The weird world of ovarian dermoid cysts

Well, I did call this blog ‘multifaceted’…

I’d never heard of teratomas or dermoid cysts until April, when I was diagnosed with a large cyst on my left ovary during investigations after I suffered a massive pulmonary embolism out of the blue with no known risk factors. [side note: the NHS is amazing and saved my life – thanks Lewisham Hospital]

The gynae doctor who gave me the diagnosis sensibly told me enough to stop me doing too much online research – basically it is a type of cyst that is almost always benign and is made from a variety of tissue, most commonly including skin, fat and hair but often also bony material. Around 10-13% of ovarian tumours are dermoid cysts (source).

Once I was on the mend I did do some cautious research of course (I am a librarian after all) but didn’t delve too deeply until my cyst was removed at the end of July. I found I could stomach (sorry) the whole topic rather more once I knew there wasn’t a cyst pressing on my internal organs and blood vessels in a potentially life-threatening manner, and had an incentive to do research as friends and family had lots of questions – how big was it? How much did it weigh? How long had it been there? Where on earth did it come from?

Once I’d learned enough to have a go at answering those questions, I thought it only right to share the fruits of my brief literature search with the wider world. I hope you enjoy my little annotated bibliography safe in the knowledge that you’ll only see disgusting images of cysts if you click through to links that I’ve indicated have them – an advantage of my list over researching this topic via a search engine or Wikipedia!

Read to the end for the most clickbaity journal article title I’ve ever seen; to my great surprise the payoff was justified.

[and yeah, I have been very lazy and not made proper citations, sorry folks…]

Overview

Management of giant ovarian teratoma: A case series and review of the literature
[includes images if you scroll down enough]

On reading this I learned that my cyst was officially GIANT (20cm – giant cysts are anything over 15 cm). 30% of people with giant cysts did not report any symptoms [I hadn’t really noticed anything before my embolism]. This article focuses on how to manage giant cysts (basically whether to remove via keyhole surgery or open surgery) but has some useful general info too and some slightly gross images.

Weight

Mandible like structure with fourteen teeth in a benign cystic teratoma
[links to images at end but not embedded]

Ok, so this is maybe the time to disclose that when the doctors opened up my cyst they found a small malformed jawbone with five teeth on it. From the scans I’ve seen I think they look like premolars or molars which tallies with the article on teeth below. The doctors were pretty gleeful when they told me about my cyst (having checked I wanted to know!) as none of them had seen a jawbone in one before, including the head of the department!

Anyway, the patient in this article had similar cyst contents to me (14 teeth on a jawbone plus the usual other stuff). Their cyst was slightly smaller (18 x 16 x 15 cm) and weighed 1.8kg. So my best estimate is that mine weighed around 2kg, and this seems about right based on my own weight loss since the cyst was removed.

Growth rate

The growth pattern of ovarian dermoid cysts: a prospective study in premenopausal and postmenopausal women

Typically *very* low in the group studied (mean average 1.8mm a year, highest 16.8mm a year) but this is a study which excluded any cysts growing at over 20mm per year so is not terribly helpful.  My cyst must have grown much faster than their average rate else I wouldn’t be old enough to have one that size.

Origin

Ovarian Mature Cystic Teratoma Containing Homunculus: A Case Report
[link is to abstract; article PDF includes images]

“Despite a number of conflicting theories (7-10) to explain the histogenesis of teratomas, the most probable ones are misplaced blastomere and parthenogenetic development of a germ cell.”

A blastomere is a cell originating from division of a fertilised egg. Parthenogenetic development is basically asexual cell reproduction (I think of it as an unfertilised egg going rogue) and seems to be the dominant theory.

I can’t really move on without mentioning that this article discusses a fetiform teratoma ie a cyst containing a homunculus, something with enough differentiated and organised tissue to resemble a human form. Around 24 had ever been reported at time this article was written. *shudder*

Pulmonary Embolism and benign cysts

Suprarenal vena caval thrombosis and pulmonary embolism associated with a benign ovarian cyst
[first page only; includes scan images]

This is the only article I could find that documented a PE caused by a benign ovarian cyst but for all I know it may not be unusual enough for articles to be written about it. There’s no evidence I had a thrombosis in my vena cava as I had typical DVT symptoms (calf pain) before my PE.

Unusual cyst contents

Dental structures in benign ovarian cystic teratomas (dermoid cysts): A study of ten cases with a review of the literature
[abstract only]

This article looks at teeth found in dermoid cysts and found they are most often pre-molar or molar. Generally neither baby nor adult in form but between the two.

“The teeth within a tumor tended not to form normal morphologic sequences. It is concluded that dental structures in ovarian teratomas are products of normal genetic/epigenetic events modified to a greater or lesser degree by unknown factors in the tumor environment.”

Benign Mature Cystic Teratoma Mimicking Normal Mandibular Development
[includes images]

“the excised teratoma showed a well-formed mandible with bone, teeth, skin, and hair”

Giant mature ovarian cystic teratoma including more than 300 teeth
[abstract only]

300? Really?! That’s just showing off.

Lactating breast tissue in benign cystic teratoma
[abstract only]

Blimey.

Benign cystic teratoma of ovary containing a homunculus
[includes very grainy images]

Another homunculus aka fetiform teratoma.

And finally…

Unusual dermoid cyst with surprise
[abstract only, includes photo; my god what a photo]

HELL YES IT WOULD DEFINITELY BE A SURPRISE IF YOU FOUND THAT GROWING ON YOUR OVARY.

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What I learned this week about intersectionality and privilege

Two events this week have really helped me think about these related issues and the privilege I hold as an urban, middle class cis white woman without disabilities.

First, Natacha Kennedy gave a powerful talk to my local Labour Party on International Women’s Day about trans rights.  All the below is my understanding of what she explained.

There are two choices when a child discloses that they are not the gender they were assigned at birth. Acceptance or nonacceptance.

Trans people face a serious threat of street harassment and violence, even worse than what cis women face.  There’s an extremely high rate of mental health issues, self harm and attempted suicide among trans children and adults.

Changes are planned to the Gender Recognition Act to streamline the process of changing legal gender, making it cheaper and less demeaning. Self identification has been legislated for in several countries already including Argentina and Ireland. Emerging evidence in Ireland of a dramatic drop in mental health issues for trans people after this law change. There is NO evidence ANYWHERE that this law change has happened that men have pretended to be trans in order to enter women only spaces and carry out abuse.

***

The second event was a conversation between authors Reni Eddo-Lodge and Chimamanda Ngozi Adichie as part of the Women of the World Festival in London at Southbank Centre.   Chimamanda shared an anecdote:

A white feminist actor was asked about her feminism. “Oh it’s not about me,” she replied, “it’s about the women of colour who are being oppressed.”

No! Both women found this deference to black women weird and false.

Better to say:  “This, this and this have all happened to me because I’m a woman in a patriarchal society. Now imagine how much worse it would be if I was black, or disabled, or trans.”

Trans women are women.  But women are all different and bring different life experiences to their feminism. This applies to trans women too, who have a deep experience of transphobia and oppression that cis women cannot experience for themselves.

This is what Chimamanda says she meant when she said trans women were different from other women. My only criticism is that I think she should have acknowledged the power imbalance by prefacing her remarks with a clear acceptance of trans women as women.

Chimamanda hates reading theory and finds it boring. She loves literature and memoirs; people’s stories; and has read a number of trans people memoirs.

I appreciated Chimamanda acknowledging her own class privilege (and cis privilege) and sharing that she felt a prickle of defensiveness when either issue is raised, which gave her some empathy with white people’s reactions to discussing race. She admitted it is hard to acknowledge privilege and harder still to act to lessen it.  I definitely feel that defensiveness and need to be aware of it and not project my feelings onto others or blame them for pointing out power imbalances and injustices. I will always make mistakes so want to get better at acknowledging them and doing better the next time.

Work links (weekly)

Posted from Diigo. The rest of my favorite links are here.

Alternatives to Delicious.com stacks

Edit 24/7/12: Gary Green has written a good explanation of what stacks are and why he liked them, if you wanted more background info.

Unfortunately Delicious has just announced that they plan to stop supporting Stacks in August. Users will still be able to save bookmarks to Delicious, but won’t be able to make a page (stack) of links where they choose the image for each link, change the order of the links, etc. Update 24/7/12: on Twitter yesterday, Delicious told me “While stacks are going away, visual tag & link displays are in development that we think your library is gonna love!”. I pointed out it might have made more sense to develop these features before removing the existing stacks functionality, but hey ho.

I co-run a Keeping Up-to-date With Your Field workshop for staff at my conservatoire, and this year a few members of staff were excited by this feature of Delicious, and keen to use it to curate pages of links for their students. I therefore quickly collated a a few alternative options for them, and thought I’d blog it here to plug the gap until Phil Bradley does it better!

 1. Delicious tags instead of stacks

If you want students to look at a selection of links, you could give them all the same tag and then send students the link to that tag (or put it on Moodle). For example, here’s my library’s links on keeping up to date on Delicious.

The downside is that you can’t choose the order of links – they’re ordered by the date you saved them.

2. Diigo

Diigo is another social bookmarking site like Delicious, and it allows you to make lists – these resemble image-free stacks and let you edit the order of links. An example list is below:

Text view

Visual view (via ‘Play as webslides’ link at top-right)

Diigo also offer a free educational account where you can set up student accounts and put them in private groups.

3. Scoop.it

These look the most similar visually to stacks. I haven’t used the site myself but had it recommended by Susan Merrick (a school teacher/librarian) at the recent London LibraryTeachMeet (which I’ve nearly finished writing up, honest!)

Downside: looks like there’s a limit of five pages (topics) per free account.

4. Jog the Web

This leads students through a menu of websites which are loaded in the same window – good if you want them to look at sites in a specific order. This was also recommended by Susan Merrick.

Downside: I have some concerns about the longevity of this site as the FAQ and support forum are inactive. Use at your own risk!