Peritoneal implantation of squamous cell carcinoma following rupture of a dermoid cyst during laparoscopic removal.
BACKGROUND
In recent years, there has been a move toward using laparoscopy in the management of presumed benign ovarian masses. This paper discusses the use of laparoscopy for ovarian masses (particularly dermoid cysts). The focus is on the implications for unexpected malignancies.


METHODS
We report here a case involving a dermoid cyst that was removed at laparoscopy and was subsequently found to contain a squamous cell carcinoma. Spillage of the cyst's contents occurred at the time of removal. At staging laparotomy, peritoneal implants of the tumor were found, upgrading the tumor from FIGO stage Ia to IIc.


CONCLUSIONS
Spillage rates of dermoid cyst content with laparoscopic removal are inevitably higher than with excision at laparotomy. It remains controversial whether upstaging from FIGO stage Ia to IIc affects prognosis; however, in this case it led to aggressive adjuvant therapy which imposed significant additional morbidity, including loss of fertility, on the patient. One should be aware of the possibility of unexpected malignancy when the decision to manage an ovarian mass laparoscopically is made.
Mayer
C
C
University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada. dmiller@bccancer.bc.ca
Miller
D M
DM
Ehlen
T G
TG
D000328:Adult; D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D003884:Dermoid Cyst / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D009366:Neoplasm Seeding; D009367:Neoplasm Staging; D010048:Ovarian Cysts / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010534:Peritoneal Neoplasms / Q000556:secondary*; D012422:Rupture, Spontaneous