International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Bhatia R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Feb;8(2):776-778

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20190324
Case Report

Para vaginal dermoid cyst: a rare occurrence

Ruby Bhatia1*, Manjit Kaur Mohi2, Anju Gupta2, Sonia Goyal2

1
Department of Obstetrics and Gynecology, MM (DU), Mullana, Ambala, Haryana, India
2
Department of Obstetrics and Gynecology, GMC, Patiala, Punjab, India

Received: 22 November 2018

Accepted: 29 December 2018

*Correspondence:
Dr. Ruby Bhatia,
E-mail: drrubybhatia@yahoo.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Dermoid cyst (cystic teratoma) showing well differentiated derivatives of all three germs cell layers, is a benign germ
cell tumour. Ovaries remain the commonest site. Paravaginal dermoid cyst is a rare occurrence. Pre-operative
diagnosis is usually difficult in majority of cases. They constitute less than 4% of all extragonadal teratomas. A 28-
year old, P2L2 female presented with paravaginal cyst, 10×10cms, non-tender, soft swelling, cystic in consistency
occupying posterior and left part of rectovaginal septum. Trans vaginal excision of cyst under regional anaesthesia
done. Cyst was ruptured while excision showing putty material with tuft of hairs. A retrospective diagnosis of mature
teratoma/paravaginal dermoid cyst was made on histopathological examination. Paravaginal dermoid cyst, a benign
cystic teratoma is a very rare occurrence. Transvaginal excision of dermoid cyst under anaesthesia remains treatment
of choice. Retrospective diagnosis on histopathological examination remains confirmatory as it may be missed on
sonography if teeth are not present in dermoid cyst.

Keywords: Benign, Dermoid cyst, Paravaginal, Teratoma

INTRODUCTION The cyst on excision shows sebaceous glands and hair

follicles.3 When teeth also form part of vaginal dermoid
Paravaginal dermoid cyst is a rare entity in gynecological cyst it is called vagina dentata-a universal symbol of
practice. Dermoid cyst (cystic teratoma) showing well men's fear of women.4 Siu et al, presented pre-operative
differentiated derivatives of all three germs cell layers is a ultrasound findings consistent with dermoid cyst of
benign germ cell tumour. Ovaries remain the commonest vagina. Hence, transvaginal ultrasound remains gold
site. 80% of benign dermoid cyst of ovary are seen in standard as a diagnostic tool when teeth /bone are present
reproductive age group. In girls younger than twenty in dermoid cyst. Trans-vaginal surgical excision remains
years of age, dermoid cyst accounts for more than half of treatment of choice for para-vaginal dermoid cyst.
ovarian neoplasms.1 Dermoid cyst occur usefully at birth Retrospective diagnosis on histopathology is
or early childhood along line of embryonic fusion over confirmatory. If teeth are absent in dermoid cyst, the
head, neck, mediastinum and presacral area. 2 Paravaginal diagnosis may be missed on ultrasonography. Complete
dermoid cyst constitutes less than 4% of all extra-gonadal excision of paravaginal dermoid cyst has good prognosis.
teratomas. Till date only 7 cases of paravaginal dermoid
cyst have been reported in the literature.2 Pre-operative CASE REPORT
diagnosis of the exact nature of vaginal cyst may be
difficult. Vaginal dermoid cyst was first reported in a A 28-year-old P2L2 presented in gynecology outpatient
44year old woman with one cm cyst just within hymen. department of Government Medical College, Rajindra

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 Bhatia R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Feb;8(2):776-778

Hospital, Patiala on 1st June 2017 with pelvic pain,

feeling of pressure with heaviness in perineum and
dyspareunia for last one year. There was no history of
local trauma. On per speculum examination, cervix was
healthy.

Pelvic examination revealed 10×10cm soft-cystic, non-

tender swelling in posterior and left half of vagina, with
restricted mobility protruding through postero-lateral
vaginal mucosa towards left side, extending up to vaginal
vault in left lateral fornix. On per rectal examination,
mass was occupying left paravaginal space, anterior to
rectum extending into left ischiorectal fossa. Patient came
with MRI Pelvis dated 21st January 2016 showed normal
uterus and bilateral ovaries. There was 9.3×7.8×7.3cm
space occupying lesion in left ischiorectal fossa. A
diagnosis of paravaginal cyst was made. Figure 2: Histopathological examination showing well
differentiated tissues of three germ cell layers-
Transvaginal excision of paravaginal cyst under regional stratified squamous epithelial lining.
anesthesia was planned after preoperative workup and
necessary investigations. Bimanual pelvic and rectal Post-operative repeat MRI whole abdomen and pelvic
examination was repeated under regional anesthesia to organs dated 13th June 2017 confirmed normal bilateral
confirm the extension of cyst. Posterior vaginal mucosa ovaries with no evidence of any other dermoid cyst in
over the cyst was infiltrated with 1:10 vasopressin gonadal or extragonadal areas. Post-operative period was
solution. 5cm long vertical incision was given in vaginal uneventful. Patient was discharged on 7th post-operative
mucosa overlying cyst. day. On follow up till date there are no complaints.

The cyst was separated from vaginal mucosa by blunt and

sharp dissection. Cyst was adherent with rectum and
separated with great difficulty with assistant's finger in
rectum during the procedure. Cyst ruptured during
excision due to dense adhesions with rectum. Thick
cheesy putty material with matted tufts of hair confirmed
diagnosis of dermoid cyst (Figure 1).

Figure 3: Histopathological examination showing well

differentiated tissues of three germ cell layers-gland,
muscle, keratin and fibro collagen skin, smooth
muscle tissue and keratin.

Figure 1: Thick cheesy putty material with matted DISCUSSION

tufts of hair in ruptured paravgainal cyst.
Dermoid cyst with well-differentiated derivatives of all
Surgery completed maintaining complete hemostasis. three-germ cell layer is a benign germ cell tumour, the
Dead space packed tightly with four vaginal packs. Inj commonest site being ovaries. More than 50% of ovarian
cefaperazone 1gram intravenous 12-hourly given for tumour in young girls <20 years is dermoid cyst.80% of
72hours. Packs removed after 48hours. Histopathological dermoid cyst in ovary are seen in reproductive phase of
examination revealed cysts lined by stratified squamous life.1 A dermoid cyst can also be present from floor of
epithelium. Underneath seen skin, smooth muscle, mature mouth until colon in gastrointestinal tract.5-7 As dermoid
neural tissues, keratin flakes and fibro collagenous stroma cyst arises from outer layers of embryonic skin cells
confirming diagnosis of dermoid cyst/mature teratoma which has capacity to mature into hair, teeth or bone
(Figure 2 and 3). thereby making possible to be diagnosed by sonography.

International Journal of Reproduction, Contraception, Obstetrics and Gynecology Volume 8 · Issue 2 Page 777
 Bhatia R et al. Int J Reprod Contracept Obstet Gynecol. 2019 Feb;8(2):776-778

Vaginal dermoid cyst is well demarcated from remains treatment modality of choice. Histopathological
surrounding vaginal tissues and its contents are hetero examination remains gold standard for retrospective
echogenic on transvaginal sonography.4 Presence of teeth diagnosis of paravaginal dermoid cyst. Follow-up till life
in vaginal dermoid cyst is defined as vagina dentata-a is mandatory. Complete resection of paravaginal dermoid
feature of men's fear of women. With creation of myths cyst (Benign teratoma) has an excellent prognosis.
and folk stories in culture of native Americans and
different areas of Russia, Japan, India and New Zealand Funding: No funding sources
vagina dentata was interpreted as castration anxiety of Conflict of interest: None declared
men. Dermoid cyst in different parts of body is also Ethical approval: Not required
rarely reported in men.6 Till date only seven cases of
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