Dermoid cyst + Polycystic Ovaries

Today I saw a young lady with intermenstrual bleeding and long menstrual cycles. She was obviously distressed about her symptoms as she had been told by 3 gynaecologists 3 different diagnoses. She was about to get married and was keen on starting a family. The diagnosis of polycyctic ovaries given by one gynaecologist made her very anxious as she knew this was associated with subfertility.
An ultrasound scan of her pelvis showed a large ovarian cyst with solid areas attached to a polycyctic ovary Her other ovary was also enlarged but with multiple small cysts. I immediately did an ovarian cancer screen for and a hormone profile. As she was in her 20's it was unlukely that she had a cancer of the ovary although I have seen a few cases of early cancer of the ovary in women in their late 20's. The most likely diagnosis was of a dermoid cyst, and this diagnosis had again been missed by the other gynaecologists.
A dermid cyst is a cyst that is present from an early age and contains all the embryonic tissues such as hair, teeth, bone, cartilage, sebum etc. They can sometimes grow quite big and twist or rupture. It is advisable in such cases to remove them if they have grown to a certain size. very often they are bilateral and at the time of operation the other ovary must be examined carefully for any small dermoid cyst that can be easily missed.