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…]


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.


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.


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]


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]



Library day in the life 5

Last day of the Library day in the life project for now; hope something interesting happens!


  • Arrived to email about the restructuring of the senior management team, so had a read and a chat about it with colleagues. Doesn’t look like it’ll affect anyone at lower levels which is good.
  • Read Eduserv newsletter and case study on installation of OpenAthens LA 2.0. This is a product we’re thinking of implementing at college so I’ll send a link on to the head of IT who’s investigating our authentication options.
  • Brief interlude from ‘proper’ work helping a colleague with their laptop that’s been playing up. Typically it booted fine when I was there watching it, but did a bit of tidying up, updating programs and advised to get backups done and recovery DVDs made asap.
  • Listserv emails as usual.
  • Quick bit of research for a colleague who runs the theatre ephemera collection which has digital images on our catalogue (using Hyperion). She wanted to investigate the possibility of watermarking those images, so I found some software that should do the job and looked at how to replace the existing Hyperion images with new ones. Think it’s either a slow, manual job or a scary dump and reload the lot, but will wait to see how keen she is to do it before investigating further.
  • Colleague asked whether junior students are covered by one of our invoice reports as a couple hadn’t been generated. I cursed myself for no longer methodically listing system config changes – I kept this up for a year or so but let it slide when things got hectic. Think the problem is that I did add juniors to be covered but only quite recently, hence the missing invoices from late last summer.
  • Bits of admin, booking a day off next week etc. Realised I forgot to have a tea break…
  • Wrote up a few potential presentation ideas for systems conference in June – hoping I can speak there as it gives me a better chance of getting funding to attend!
  • Lunch including errands – been selling some spare books on Amazon so have regular trips to the Post Office at the moment!
  • Went out to the library desk to pick up some serials cards for adding to the system; got caught up in helping out at the desk as it was busy, so issued some CDs and helped a student find the Orchestral Musician CD-ROMs he needed. Also found a letter in my pigeonhole informing me of our massive 0.5% pay rise this year ;)
  • I’m gradually adding control records for our journals to Symphony’s serials module so we can automatically add issues to our catalogue and be reminded to claim missing issues. It’s a slow process but I’m trying to get at least a few done each week. In the process I’m also adding/tidying/improving the journals’ catalogue records, which is a slow process as I hardly do any cataloguing these days!
  • Tea break, chat with colleague and enjoyed watching the brief snow flurry outside – strange wind currents in the courtyard meant it was falling upwards at one point…
  • Back to serials module. The journal I set up from scratch today has regular special issues, so used the opportunity to put together a quick procedural guide on how to check in a special issue for the library assistants. Also wrote up how to check in a normal issue, and one received out of sequence.
  • Quick sysadmin task to finish the day – cleared out a couple of hundred old system reports. Regretted that I hadn’t found time to update my stats spreadsheet this week – means it’ll be doubly tedious next week! (really must find a way to automate the process a bit more…)

There’s my week done then. Rushing off to town now but may post thoughts on the experience later!

Library day in the life 4

Day four of five; hope this is still vaguely interesting!


  • Boss chatted with us about negotiation skills training she went on yesterday afternoon. Sounded very interesting but also very difficult! She was also taught the art of ‘flinching’ which none of us could do without laughing, and was told to eliminate ‘floppy’ language which seems fair enough in a negotiation scenario but she was advised to eliminate it in day-to-day management as well. She wasn’t impressed by this as it meant going from politely asking to get stuff done to demanding it!
  • Usual catching up with listservs etc, plus planning route to MLT meeting at British Library later, as the DLR station we usually change at is closed at the moment.
  • Made a few tweaks to user ed session based on ideas from colleague. Continued work on handout.
  • Tea break!
  • Finished off handout and got it down to one A4 page; hoping that means it’s less fussy than BMus ones.
  • Early lunch (noon).
  • Admin – scheduling meetings and user ed. Finally getting to do a session for our Indian Music students based at the Bhavan Centre which should be interesting! It’s not until mid-Feb so I’ve got a bit of time to flesh out my plans for content.
  • Travel with colleague to British Library for MLT meeting.
  • Meeting itself went smoothly with stand-in chair, and finished just after 5. Did post-mortem on completed funded scoping study and discussed how to disseminate results more widely, then looked at progress of next project and a potential funding request coming our way, plus ongoing items of business.

Library day in the life 3


  • Usually start work at 11am on Wednesdays – arrived by 10.30am today for dull reasons I won’t go into, so spent a bit of time chatting to colleague/writing up comments for a IAML prize submission before work proper began.
  • Caught up with listserv emails, and got sucked into a discussion on the LIS-WEB2 list. Hoping my contribution makes sense!
  • Finally got back to writing BA session.
  • Received notes from our last library staff meeting a couple of weeks ago and gave them a quick read to ensure I’d either carried out my action points or was at least aware of them.
  • Lunch – spent some time perusing my library’s copy of Time Out to find things to do with a friend who’s visiting at the weekend.
  • Afternoon – back to BA session. Finding a fair bit of relevant material with our online resources which is good – there’s definitely been an improvement since we started running musical theatre courses.
  • Again mixed with bits of admin, e.g. new BMus handbook coming through with updated reading lists. Unfortunately think we’re seeing them at the same time as the students. I’ll need to consider how we add websites to our reading lists on the catalogue – considering something using our account as feel ‘cataloguing’ websites is usually a Bad Idea.
  • Tea break at 4.30pm.
  • Finally finished BA session cribsheet, just into my #latenightlibrarian time! Sent it to colleague so she can tweak as desired for her class. Also sent it to colleague helping out with my session so he can take a quick look beforehand. I always feel these cribsheets take way longer than they should; perhaps I’m being harsh on myself, or perhaps I’m overly detailed and pedantic in my session-writing. Probably both.
  • Printed off some papers for MLT meeting tomorrow. Emailed trustee standing in as chair to explain a couple of agenda items.
  • Bit more admin, including going through to-do list ticking off items and starring new top priorities.
  • Went on to do something I hadn’t starred because it was easy and quick to do! (checking Surveymonkey pro account cost and that it could be paid monthly just for the months we need pro features).
  • Made a good start on BA session handout – what do other people put on library session handouts? I had student feedback that mine were ‘fussy’ or something to that effect.
  • Nearly closing time (7pm) so went to help colleague empty library and tidy up – library unusually busy right up to closing as there’s three deadlines tomorrow. Then hometime!

Library day in the life 2

Continuing the Library day in the life project all week if I can!


  • Arrived at work and heard that my boss had the same brief illness as me but is coming in later. Feeling guilty about that!
  • Chatted to colleagues about how the user ed went yesterday – good chance to view attitudes of staff and students, e.g. how important the immediacy of full-text is to them. I knew it was important, but the expectation that *everything* would be instantly available still surprised me, especially at that level of study.
  • Read listserv emails as yesterday.
  • Emailed lecturer from yesterday’s user ed to pass on attendance register and solicit feedback.
  • Paperwork tidy-up – mainly sorting out stuff from user ed so the folder’s ready for the next sessions. Ended up filing away some other paperwork that’s been lingering on my desk for a few weeks so the current stuff is more visible.
  • While clearing out found some hastily scribbled notes on a UNIX command from when I was investigating backup procedures before Christmas, so typed these up in a document for future reference.
  • Helped colleague with systems problem – hold wizard wasn’t acting as expected. I found and explained the ‘correct’ process to do what was needed, and agreed the wizard wasn’t intuitive!
  • Tea break :)
  • Wrote urgent email to academic – we’re running brand-new training for 3rd year musical theatre students next week which is supposed to help them with their personal projects (dissertation equivalent). Great, but unfortunately I’ve not managed to find out what their project proposals are yet! For now I’m going with the vague indications I was given months ago and am asking specific focused questions in the hope I’ll get a quick response.
  • Bit of admin, including replying to emails from yesterday afternoon, and confirming meeting in a couple of weeks with colleague at sister college library. We’re collaboratively writing a staff development session on web 2.0 type stuff. Bonus: arranged meeting for straight after lunch, so that day I get to eat at their wonderful college cafe :)
  • Back to writing the training for next week! Luckily a large amount can be adapted from existing sessions, just changing the focus and example searches to suit the audience (hopefully). I don’t find doing this a lot of fun though, so end up procrastinating by finding other little tasks to do (e.g. the admin above!).
  • Academic mentioned earlier turned up with printout of proposal topic summaries, hurrah! Didn’t quite sound like he’d actually seen my email, but the main thing is that I now know what sort of material will help them. Phew. Used info to continue work on session (which was along the right lines)
  • Lunch.
  • Chat with colleague who’s leading one of the two user ed sessions next week to give her the proposal topics and show her my session cribsheet so far – gives her a chance to play around with the resources (one of which is new to us) and look out a few relevant print resources so we can remind the students of their existence!
  • More work on fleshing out cribsheet, interspersed with bits of admin, including a couple more MLT emails finalising arrangements for Thursday. Repeat until 5pm (I can take an afternoon tea break but often don’t get round to it).

Library day in the life

I’m finally joining in with the Library day in the life project (4th time lucky!). Joeyanne Libraryanne is joining in too and has posted a good intro to the project along with her blogpost for today. Basically, it involves lots of librarians writing about their day to show what they get up to. Here’s what I did today:

  • Unusually, I didn’t get to work for 9. I was unwell yesterday evening and was worried that it might be a stomach bug, so ate a small breakfast first thing, then waited at home until 9am to check all was well before boarding a train! My normal leaving time is around 8am.
  • Reached my desk around 10.15am. I was supposed to implement changes to AV loan lengths/fines on the system then restart it first thing; slightly scuppered by my illness. Luckily the library was still quiet so I was able to get everyone off the system to restart it so the config changes took effect (an advantage of working in a small library!). I then tested the new loan period and fines and asked a colleague to stick a sign up at the desk and on our noticeboard to add to the email we’d already sent advertising the changes.
  • Next I dealt with inbox emails from the weekend  –  a Naxos Music Library access problem plus login details request for another audio resource; details of a student change of course requiring library and Athens account extension. My boss had received another report of Naxos trouble so she asked the company to investigate.
  • Colleague passed on an answerphone message re: trouble accessing JSTOR remotely. Phoned back, established student had Athens account and advised on access (and how to reset password if needed).
  • Answered call put through to me (not sure why) from reception, from a lady clearing out house of deceased relative. Established donation was small number of old piano tutors plus certificates from my college from the 1920s, and she agreed to post the items down to us (we don’t tend to collect small donations, especially as she was based in Norfolk and we’re in London!). I don’t usually have so many phone calls!
  • Lib asst sent me draft of requested poster advertising AV loan changes, saying he felt it was a bit boring, so I spent a fun ten minutes or so making it pretty (inserting background photo etc). Turns out Word prints background images differently from how it displays them on print preview etc, but it looked amusing so I left it! (loads of CD shelves reaching into the horizon). Also posted news item about loan changes to student intranet to cover all bases.
  • Caught up on listserv emails from the weekend – Sirsi customer lists plus various librarian/tech lists.
  • Lunch – luckily feeling a lot better so polished off a cheese salad roll, apple and packet of crisps.
  • Received an email from the chair of the Music Libraries Trust (MLT). I’m secretary, we’re meeting on Thursday and he’d just found he couldn’t attend so wanted to check I was happy with alternative chairing arrangements before he made them.
  • Reviewed notes from meeting with my boss last Friday, and updated my to-do list with tasks accordingly. Glad I did this as I spotted a secondary task related to the CD/DVD changes (updating overdue notice text with the new fine information) that I’d completely forgotten about!
  • Bits and pieces preparing for user ed – picking up equipment, room setup, going over script etc, followed by…
  • …1.5 hour user ed session for Masters Jazz students. We had 7 out of 9 attend which is pretty good. Their lecturer stayed and participated in the session, which is great because a) it demonstrates the value of what we do to the students (since they hopefully already have a positive relationship with the lecturer), b) it means I get direct feedback from the lecturer about the content and delivery of the session, and c) he got a mini-refresher course on the online resources we cover! The session went quite well I think; my boss was helping out and said some the students went ‘off-piste’, but were at least mostly looking at the resources when I was, which is fine by me. Luckily there was at least one student who really engaged and asked interesting questions which helps the session along. Was quite amusing when ‘Irish Pirate Ballads’ or similar popped up as a featured resource on Music Online; I then used it as an example recording and we marvelled at the bearded men in the liner notes ;)
  • That finished at 4.30 and I got a round of applause (!!!); by the time we’d shut down the training PCs (located in a shared training/meeting room so they have to be folded away), taken back the equipment etc. it was 5pm and the end of my day. I’m staying on a bit as my friend lives nearer my work than home, and we’re off to a pub quiz in a bit. I’m finishing off this blog post until it’s time to go.

Does this look like a lot to do in one day? Most days I look back, wonder where all the time went and despair at how little seems to have got done! I’ve seen other people are planning to carry on with the day in the life project all week; think I’ll try to do the same as it’s interesting to see where all the time goes.

My library roots/routes

Working at the BL, 2009Working out of the office at the BL, 2009

Thought I’d join in with the Library Routes Project and blog about how I ended up as a librarian, and how I got to my current post.


I was a very early reader; apparently I taught myself to read a bit when I was 3, and the teachers at nursery school worried about me for a while because I insisted on reading all the picture books before I’d go and play with the other children. I used my public library regularly and had my own bookshelves too, holding favourite reads that I’d plough through over and over again. When I was a little older a few friends joked that I’d grow up to be a librarian, and this would bug me for some reason, I guess because it implied I was nerdy. Anyway I loved computers, and librarians don’t do anything computery, do they?

My parents had drummed into me from an early age that I was expected to go to uni, and so I did. I considered studying Computer Science for a long while, but ended up going for one of my other favourite subjects: Music at Southampton University. By this time I was going out with my now-husband, and moved in with his family over the holidays so I could get work in London. His mum worked for the local council, saw an advert for vacation library assistants, and encouraged me to apply. I thought ‘why not?’ as the pay was decent for a holiday job and the hours were ideal, and I was fortunate enough to get a post.

My role was an unusual one – a vacation assistant based almost entirely behind the scenes, working for the community library service rather than a particular branch. Lots of photocopying worksheets for kids doing summer events; basic circulation, processing and withdrawing old stock; helping out colleagues with IT bits and pieces etc. One of the most interesting bits for me was preparing playgroup loans – crates of 30-odd books with a set number from each section of stock kept in rolling stacks (board books, picture books, multicultural, non-fiction etc). A few times I got to go out as a second person on the mobile library which was based at my workplace; unfortunately this was never a fantastic experience as the mobile staff only wanted a helper if they were going somewhere a bit dodgy! I ended up doing this job for all three of my student summers, getting slightly more responsible tasks each time, but I still didn’t think of librarianship as a career, maybe because outreach/children’s work didn’t particularly appeal.


What finally got me thinking seriously about it as a career was a blog post a friend of mine did when she was considering what to do after uni. She linked to a few different pages about librarianship and graduate trainee schemes, including the CILIP website. I’d had no other serious career plans at the time (writing jingles for a living sounded fun but precarious) and suddenly this seemed like a decent option, with a logical career progression which meant I’d know what to do for the next few years! I ended up following the ‘traditional’ career route she’d researched pretty closely – in my final year at uni I applied to some traineeships and spent the next year at the London Library (a lovely place to work and to visit if you get the chance). From there I got a place on the full-time MSc in Library and Info Studies at City plus AHRC funding (yes, I was a truly lucky one), enjoying the geeky modules, tolerating the rest and writing my dissertation on using tagging to describe music according to its mood/emotion.

Between finishing the diploma and starting the dissertation I worked for a month as a library assistant at Trinity College of Music as sick leave cover, and apparently I made a positive impression! This experience got my foot in the door of music libraries, and I’m sure played a big part in me getting an Assistant Librarian job at the Royal College of Music after completing my dissertation (after several unsuccessful interviews elsewhere, including a cringeworthy experience at the BBC for which I was woefully underprepared…).

My current job is Librarian (Systems and User Education) at Trinity College of Music – as a temp I envied my colleague doing the job, so when I heard it was becoming vacant I just had to go for it. To my great fortune I was appointed and this week I’ll have been working at TCM for two years! I love the systems side of things, and have been incredibly lucky as the Jerwood Library’s a very supportive workplace and my boss has encouraged me to get plenty of training and attend events to continue my professional development (although I’ve decided not to formally charter for now). The user education side comes less naturally to me – I do love helping people to find information and empower them to do it themselves, but I’m not a natural ‘teacher’ of groups. I also look after online resources and marketing, which means I get to use Facebook for work!

Since starting at TCM I’ve become embroiled in the world of music libraries – I’ve joined IAML(UK & Irl) and attended one of their Annual Study Weekends which was very interesting and good fun. I’m also the current secretary of the Music Libraries Trust which is another new experience for me and fascinating to see how a grant-making group works from the inside! Who knows what awaits me in the long term – right now I feel quite strongly that I wouldn’t like my boss’ job leading a whole library because of the amount of bureaucracy and diplomacy that requires. A 100% systems/online resources/e-librarian type job in the future is appealing but I’m happy where I am at the moment. I got to where I am today with a large amount of good luck (e.g. the timing of various vacancies); I think serendipity must play a role in most people’s careers!