Benign Dermoid Cyst Rupture: Laparoscopy vs. Laparotomy - A Patient's Concern

Question
My gyno has been monitoring a 5 cm. dermoid cyst on my right ovary that has not grown in the past year and a half. It is benign. Recently, he found that it now has a 2 cm. liquid cyst attached to it and he has recommended I hafve a laparotomy, as I do not want to have the ovary removed. I am 38 years old and may still want to have children. I would prefer to have a laporoscopy than a laporotomy, but above all, I would like to know if it would be gravely dangerous for me to not have it removed and allow it to burst? As it is a dermoid and is mainly full of hair (I was told), how would that affect my abdomen once it ruptured?

Answer
Dear Maria,

A dermoid cyst on the ovary is a somewhat bizarre tumor, usually benign, in the ovary that typically contains a diversity of tissues including hair, teeth, bone, thyroid, etc. A dermoid cyst develops from a primary oocyte that is retained within the ovary. Because of the type of cell it begins as, it can give rise to all orders of cells necessary to form mature tissues and often recognizable structures such as hair, bone and sebaceous (oily) material, neural (nerve) tissue, and teeth.

The average age of detection is 30. Up to 15% of women with ovarian teratomas (dermoid cysts) have them in both ovaries. Dermoid cysts can range in size from a centimeter (less than a half inch) up to 45 cm (about 17 inches) in diameter.

These cysts can cause the ovary to twist (torsion) and endanger its blood supply. The larger the dermoid cyst, the greater the risk of rupture with spillage of the greasy contents which can create problems with adhesions, pain, etc. Although the large majority (about 98%) of these tumors are benign, the remaining fraction (about 2%) does become cancerous (malignant). That is why removal of the dermoid cyst is usually the treatment of choice. This can be done by laparotomy (open surgery) or often a laparoscopy (with a scope). Torsion (twisting) of the ovary by the cyst is an emergency and calls for urgent surgery. At this point, if the ovary remains intact and fairly unaffected, they should not have to remove the ovary. However, I personally would not recommend refusing treatment and allowing it to burst.

I hope this information has helped you and answered your questions. I wish you good luck and a speedy recovery with whichever treatment method you decide upon!

Brenda