Dermoid cyst in an elderly man and its successful surgical treatment using robotic technologies: Clinical case

Introduction. Primary mature retroperitoneal dermoid cysts constitute a fairly rare pathology that is uncommon in men aged 50 years and older. In this article, we describe a case of a 68-year-old man with a large mature paravesical dermoid cyst extending into the rectovesical pouch and its successful surgical treatment using a da Vinci Xi robotic surgical system. Aim. To discuss the advantages of robotic access in the removal of large pelvic masses to achieve a speedy, successful outcome.

Materials and methods. An oval-shaped mass in the right side of the lesser pelvis measuring 66×85×62 mm was detected during a pelvic MRI exam performed as a follow-up after an adenomectomy. The attempted ultrasoundguided puncture was unsuccessful. A diagnostic laparoscopy was indicated to collect biopsy samples of the mass, with its subsequent removal if possible. Histology results verified the presence of a retroperitoneal dermoid cyst. In order to ascertain its localization and relationship with surrounding tissues, as well as to determine the structural parameters, a PET CT scan was performed. The planned robot-assisted laparoscopic excision of the retroperitoneal pelvic mass was performed.

Results and discussion. A general visual examination showed the removed specimen to be a cyst filled with a mushy mass of dirty white color, having an unpleasant odor and a large number of follicles. The histological study revealed an inflamed, ruptured retroperitoneal dermoid cyst.

Conclusion. The clinical case shows that old age mature dermoid cysts are found in the elderly; however, with timely diagnosis, they can be fully treated.

1. Kuprashvili M.I., Glazkova O.L., Ignatchenco O.Yu., Shevyakova T.V., Romanovskaya O.A., Sumiatina L.V., et al. Benign dermoid cyst with atypical clinic and ultrasonic characteristicsin young woman. Russian Journal of Human Reproduction. 2017;23(6):24–7 (In Russ.). DOI: 10.17116/repro201723624-27

2. Chibani H., El Ouardani S., Rezzoug F., Arghal M., Jabi R., Nassira K., et al. A rare case of retroperitoneal immature teratoma in a young adult male: a case report from eastern Morocco. Cureus. 2024;16(8):e66290. DOI: 10.7759/cureus.66290

3. Varlas V.N., Cloțea E.M., Varlas R.G., Pop A., Peneș O., Crețoiu D., et al. Immature sacrococcygeal teratoma: a case report and extensive review of the literature. Diagnostics (Basel). 2024;14(3):246. DOI: 10.3390/diagnostics14030246

4. Tiu A., Sovani V., Khan N., Hooda S. Primary retroperitoneal mature cystic teratoma (dermoid cyst) in a 51-year-old male: case report and historical literature review. SAGE Open Med Case Rep. 2017;5:2050313X17700745. DOI: 10.1177/2050313X17700745

5. Mahjoubi M.F., Hamdi Kbir G., Maatouk M., Messaoudi S., Rezgui B., Ben Moussa M. Extra-gonadal mature teratoma: A case report of retroperitoneal location with a literature review. Clin Case Rep. 2022;10(7):e6093. DOI: 10.1002/ccr3.6093

6. Poljo A., Klasen J.M., von Strauss Und Torney M., Posabella A., Taha-Mehlitz S., Hummer B., et al. A rare case of retroperitoneal teratoma with evidence of papillary thyroid carcinoma: a case report. BMC Endocr Disord. 2024;24(1):85. DOI: 10.1186/s12902-024-01606-4

7. Xiao J., Cai L., Pu J., Liu W., Jia C., He X. Clinical characteristics and prognosis of cystic degeneration in retroperitoneal schwannoma: A retrospective study of 79 patients. Cancer Med. 2023;12(5):5615–29. DOI: 10.1002/cam4.5411

8. Chalhoub K., Abou Zahr R., Mansour E., Aoun M., Jabbour M. Primary mature cystic teratoma compressing the prostate in a 28-year-old male: a case report and literature review. Case Rep Urol. 2019;2019:8970172. DOI: 10.1155/2019/8970172

9. Sellke N., Tay K., Zhou E., Harper H., Ahmed A., Hagos T., et al. Case — giant primary retroperitoneal teratoma with neuroendocrine components. Can Urol Assoc J. 2023;17(11):E405–7. DOI: 10.5489/cuaj.8401

10. Trivedi J., Sutherland T., Page M. Incidental findings in and around the prostate on prostate MRI: a pictorial review. Insights Imaging. 2021;12(1):37. DOI: 10.1186/s13244-021-00979-7

11. Kelly-Hedrick M., Frerich J.M., Peairs E.M., Cardona D.M., Arcot R., Smith B., et al. Retroperitoneal dermoid cyst presenting with radiculopathy symptoms: a case report. J Surg Case Rep. 2022;2022(12):rjac588. DOI: 10.1093/jscr/rjac588

12. Mohammed S.A., Kazali B.A., Ibrahim B.M., Mohammed H.Y., Gebrechristos S., Mersha M.K. Primary retroperitoneal mature teratoma in a young female: case report. Int J Surg Case Rep. 2024;115:109321. DOI: 10.1016/j.ijscr.2024.109321

13. Ma X., Xiao J., Wang W. Retroperitoneal dermoid cyst mimicking a liposarcoma based on imaging assessment: case report and literature review. Gland Surg. 2021;10(6):2062–8. DOI: 10.21037/gs-21-65

14. Liu R., Chen J., Shao C., Cheng N. Primary immature teratoma in the liver with growing teratoma syndrome and gliomatosis peritonei: a rare case report. Diagn Pathol. 2022;17(1):86. DOI: 10.1186/s13000-022-01267-8

15. Tojal A., Santos N., Vicente J., Carrilho N., Casimiro C. Retroperitoneal mature cystic teratoma involving the left adrenal gland in a 75-year-old male: a case report and literature review. J Surg Case Rep. 2020(11):rjaa451. DOI: 10.1093/jscr/rjaa451

16. Zhang Y., Liu H., Hou W., Cheng H., Wang F., Zhang L., et al. Retroperitoneal dermoid cyst complicated with uterine adenomyoma: a case report and literature review. J Int Med Res. 2024;52(6):3000605241255810. DOI: 10.1177/03000605241255810

17. Mudhher R., Agha Z.Z.A., Melder G., Shokouh-Amiri H., Covington J.D., LaBarre N.T., et al. Literature review and robotic management of a rare case of primary retroperitoneal mucinous cystadenoma. Radiol Case Rep. 2024;19(12):5798–803. DOI: 10.1016/j.radcr.2024.08.057

18. Gutt C.N., Oniu T., Mehrabi A., Kashfi A., Schemmer P., Büchler M.W. Robot-assisted abdominal surgery. Br J Surg. 2004;91(11):1390–7. DOI: 10.1002/bjs.4700

19. Kriger A.G., Berelavichus S.V., Son A.I., Gorin D.S., Ahtanin E.A., Kaldarov A.R., et al. Surgical treatment of retroperitoneal masses. Pirogov Russian Journal of Surgery. 2017;1:15–26 (In Russ.). DOI: 10.17116/hirurgia2017115-26

20. 20. Pushkar’ D.Yu., Kolontarev K.B. Robot-assisted radical prostatectomy. Functional result. Part I. Pirogov Russian Journal of Surgery. 2019;3:111–20 (In Russ.). DOI: 10.17116/hirurgia2019031111