Dermoid cyst Biopsy

Biopsy

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Histopathology of dermoid cyst.

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Dermoid Cyst Biopsy - Comprehensive Medical Test Guide

Why is it done?
- Definitive diagnosis and pathological confirmation of dermoid cyst (mature cystic teratoma) composition and tissue types
- Exclusion of malignant transformation or malignancy within the cyst, particularly in older patients or cysts >9 cm
- Differentiation from other ovarian cystic lesions with similar imaging appearance (mucinous cystadenoma, serous cystadenoma, other germ cell tumors)
- Evaluation of cyst contents when imaging findings are inconclusive or atypical
- Assessment of complications such as rupture, infection, or torsion
- Typically performed when lesion is surgically removed (excisional biopsy) or when needle aspiration biopsy is warranted for pre-operative assessment
Normal Range
- Normal/Benign Result: Histopathological confirmation of mature cystic teratoma with mature (well-differentiated) tissue components including dermal elements (hair follicles, sebaceous glands, sweat glands), ectodermal tissues, endodermal tissues, and/or mesodermal tissues
- Normal findings include: Well-organized squamous epithelium, absence of nuclear atypia, absence of mitotic activity, benign keratinous material, lipid content, cartilage, bone, or other mature tissues; absence of hemorrhage or acute inflammation
- Interpretation: Negative for malignancy; benign lesion with no malignant transformation
- Abnormal/Atypical findings: Presence of immature components, nuclear atypia, increased mitotic figures, solid areas, hemorrhage, necrosis, or evidence of malignant transformation such as squamous cell carcinoma, mucinous adenocarcinoma, or solid tumors within the cyst
- Units of measurement: Qualitative pathological report with descriptive histology and grading of cellularity and differentiation; no numerical values
Interpretation
- Benign Mature Cystic Teratoma: Confirms diagnosis with well-differentiated tissues from multiple germ layers; indicates good prognosis and low recurrence risk; typically managed with surgical excision
- Malignant Transformation (1-3% of cases): Most common is squamous cell carcinoma (80-90% of malignant transformations); also adenocarcinoma, melanoma, or sarcoma; indicates need for more aggressive treatment (chemotherapy, radiation) and close follow-up; increased mortality risk
- Immature Teratoma: Contains embryonic or primitive tissues (neuroepithelium, primitive mesenchyme); classified as malignant germ cell tumor (grade 1-3 based on immature element percentage); requires chemotherapy and close surveillance; prognosis depends on grade and stage
- Rupture/Complications: Biopsy may show acute inflammatory changes, hemorrhage, chemical peritonitis signs, or granulomatous inflammation; indicates need for urgent surgical intervention and management of peritoneal involvement
- Torsion/Infection: Histology may show infarction, necrosis, vascular thrombosis, or acute/chronic inflammatory infiltrate with bacterial organisms; requires appropriate medical/surgical management
- Factors affecting interpretation: Patient age (malignant transformation more common >40 years), cyst size (>9 cm increased malignancy risk), imaging characteristics, clinical presentation, adequate tissue sampling and pathologist expertise
Associated Organs
- Primary organ system: Reproductive system (ovaries most common site in women); also occur in sacrococcygeal region (most common in infants/children), testis, mediastinum, pineal gland, and other midline structures
- Germ cell origin: Arises from pluripotent primordial germ cells that fail to complete normal differentiation; derived from ectoderm, mesoderm, and endoderm
- Associated medical conditions: Mature cystic teratoma (dermoid cyst), immature teratoma, ovarian torsion, ovarian rupture, peritonitis, chemical peritonitis, malignant ovarian neoplasms, Struma ovarii (thyroid tissue-containing teratoma), carcinoid syndrome
- Potential complications: Cyst rupture with acute peritonitis and chemical inflammation, ovarian torsion with vascular compromise and infarction, infection and abscess formation, hemorrhage into cyst, malignant transformation, infertility (if ovary compromised), metastasis (if malignant), adhesions post-surgery
- Systemic effects of malignancy: Paraneoplastic syndromes, constitutional symptoms (weight loss, fever, fatigue), elevated tumor markers (CA-125, CEA, AFP depending on histology), peritoneal spread, ascites formation
Follow-up Tests
- For benign mature cystic teratoma: Pelvic ultrasound or MRI at 3-6 months post-surgery to assess for recurrence; annual imaging if contralateral ovary involved; tumor markers (CA-125) baseline then as needed; clinical follow-up at 2 weeks, 6 weeks, and 3 months post-operative
- For malignant transformation: Oncology consultation, tumor marker panel (CA-125, CEA, AFP, SCC antigen depending on malignancy type), staging CT/MRI (abdomen, pelvis, chest), colonoscopy or esophagogastroduodenoscopy if mucinous component, bone scan if indicated; chemotherapy protocol initiation
- For immature teratoma: Urgent oncology referral, complete staging workup (CT chest/abdomen/pelvis, tumor markers including AFP), chemotherapy with bleomycin/etoposide/cisplatin (BEP) or similar regimen, serial tumor marker monitoring, repeat imaging after chemotherapy cycles, surveillance imaging every 3 months for 2 years then every 6 months
- For complications (rupture/torsion/infection): CBC with differential (infection assessment), comprehensive metabolic panel, blood cultures if fever, peritoneal fluid culture and analysis, CT imaging to assess peritoneal spread, antibiotic therapy, possible repeat imaging in 48-72 hours
- Monitoring frequency recommendations: Benign: Annual imaging x 3-5 years; Immature/malignant: Every 3 months for 2 years, then every 6 months for years 2-5; longer surveillance based on stage and residual disease; tumor marker monitoring monthly during treatment, then quarterly during surveillance
- Complementary tests: Immunohistochemistry staining (keratin, CD30, PLAP for germ cell markers), cytogenetics or molecular testing if indicated, endocrine testing if Struma ovarii suspected (TSH, free T4), flow cytometry if malignant hematologic component
Fasting Required?
- Fasting requirement: YES - fasting is required if biopsy is obtained via surgical procedure or needle aspiration under anesthesia
- Fasting duration: Minimum 6-8 hours for most surgical procedures; typically NPO (nothing by mouth) from midnight before early morning procedure; may be 2-4 hours before sedation depending on type of sedation and institutional protocol
- Liquid intake guidelines: Clear liquids may be allowed up to 2-3 hours before procedure (water, apple juice, black coffee); specific instructions provided by surgical center based on anesthesia type
- Medications to avoid or hold: Anticoagulants (warfarin, dabigatran) - hold per institution protocol; NSAIDs and aspirin - hold 5-7 days before procedure; antiplatelet agents - coordinate with surgeon; metformin - hold day of procedure; ACE inhibitors/beta-blockers - usually continue with small sip of water per anesthesia instruction
- Additional preparation requirements: Pre-operative labs (CBC, CMP, coagulation studies, blood type and cross if transfusion possible); EKG if >40 years or cardiac history; chest X-ray if pulmonary disease; pelvic ultrasound or MRI for surgical planning; informed consent after discussion of risks/benefits; empty bladder before procedure; remove jewelry, piercings, makeup, nail polish; arrange transportation (cannot drive after anesthesia); shower with antimicrobial soap night before
- Post-procedure dietary guidelines: Start with sips of clear liquids after full recovery from anesthesia; advance to soft diet as tolerated; resume regular diet within 24 hours if tolerated; increase fluid intake; avoid heavy meals for 24-48 hours

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