Dr. Pooja Gupta Jain, Dr. Alka Shukla, Dr. Poonam Raikwar
Introduction: Dermoid cyst is a teratoma of cystic nature arising from Germ cell. It is the most common Ovarian Germ cell tumour of reproductive age, accounts for 10 to 20 % of all ovarian neoplasms with 1 to 2 % malignancy risk. A Parasitic dermoid cyst is a new entity and actual incidence is not known. It is very rare and only 12 cases have been reported. We are reporting one such case.
Aims & Objectives: Our aim is to report a rare case of dermoid cyst in the Pouch of Douglas with the objective of adding one more differential diagnosis in the entity of masses of the Pouch of Douglas and how to manage such a rare case of gynaecology.
Background: A parasitic dermoid cyst is a very rare entity. Omentum is the most common parasitic site followed by the pouch of douglas. 32 cases of dermoid cyst in omentum & 12 cases of teratoma in the pouch of douglas have been reported since the 1st case of it which was described by Lefowitch & et al. Etiopathogenesis is unknown, but some theories have been proposed. One theory says auto amputation resulting from torsion of ovarian dermoid cyst with subsequent re-implantation in a Douglas’ pouch, in these cases, one of the ovaries was small or absent or the teratoma contained ovarian tissues. Other theories say that teratomas in Douglas' pouch may originate from an ectopic ovary or from displaced primordial germ cells.
Case: Young unmarried girl with complaints of irregular cycle and pain in abdomen since 6 months was investigated. On general & systemic examination no significant abnormality detected. Sonography showed 7 by 7 cm complex ovarian cyst on the right side with an impression of dermoid cyst. Blood investigations along with tumour marker were within normal range. Surprisingly on laparoscopy uterus and both tubes and ovaries appears normal and cyst of 7 by 7 cm found in pouch of douglas attached to posterior surface of uterus. Enucleation of cyst was done and sends for histological examination. Results were dermoid cyst.
Conclusion: This is a rare case of dermoid cyst in douglas pouch. This case puts some light and helps other gynaecologists in managing such kind of case.