside or inside the upper skin fold and looks like a round formation of dense consistency ranging in size from a small pea to 2-3 centimeters in diameter. As a rule, the skin of the eyelid is not inflamed; the eyelid itself can maintain normal mobility if the dermoid is small and grows slowly. Cysts on the eyelids are rarely bilateral; the dermoid is located in the lateral, less often in the medial part of the eyelid and is well palpated in the form of a tumor limited by a capsule, elastic, painless, and quite mobile.

Diagnosing a dermoid cyst of the eyelid is quite simple, since it is visible to the naked eye; a biopsy is extremely rarely prescribed for clinical symptoms similar to those of a cerebral hernia. If the formation is not reduced when palpated, does not go deeper, there is no dizziness, nausea or headache, and radiography of the cyst shows its clear contours, then the dermoid can be considered defined and subject to surgical treatment.

Typically, the cyst is detected at an early age before 2 years and is subject to regular monitoring, since it develops extremely slowly and the indications for immediate surgery are not urgent. If there is no sharp increase, limited eyelid mobility, 2-4th degree ptosis, no pressure on the eyeball or optic nerve, dermoid cyst on the eyelid is operated on at a later age, starting from 5-6 years, the intervention is carried out under general anesthesia in a hospital setting. The course of dermoid development is benign in 95% of cases; the cyst stops growing as soon as eye growth ends and, in fact, it is only cosmetic defect. However, there is a small risk of malignancy and the possibility of tumor progression (no more than 2%), so almost all ophthalmologists recommend removal of the dermoid at the first opportunity.

Dermoid cyst of the orbit

An orbital cyst, which is diagnosed as dermoid, can develop over decades and begins to rapidly increase during hormonal storms - during puberty, during pregnancy and menopause. However, most often a dermoid cyst of the orbit is detected before the age of 5 years and accounts for up to 4.5-5% of all eye tumors.

The tumor is formed from undifferentiated epithelial cells, which accumulate near the junction of bone tissues, the cyst is localized under the periosteum. The formation is round in shape, often yellowish in color due to secreted cholesterol crystals from the inner wall of the capsule. Lipid elements, particles of hair, and sebaceous glands may be found inside. Most often, the dermoid is located in the upper quadrant inside the orbit of the eye, without causing displacement of the eyeball (exophthalmos); if the cyst is localized outside, then it causes exophthalmos of the eye downwards and inwards.

A dermoid cyst of the orbit develops asymptomatically; complaints may only concern swelling of the upper eyelid and some discomfort when blinking. Also, the formation can be located deep in the orbit; such a cyst is diagnosed as a Kronlein's pouch-shaped cyst or a retrobulbar dermoid cyst. With this localization, the tumor provokes exophthalmos, the apple is displaced to the side opposite to the location of the cyst. In such situations, the patient may complain of a feeling of fullness in the orbit, pain and dizziness.

Diagnosis of orbital dermoid is not difficult; it is immediately differentiated from a cerebral hernia or atheroma, in which the tumor visually increases with inspiration, bending, and other physical efforts. In addition, atheromas and hernias are characterized by slower pulsation when pressed, since the cyst cavity is penetrated by vessels, which is not the case in a dermoid with dense contents. A clarifying and confirming diagnostic method is computed tomography, which visualizes the location, shape and clear contours of the cyst.

Orbital dermoid is treated with surgery, which is performed according to indications in case of rapid progression of the tumor, danger of its suppuration, or in connection with visual impairment.

Dermoid cyst above the eyebrow

A benign neoplasm in the eyebrow area is most often a dermoid, that is, a congenital cyst filled with embryonic elements. The etiology of the development of dermoids has not been fully studied, but there is a theory accepted by many doctors that speaks of a violation of embryogenesis when early period During the formation of the embryo, parts of the ectoderm are displaced and separated. Over time, these elements are grouped and encapsulated by the epithelial membrane. Inside the cyst you can find parts of the sebaceous and sweat glands, keratinized elements, hair follicle cells, and bone tissue. The cyst also contains jelly-like lipid fluid and cholesterol crystals.

Surgeons say that the arch area is the most typical location for a dermoid cyst above the eyebrow. The size of the formation ranges from millimeter parameters to 3-5 centimeters in diameter; the older the person, the larger the dermoid, which increases in parallel with the growth of the head.

A dermoid cyst above the eyebrow is removed at the age of 5-6 years; previously it is observed and not touched. If education does not cause harm, does not violate visual functions, does not fester, it can be left under observation longer. However, due to possible inflammation as a result of bruises, head injuries, associated infectious diseases and in order to eliminate the risk of degeneration into a malignant tumor, dermoid at the first opportunity and favorable conditions should be removed. The course and prognosis of dermoid cysts are usually favorable; relapses after surgery are rare if the cyst was not completely removed.

Dermoid cyst on the face

The favorite place that a dermoid cyst chooses for its location is the face and head.

A dermoid cyst on the face and head can develop in the following areas:

Edge of the eye.
Orbit (orbital cyst).
Hairy area of the head.
Brow area.
Eyelids.
Whiskey.
Oral cavity (bottom).
Lips.
Nasolabial folds.
Neck (under the lower jaw).

A dermoid cyst on the face develops and grows very slowly, often over decades. Patients seek help from a surgeon only in case of a sharp increase in the cyst and an obvious cosmetic defect, less often in situations where the cyst suppurates or becomes inflamed. It is extremely rare that a neoplasm causes functional impairment; most often this happens with an oral cyst - it becomes difficult to talk and even eat food.

Palpation of the cyst does not cause pain; if the tumor is small, as it grows, it can become inflamed, especially when localized on the floor of the mouth in the middle, in the area hyoid bone or in the chin area. Cysts of this type seem to protrude under the tongue, interfering with its work (it rises).

Dermoids on the face are subject to surgical treatment; as a rule, it is indicated at the age of 5 years, not earlier. The operation is performed in a hospital setting under general anesthesia, taking into account the patient’s health condition and the size and location of the cyst. The course of the disease is favorable, relapses are extremely rare.

Dermoid cyst of the corner of the eye

Dermoid of the corner of the eye is considered a completely benign formation and differs from other types of cysts in its favorable course and prognosis.

A dermoid cyst of the corner of the eye can have very small sizes - from a millet grain to quite obvious, visually manifested formations of 4-6 centimeters. The main danger of dermoid in the eyes is the potential for deep growth and a small percentage of malignancy (up to 1.5-2%). Also, external localization and access to the cyst provokes the danger of injury, inflammation and suppuration.

If the dermoid, located in the corner of the eyes, does not impair vision, does not interfere with the development of the orbit, eyelids, or does not provoke ptosis, it is observed and not treated until the age of 5-6 years. A cosmetic defect at an early age is not an absolute indication for surgery, although in the future it cannot be avoided. In addition, surgery is contraindicated in the presence of chronic diseases, cardiac pathologies, because radical treatment involves the use of general anesthesia.

In cases of cyst growth or enlargement, excision is performed, especially when amblyopia (visual impairment) develops. Treatment should not be delayed, since the dermoid cyst of the corner of the eye can grow further and affect the nearby tissues of the eyeball and eyelid. Complications and relapses are possible, as after any other operation, but their risk is minimal and is not comparable to the obvious benefits of dermoid removal.

Dermoid cyst of the coccyx

Dermoid of the sacrococcygeal zone, due to its constant increase, provokes deviation of the coccyx and the appearance of symptoms similar to the epithelial coccygeal tract.

Previously, these diagnoses were identical and were treated in the same way, but currently clinical practice The diseases are differentiated and there are different definitions - dermoid cyst of the coccyx, coccyx fistula, pilonidal sinus, and so on. There are no significant differences in the diagnosis, but in their own way etiological features these formations are still different, although real reasons coccyx dermoids have not yet been identified.

Dermoid cyst of the coccyx, etiology.

In clinical practice, two versions of the development of dermoids in the sacrococcygeal region are accepted:

An epithelial dermoid cyst is formed as a congenital, embryonic defect caused by incomplete degenerative formation (reduction) of ligaments and muscle tissue tail
Coccyx dermoid develops due to pathological embryonic abnormalities and separation of growing hair follicles penetrating into the subcutaneous tissue of the coccygeal region.

Interestingly, static data show almost zero percentage of dermoid cysts in the coccygeal bone in representatives of the Negroid race, and a large percentage in representatives of Arab countries and residents of the Caucasus. A dermoid cyst in the coccyx is diagnosed mainly in men; women suffer from it three times less often.

The localization of the dermoid is typical - in the middle of the intergluteal line ending at subcutaneous tissue coccyx with frequent opening in the form of a fistula (epithelial tract).

This move ensures constant discharge of the contents of the cyst, and blockage leads to its inflammation and infection. The contents of the cyst contain particles of hair, fat or elements of the sebaceous glands.

Dermoid cysts of the coccyx are characterized by suppuration, which provokes obvious clinical manifestations. An uncomplicated dermoid cyst of the coccyx can develop asymptomatically for years, rarely manifesting itself as transient pain during prolonged sedentary work. Suppuration provokes an increase in body temperature, throbbing pain, the person cannot sit, bend over, or squat.

Coccyx dermoid can only be treated radically - surgery, by excision of the epithelial tract, scars and possible fistulas at the same time. Most often, surgery is performed under local anesthesia when the cyst is in remission, without suppuration. Further treatment involves taking antibiotics, sanitation of the coccyx area, local anesthesia.

Dermoid cyst on the head

A dermoid is a formation in the form of a cyst with a capsule and contents of hair, sebaceous glands, fats, bone tissue, keratinized particles, and scales. A dermoid cyst on the head is the most common localization of benign formations of congenital etiology. The inner and outer walls of the cyst are most often similar in structure to the skin and consist of ordinary dermal layers - cuticle, epithelium.

The typical arrangement of dermoids on the head is as follows:

Upper eyelids.
Corners of the eyes.
The bridge of the nose or the area of the brow ridges.
Lips.
Nasolabial folds.
Back of the head.
Submandibular region.
Floor of the mouth.
Orbit, conjunctiva of the eye.
Rarely - cornea of the eye.

Since a dermoid cyst on the head is formed as a result of impaired embryogenesis in the areas of embryonic grooves and branches, it is most often located in three areas:

Mandibular zone.
Periorbital zone.
Perinasal area.
Less commonly, dermoids are localized at the bottom oral cavity, in the tissues of the neck, temples, in the area of masticatory muscles, on the cheeks.

Scalp dermoids, like all other benign congenital cysts, develop slowly and gradually; they can maintain their small size for many years without manifesting clinically and without causing any discomfort other than cosmetic. Treatment of dermoid cysts of the head is carried out surgically, in inpatient conditions under general anesthesia. The course and outcome of the operation are favorable, relapses are possible only in the case of a combination of dermoids with other tumor or inflammatory processes, as well as in case of incomplete excision of the cyst.

Dermoid cyst on the neck

A dermoid cyst on the neck belongs to the group of congenital mature teratomas. The cavity of the cystic formation is filled with contents characteristic of a dermoid - hair follicles, keratinized scales, fatty, sebaceous elements, and skin particles. Most often, neck dermoids are localized in the sublingual region or in the area of the thyroid-lingual passage. Geneticists studying the etiology of dermoids claim that neck cysts form before the 5th week of embryonic development, when thyroid and language.

A dermoid cyst on the neck is visible almost immediately after the baby is born, but small formations may go unnoticed due to typical infantile folds. The cyst develops very slowly and does not bother the child or cause pain. Pain may occur in case of inflammation of the formation or its suppuration. Then the first sign appears - difficulty swallowing food, then intermittent breathing appears.

A dermoid cyst of the neck, located in the area of the hyoid bone, provokes skin deformation and is visible to the naked eye; in addition, the cyst can be hyperemic and have an opening in the form of a fistula opening.

Neck dermoids are treated with surgery, which is performed at the age of 5-7 years; earlier surgery is possible only in emergency conditions - risk of malignancy, acute inflammatory process or impaired swallowing or breathing function. Treatment of this type of cyst is complex; the operation is performed under general anesthesia and can have complications due to the close location of the cyst and many functionally important muscles.

Dermoid cyst of the brain

Among all brain tumors, dermoid is considered the safest and most treatable.

A dermoid cyst of the brain is formed in the earliest stages of embryogenesis, when skin cells, whose purpose is to form the face, enter the spinal cord or brain. The etiology of all dermoids has not been fully clarified, but its congenital nature does not raise doubts among doctors. It should also be noted that dermoid formations are most often localized on the surface of the head, but not the brain itself; such cases are diagnosed extremely rarely, mainly in boys under the age of 10 years.

The typical location chosen by a dermoid cyst of the brain is the cerebellopontine angle or midline structures.

Symptomatically, the cyst may not appear for quite a long time; pain and cerebral manifestations in the form of dizziness, nausea, and lack of coordination are rare in the case of a sharp growth of the tumor or its proliferation, suppuration.

The method of treatment is only surgical; the method will be determined depending on the location and size of the cyst. Endoscopy or craniotomy may be used. The outcome is usually favorable rehabilitation period it is also rarely accompanied by complications. Cerebral dermoid is operated on no earlier than 7 years for urgent reasons.

Pararectal dermoid cyst

A pararectal dermoid cyst is a mature teratoma that contains elements of keratinized particles, hair, elements of sebaceous and sweat secretions, skin, and cholesterol crystals. The etiological causes of perirectal dermoids are not specified, but it is believed that they are associated with embryonic developmental defects, when the germ layers begin to separate into a place atypical for the formation of organs.

Clinically, a pararectal dermoid cyst is visible as a round, convex formation that is painless to the touch. Such a dermoid quite often ruptures spontaneously, forming a fistula or even an abscess. Unlike a coccyx dermoid, a pararectal cyst opens into the perineum or rectum.

Most often, dermoid is diagnosed during a routine rectal examination using palpation or in the case of suppuration or inflammation. In addition to palpation, sigmoidoscopy and fistulography are performed. It is believed that coccyx dermoid and pararectal cyst are similar in symptoms, so it is necessary to differentiate them, in addition, it is necessary to exclude rectal tumors, which are often combined with dermoids.

Pararectal formations are prone to malignancy more often than benign cysts localized in other areas, therefore early diagnosis and timely surgery are necessary conditions to minimize risk.

Dermoid cyst in a child

Dermoid cysts in children, as a rule, are detected very early, in 60-65% of cases in the first year of life, in 15-20% in the second year, and extremely rarely at a later date. Such early detection of benign cysts is associated with embryonic, dysontogenetic etiology, that is, formations are formed at the intrauterine stage and are visible almost immediately after birth.

Fortunately, a dermoid cyst in a child is rare; among all benign childhood neoplasms, it accounts for no more than 4%.

A dermoid in children is an organoid cyst consisting of tissues of various structures and organs. Hair follicles, particles of bone, nails, teeth, skin, and sebaceous glands can be found in the capsule. Cysts develop slowly but constantly and can be localized on the head, in the eye area, tailbone, etc. internal organs– in the ovaries, brain, kidneys. Accordingly, a dermoid cyst can be external or internal. Cysts enlarge without provoking clinical symptoms, however, all of them must be excised after the age of 5-7 years, since they are potentially dangerous in terms of dysfunction of nearby organs, in addition, there is a risk of them developing into malignant formations (1.5-2% of cases) .

Can a dermoid cyst resolve?

The myth that dermoids can disappear on their own should be debunked. The question of whether a dermoid cyst can resolve can be considered unreasonable, because the very contents of the formation indicate that lipid elements, particles of teeth, skin, bone parts, hair, in principle, cannot disappear and dissolve in the body.

Of course, many try traditional methods, delaying the operation, especially if it concerns a child. However, we must admit the fact - dermoids never dissolve, no matter how drug treatment, nor with herbal treatment.

Can a dermoid cyst resolve? It definitely cannot. Unlike other types of cysts, such as follicular cysts, dermoids consist of a very dense capsule with contents that only need to be cut out, just like a diseased tooth, and cannot disappear on their own at the behest of magic spells or herbal lotions. Dermoids do not need to be operated on if they do not interfere with the functioning of other organs and systems and do not cause a cosmetic defect intense desire neutralize it. However, it is necessary to recall the risk of malignancy, that is, the potential for a dermoid cyst to develop into cancer, including squamous cell cancer. Therefore, radical excision of the cyst is the only way to get rid of it forever.

Recurrence of dermoid cyst

Dermoids can only be treated surgically; as a rule, the outcome of the operation is favorable in 95% of cases. However, there are complications, which include recurrence of the dermoid cyst. This is possible under the following circumstances and conditions:

Severe inflammation and suppuration of the cyst.
Evacuation of purulent contents into nearby tissues when the cyst ruptures.
Incomplete excision of the dermoid if its localization is unclear or if it grows strongly into nearby tissues.
Incomplete removal of the cyst capsule due to deterioration of the patient's condition during surgery.
Large cysts during laparoscopy.
In case of insufficient drainage of purulent contents.

As a rule, recurrence of a dermoid cyst is rare; more often the operation takes place with minimal risk and traumatization, the stitches are almost invisible and dissolve quickly. Radical excision of the cyst is indicated only if the cyst has frozen in development, or after inflammation is in a stage of stable remission.

Treatment of dermoid cyst

Dermoids are subject to surgical treatment; as a rule, excision of such cysts is carried out from 5-7 years of age and at a later period.

Treatment of a dermoid cyst involves excision (excision) within the boundaries of healthy tissue; less often, the nearby area is also excised to neutralize possible complications. Surgery is performed both under general anesthesia and under local anesthesia, for example, for coccyx dermoid.

If the formation is small in size, treatment of a dermoid cyst does not exceed half an hour; more complex procedures are required for large purulent cysts.

Also, long-term surgery is expected for dermoid cysts of the brain.

Today medical technology so perfect that after the intervention the patient can practically forget about the operation on the second day; laser techniques for removing cysts, endoscopy, and laparoscopy are especially effective.

In addition, surgeons strive to minimize injuries to nearby tissues and apply such masterful cosmetic sutures that even during facial surgery, the patient forgets after a while that he once had a cosmetic defect in the form of a dermoid. The operation consists of opening the cyst, evacuating the cystic contents and draining the cavity if it suppurates. It is also possible to perform deep excision of the capsule to prevent recurrence of the cyst. Treatment of dermoid cysts has a favorable outcome and is considered one of the safest in surgical practice.

Laparoscopy of dermoid cyst

Laparoscopy has long become popular due to its low invasiveness and effectiveness. Currently, laparoscopy of a dermoid cyst is the ash standard in surgical practice, which is used to excise a dermoid of any size, even up to a maximum of 15 centimeters.

With laparoscopy, the incisions are virtually bloodless, as surgeons use electric, laser, and ultrasound instruments. All this together allows not only good control of the process, but also, simultaneously with the incisions, sealing of damaged tissues, processing their edges. Laparoscopy of a dermoid cyst is especially effective during surgery on the ovaries, since any woman strives to preserve reproductive function and, indeed, after six months, conception is quite possible and will not cause any complications. In addition, the laparoscopic method is also good in a cosmetic sense, because postoperative scars are practically invisible and resolve within 2-3 months without a trace.

The only area where laparoscopy may not be appropriate is the brain, especially if the dermoid is located in a hard-to-reach place. Then craniotomy is inevitable, however, even with this surgical intervention the prognosis is quite favorable.

Dermoid cyst removal

Removal of a dermoid cyst is only possible surgical method, the choice of which depends on the location of the tumor, its size, the patient’s health status and other factors.

As a rule, dermoid removal is carried out no earlier than the age of five, when the patient is already able to withstand both local and general anesthesia.

If the cyst has purulent contents, it is removed only after anti-inflammatory treatment and transition to the stage of stable remission. When the formation develops slowly and without inflammation, removal of the dermoid cyst is carried out routinely using conventional surgery or laparoscopically.

The cyst is opened, its contents are scraped out, and the doctor makes sure that all elements are evacuated without a trace in order to avoid relapses; the same is done with the cyst capsule. Excision of the capsular walls is important, especially if the cyst has grown deeper into nearby tissue. Surgical intervention is carried out within the boundaries of healthy tissue and lasts from 15 minutes to several hours when intervening in the brain (trepanation).

For small dermoids localized on the coccyx or head area (epidermal cysts), local anesthesia is possible, but small children who are not capable of a long stay in operating conditions are subject to general anesthesia.

Removal of a dermoid cyst is not only desirable, but mandatory, given the risk of suppuration, dysfunction of many organs due to enlargement of the dermoid, and also due to the risk of malignancy, albeit low - only up to 2%.

Treatment of dermoid cysts with folk remedies

Unlike other diseases that you can try to neutralize with phototherapy and unconventional methods, treating dermoid cysts with folk remedies is a myth. Apart from wasting time and increasing the risk of suppuration, inflammation and transformation of the cyst into a malignant tumor, such treatment will not bring anything else.

Dermoids are treated only surgically, which is usually less traumatic and effective. Lotions, compresses, decoctions, spells and other methods will not help, this is a fact that is not even disputed. No matter how much a person would like to avoid surgery, especially if we are talking about a child, it will have to be done, because the dermoid is simply not able to resolve due to its embryonic contents, consisting of hair, fat, sebaceous elements, and bone particles. Treatment of dermoid cysts with folk remedies will not replace a truly effective method - surgery.