Spectrum of Clinical Presentation of Ovarian Dermoid Cysts Across Different Age Groups: A Two-Year Observational Study

Abstract

Background: Ovarian dermoid cysts (mature cystic teratomas) are the most common benign ovarian neoplasms in reproductive-age women, yet their clinical presentation is notoriously diverse, ranging from incidental asymptomatic findings to acute surgical emergencies. This study aimed to document the varied clinicopathological presentations, imaging characteristics, surgical management, and histopathological outcomes of ovarian dermoid cysts encountered at a tertiary care centre over two years. Methods: A retrospective observational study was conducted over 24 months. Nineteen cases of surgically managed ovarian dermoid cysts were enrolled. Clinical data including patient demographics, presenting symptoms, imaging findings (ultrasonography, MRI, CT), tumour marker profiles, surgical procedures, and histopathological reports were collected and analysed. Results: Patient age ranged from 14 to 48 years. Seventeen cases (89.5%) were benign mature cystic teratomas on histopathology. One case (5.3%) was a mixed malignant germ cell tumour (immature teratoma 87% + yolk sac tumour 10% + embryonal carcinoma 3%), and one case demonstrated struma ovarii as a monodermal variant. Ovarian torsion complicated five cases (26.3%). Three cases occurred during pregnancy (cases 6, 7, 8). Bilateral involvement was documented in three patients (15.8%). AFP elevation (>520 U/mL) was the sole early tumour marker signal in the malignant case. Surgical management ranged from laparoscopic cystectomy to emergency laparotomy with bilateral salpingo-oophorectomy. Conclusion: Ovarian dermoid cysts exhibit a wide clinical spectrum including torsion, bilateral disease, pregnancy associated complications, and rare malignant transformation. Individualized surgical planning, careful tumour marker interpretation, and thorough histopathological evaluation are essential. Elevated AFP should raise suspicion for malignant germ cell components even when other markers remain normal.