Dermoid cyst: Difference between revisions

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{{Fixation - standard}}
{{Fixation - standard}}
Used synonymously with '''dermoid'''.


==Gross processing==
==Gross processing==
Example gross report:
Example gross report:
{|
{|
| (Optionally: A. Labeled - __ The specimen is received in formalin and consists of) tan-pink to yellow cystic ovarian tissue measuring __ cm. The cyst lining reveals multiple patches of hair with associated greasy yellow keratinous material. Cross-sections show several plate-like areas of rubbery grey-white cartilage. Representative sections are submitted for microscopic examination in one cassette.
| (Optionally: A. Labeled - __ The specimen is received in formalin and consists of) tan-pink to yellow cystic ovarian tissue measuring __ cm. The cyst lining reveals multiple patches of hair with associated greasy yellow keratinous material. Cross-sections show several plate-like areas of rubbery grey-white cartilage. Representative sections are submitted for microscopic examination in three cassettes.
|}
|}
===Tissue sampling===
Generally sample approximately 3 cassettes in order to be able to rule out immature elements.
There is no need to sample by Rokitansky nodules as these do not have any significant risk of containing immature elements.


==Microscopic evaluation==
==Microscopic evaluation==
The main components are:
*Diagnosis as a teratoma
*Ruling out an immature teratoma, and thereby establishing a diagnosis as a "mature (cystic) teratoma".
===Teratoma diagnosis===
[[File:Histopathology of ovarian dermoid cyst.jpg|thumb|Mature cystic teratoma (dermoid) cyst, showing components from several germ layers.]]
[[File:Histopathology of ovarian dermoid cyst.jpg|thumb|Mature cystic teratoma (dermoid) cyst, showing components from several germ layers.]]
The diagnostic criterion is a well-differentiated components from at least two germ layers (ectoderm, mesoderm and/or endoderm).<ref name="SahinAbdullazade2017">{{cite journal|last1=Sahin|first1=Hilal|last2=Abdullazade|first2=Samir|last3=Sanci|first3=Muzaffer|title=Mature cystic teratoma of the ovary: a cutting edge overview on imaging features|journal=Insights into Imaging|volume=8|issue=2|year=2017|pages=227–241|issn=1869-4101|doi=10.1007/s13244-016-0539-9}}</ref> Common representative tissues of these are:
The diagnostic criterion is a well-differentiated components from at least two germ layers (ectoderm, mesoderm and/or endoderm).<ref name="SahinAbdullazade2017">{{cite journal|last1=Sahin|first1=Hilal|last2=Abdullazade|first2=Samir|last3=Sanci|first3=Muzaffer|title=Mature cystic teratoma of the ovary: a cutting edge overview on imaging features|journal=Insights into Imaging|volume=8|issue=2|year=2017|pages=227–241|issn=1869-4101|doi=10.1007/s13244-016-0539-9}}</ref><ref>{{cite web|url=https://www.pathologyoutlines.com/topic/ovarytumorteratomamature.html|title=Teratoma-mature|website=Pathology Outlines|author=Shannon Mingo Welter, M.D., Mahmoud A. Khalifa, M.D., Ph.D.}} Last author update: 10 August 2021</ref> Representative tissues of these are:
*'''Ectoderm''':  
*'''Ectoderm''':  
<gallery>
<gallery mode=packed heights=180>
File:Epidermis and epidermal appendages a mature cystic teratoma.jpg|Epidermis (stratified) and epidermal appendages
File:Epidermis and epidermal appendages a mature cystic teratoma.jpg|Epidermis (stratified) and epidermal appendages
File:Nervous tissue in a mature cystic teratoma.jpg|Nervous tissue
File:Nervous tissue in a mature cystic teratoma.jpg|Nervous tissue
File:Histopathology of brain tissue in a mature teratoma.jpg|Brain tissue (here ventricle-forming)
</gallery>
</gallery>
*'''Mesoderm''':  
*'''Mesoderm''':  
<gallery>
<gallery mode=packed heights=180>>
File:Cartilage in a mature cystic teratoma.jpg|Cartilage
File:Cartilage in a mature cystic teratoma.jpg|Cartilage
File:Histopathology of fatty tissue in a mature teratoma.jpg|Fatty tissue
File:Histopathology of bony tissue in a mature teratoma.jpg|Bone and teeth<ref group=notes>Teeth also contain ectodermal (outer) layers of embryonic tissues.<br>- {{cite web|url=https://www.britannica.com/science/tooth-germ|title=Tooth germ|website=Encyclopaedia Britannica|accessdate=2021-03-31}}</ref>
</gallery>
</gallery>
Striated muscle, smooth muscle
Striated muscle, smooth muscle
*'''Endoderm''':
*'''Endoderm''':
<gallery>
<gallery mode=packed heights=180>>
File:Respiratory epithelium in a mature cystic teratoma.jpg|Respiratory epithelium (pseudostratified ciliated)
File:Respiratory epithelium in a mature cystic teratoma.jpg|Respiratory epithelium (pseudostratified ciliated)
File:Histopathology of pancreatic tissue in a mature cystic teratoma.jpg|Pancreatic tissue
File:Histopathology of pancreatic tissue in a mature cystic teratoma.jpg|Acinar glandular tissue (pancreatic tissue shown)
File:Histopathology of choroid plexus tissue in a mature teratoma.jpg|Choroid plexus
</gallery>
</gallery>
:*Thyroid tissue
:*Thyroid tissue
:*Gastrointestinal mucosa
:*Gastrointestinal mucosa
===Immature teratoma===
The finding of immature tissues confer a diagnosis of immature teratomas:
<gallery mode=packed heights=180>>
File:Histopathology of immature neuroepithelium in immature teratoma.jpg|thumb|Immature neuroepithelium
</gallery>
Immature neuroepithelium is the most common finding, but immature cartilage and/or skeletal muscle are occasionally seen.<ref name=":5">{{Cite book |title=Modern surgical pathology |date=2009 |publisher=Saunders/Elsevier | vauthors = Weidner N |isbn=9781416039662 |edition=2nd |location=Philadelphia, PA |oclc=460883320}}</ref>


==See also==
==See also==
*[[Ovarian cyst]]
*[[Ovarian cyst]]
{{Bottom}}
{{Bottom}}

Latest revision as of 19:57, 8 November 2023

Author: Mikael Häggström [note 1]

Fixation

Generally 10% neutral buffered formalin.

Gross processing

Example gross report:

(Optionally: A. Labeled - __ The specimen is received in formalin and consists of) tan-pink to yellow cystic ovarian tissue measuring __ cm. The cyst lining reveals multiple patches of hair with associated greasy yellow keratinous material. Cross-sections show several plate-like areas of rubbery grey-white cartilage. Representative sections are submitted for microscopic examination in three cassettes.

Tissue sampling

Generally sample approximately 3 cassettes in order to be able to rule out immature elements.

There is no need to sample by Rokitansky nodules as these do not have any significant risk of containing immature elements.

Microscopic evaluation

The main components are:

  • Diagnosis as a teratoma
  • Ruling out an immature teratoma, and thereby establishing a diagnosis as a "mature (cystic) teratoma".

Teratoma diagnosis

Mature cystic teratoma (dermoid) cyst, showing components from several germ layers.

The diagnostic criterion is a well-differentiated components from at least two germ layers (ectoderm, mesoderm and/or endoderm).[1][2] Representative tissues of these are:

  • Ectoderm:
  • Epidermis (stratified) and epidermal appendages
    Epidermis (stratified) and epidermal appendages
  • Nervous tissue
    Nervous tissue
  • Brain tissue (here ventricle-forming)
    Brain tissue (here ventricle-forming)
  • Mesoderm:
  • Cartilage
    Cartilage
  • Fatty tissue
    Fatty tissue
  • Bone and teeth[notes 1]
    Bone and teeth[notes 1]

Striated muscle, smooth muscle

  • Endoderm:
  • Respiratory epithelium (pseudostratified ciliated)
    Respiratory epithelium (pseudostratified ciliated)
  • Acinar glandular tissue (pancreatic tissue shown)
    Acinar glandular tissue (pancreatic tissue shown)
  • Choroid plexus
    Choroid plexus
  • Thyroid tissue
  • Gastrointestinal mucosa

Immature teratoma

The finding of immature tissues confer a diagnosis of immature teratomas:

  • Immature neuroepithelium
    Immature neuroepithelium

Immature neuroepithelium is the most common finding, but immature cartilage and/or skeletal muscle are occasionally seen.[3]

See also

Notes

  1. ↑ Teeth also contain ectodermal (outer) layers of embryonic tissues.
    - . Tooth germ. Encyclopaedia Britannica. Retrieved on 2021-03-31.
  1. ↑ For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page

References

  1. ↑ Sahin, Hilal; Abdullazade, Samir; Sanci, Muzaffer (2017). "Mature cystic teratoma of the ovary: a cutting edge overview on imaging features ". Insights into Imaging 8 (2): 227–241. doi:10.1007/s13244-016-0539-9. ISSN 1869-4101. 
  2. ↑ Shannon Mingo Welter, M.D., Mahmoud A. Khalifa, M.D., Ph.D.. Teratoma-mature. Pathology Outlines. Last author update: 10 August 2021
  3. ↑ Modern surgical pathology (2nd ed.). Philadelphia, PA: Saunders/Elsevier. 2009. ISBN 9781416039662. OCLC 460883320. 

Image sources


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