E4954. What Radiologists Need to Know about Dermoids: A Pictorial Essay of Dermoids Beyond the Abdomen and Pelvis
Authors
Nikolas Brozovich;
Augusta University
Thomas Estes;
Augusta University
Manohar Roda;
Yale University
Frank Miller;
Northwestern University
Camila Vendrami;
Northwestern University
Courtney Moreno-; ;
Emory University
Pardeep Mittal;
Augusta University
Background
Dermoid tumors are often incidentally found on routine imaging and readily diagnosed on ultrasound, CT, and MRI due to their characteristic features. Radiologists must be familiar with the spectrum of dermoid tumors to accurately diagnose and aide in patient management. Beyond the pelvis, mature/immature teratomas can be diagnosed in multiple organ systems with sacrococcygeal, testicular, mediastinal, CNS, and retroperitoneal teratomas often encountered in clinical practice.
Educational Goals / Teaching Points
General pathology of dermoid tumors. Characteristic image findings and potential consequences of ovarian teratomas. Case collection of extrapelvic dermoid tumors.
Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
Ovarian teratomas are the most common germ cell neoplasm, composed of mature or immature tissues, with mature cystic teratomas (dermoid cysts) being the most common. Mature cystic teratomas are composed of at least two of the three well-differentiated germ cell layers and can present with torsion, rupture, malignant degeneration, and rarely, malignant transformation. Immature teratomas compromise less than 1% of ovarian teratomas and usually present as a large, heterogenous, predominately solid lesion with irregular calcifications, cystic elements, and small foci of fat. Immature teratomas are associated with concurrent mature/immature teratomas. Mature solid teratomas are predominately solid and must be extensively biopsied or excised to exclude an immature teratoma. Monodermal tumors are comprised of exclusively or predominantly a single type of tissue, with the three main types being struma ovarii, ovarian carcinoid tumors, and tumors with neural differentiation.
Conclusion
Desmoid tumors present with a spectrum of pathology routinely encountered within the pelvis and beyond the pelvis. Mature cystic teratomas are often easily differentiated from their predominately solid immature teratoma counterparts. Additionally, rarer dermoid tumors, such as struma ovarii and carcinoid tumors, present as monodermal teratomas without fat.
