Cecal dermoid cyst

Victoria Valinluck Lao, Rebecca Stark, Thomas S. Lendvay, George T. Drugas
2014 Journal of Pediatric Surgery Case Reports  
Dermoid cysts of the cecum are very rare; including this report only three cases have been described in pediatric patients. We describe a case of a girl found to have a cecal dermoid cyst with no previous history of abdominal trauma or intraabdominal operations. Unlike acquired dermoid cysts that likely result from epithelial implantation following a surgical procedure or trauma, congenital dermoid cysts of the abdominal viscera are thought to result from ectodermal implantation during
more » ... ion during embryogenesis. We discuss the distinction between acquired and congenital dermoid cysts, their presentation as well as differential diagnoses. Ó 2014 The Authors. Published by Elsevier Inc. All rights reserved. Cecal dermoid cysts can be acquired or congenital. In the acquired form they are thought to arise from epithelial implantation from previous trauma or surgery, whereas in the congenital form it is thought to arise from ectodermal implantation during embryogenesis [1e3]. The bowel therefore is an unusual site for these dermoid cysts, especially of the congenital type. These cysts are more commonly found in the mediastinum, head and neck, sacrococcygeal area, central nervous system (CNS) and gonads. We present a rare case of a congenital cecal dermoid tumor in a pediatric patient. Case report The patient is a postmenarchal 16 year-old girl with a history of a previously repaired lumbosacral lipomeningocele, and neurogenic bowel and bladder with vesicoureteral reflux. Due to her chronic recurrent urinary tract infections, poorly functioning dysplastic right kidney with staghorn calculi, and presumed reflux nephropathy, the decision was made to do a right nephroureterectomy. Preoperative CT imaging of the abdomen and pelvis in preparation for a planned right nephrectomy and partial ureterectomy revealed an incidental 5 cm pelvic cystic mass initially thought to arise from the left ovary ( Figs. 1 and 2) . This mass was asymptomatic. At the time of the laparoscopic right nephrectomy and partial ureterectomy, the pelvis was explored for this mass. Inspection of the pelvis confirmed a normal uterus and adnexa. A well-circumscribed cystic mass of approximately 5 cm extending into the left pelvis was identified at the base of a dilated, redundant cecum with notable absence of the appendix. The mass appeared to arise from the convergence of the three tinea, suggesting that it arose within the appendix (Fig. 3) . Primary resection of the mass was performed with enterorrhaphy of the cecal serosa. There were no other masses in the cecum or ascending colon. The right colon mesentery as well as the mesoappendiceal basin was without adenopathy. The patient's post-operative course was uneventful and the patient recovered without complications. The pathology results revealed a soft cystic mass measuring 5 Â 3.7 Â 3.2 cm with smooth outer surface and bisection released tan caseous material (Fig. 4) . Sections of the cyst wall show a fibrous outer surface and inner lining composed of keratinizing squamous epithelium with multiple sebaceous glands, hair follicles and eccrine ducts ( Fig. 5a and b) . The intraluminal contents consisted of hair shafts and keratinous debris. The small tissue emanating from the outer surface of the specimen consists of fibroadipose tissue. No malignant neoplasm or Müllerian structures were identified. There was no communication with the cecal q This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/3.0/).
doi:10.1016/j.epsc.2014.06.015 fatcat:f5gyzcypbjc67g7sj76yxmwnjy