Journal of Medicine and Health (JMH)
Vol. 5 No. 1 February 2023

e-ISSN: 2442-5257
https://doi.org/10.28932/jmh.v5i1.2473

Case Report

A Case of Giant Dermoid Cyst at Sacrococcygeal in Adult at “X”
Hospital in Bandung
Laporan Kasus Giant Kista Dermoid pada Regio Sakrokoksigeal di Rumah Sakit “X” di
Bandung
Farid Yudoyono1,2*, Christian Ade2, Hasan Baraqbah1,2, Adhitya R Yudhadi1
1Neurospine and Pain Center, Santosa Hospital Bandung Kopo
Jl. K.H Wahid Hasyim No.461-463, Bandung, Jawa Barat, 40227, Indonesia
2Department of Neurosurgery, Padjadjaran University Faculty of Medicine, Bandung
Indonesia
Jl. Pasteur no.38, Bandung, Jawa Barat, 40161, Indonesia
*Corresponding author
Email: faridspine@gmail.com
Received: April 29, 2020
Accepted: December 23, 2022

Abstract
Dermoid cysts are benign tumors that can be found anywhere in the body. There is no
dermoid cysts clear data yet in Indonesia. In the spine, these tumors generally occur in the
lumbar region and are often accompanied by congenital spinal dysrafism and/or dermal sinus
passages. Dermoid cysts arise from abnormal growth of the ectodermal folds during pregnancy.
Its incidence is 0.7 – 1.8% of all central nervous system tumors. The aim of reported this case is
to highlight the role of a diagnostic and evaluate the surgical outcome. A 47 year old female
patient with a lump in the sacrococcygeal area measuring 20 x 18 x 16 cm, with hard and soft
consistency. MRI images show a hypo and hyperintense mass without spinal deformity. After the
tumor was removed, the patient was allowed to go home for the 2nd day without complications.
In conclusion, extraspinal dermoid cyst is a rare case that requires special diagnostic and
surgical modalities to provide better clinical results.
Keywords: dermoid cyst; excision; sacrococcygeal; spinal dysraphism
How to Cite:
Yudoyono F, Ade C, Baraqbah H, Yudhadi AR. A case of giant dermoid cyst at sacrococcygeal
in adult at “x” hospital in Bandung. Journal of Medicine and Health. 2023; 5(1), 74-9. DOI:
https://doi.org/10.28932/jmh.v5i1.2473
© 2023 The Authors. This work is licensed under a Creative Commons AttributionNonCommercial 4.0 International License.

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Vol. 5 No. 1 February 2023

A Case Of Giant...
e-ISSN: 2442-5257

Case Report
Abstrak
Kista dermoid adalah tumor jinak yang dapat ditemukan di mana saja di tubuh. Insiden
kasus kista dermoid di Indonesia belum ada data yang pasti. Di tulang belakang, tumor ini
umumnya terjadi di daerah pinggang dan sering disertai disrafisme tulang belakang bawaan
dan/atau saluran sinus dermal. Kista dermoid timbul dari pertumbuhan abnormal lipatan
ektodermal selama kehamilan. Insidensinya adalah 0,7 – 1,8% dari semua tumor sistem saraf
pusat. Tujuan dari penulisan laporan kasus ini adalah untuk menekankan pentingnya peran
diagnostik dan mengevaluasi hasil bedah. Seorang pasien wanita berusia 47 tahun dengan
benjolan di daerah sacrococcygeal berukuran 20 x 18 x 16 cm, dengan konsistensi keras dan
lunak. Gambar MRI menunjukkan massa hipo dan hiperintens tanpa kelainan bentuk tulang
belakang. Setelah tumor diangkat, pasien diperbolehkan pulang untuk hari ke-2 tanpa
komplikasi. Simpulan, kista dermoid ekstraspinal merupakan kasus langka yang memerlukan
modalitas diagnostik dan bedah khusus untuk memberikan hasil klinis yang lebih baik.
Kata kunci: eksisi; kista dermoid; spinal dysraphism; sakrokoksigeal

Introduction
Dermoid cysts are benign tumors when located in the spine usually accompanied by
congenital spinal dysraphism or the dermal sinus tract. 1,2 Dermoid cysts originate from growth
abnormalities in the ectodermal fold. The peak incidence of these diseases occurs in the age of
twenty to thirty.3 The symptoms are caused by the effect of the increased volume of the tumors
which has compression effect to the surrounding nerve and soft tissue. 3,4 Rupture of the skin is
associated with high rates of morbidity and mortality.5 Dermoid cysts are rare disease, where the
disease only covers 0.7-1.8% of all central nervous system tumors, especially tumors that occur
in adults and are located in the intramedullary.6
MRI is the choice of imaging modality for this case. These cysts generally have uni- or
multilocular cyst lesions with varying intensity characteristics because of the varying cyst
contents. Components of the cyst are divided into two: fluid and lipids. Fluid in cysts gives a
picture of hypointense, whereas lipids in cysts give a picture of hyperintense on T2WI MRI.
Based on the components that are most numerous in cysts, the intensity of MR images can be
different. Generally, enhancements to intravenous contrast are low, depending on the amount of
soft tissue in the cyst.7,8 Other abnormalities can occur together with dermoid cysts, for example
myelomeningocele, hypertrichosis, dermal sinus tract, or a combination of all three. 3,7 In
dermoid cysts, skin components, such as oil glands, sweat glands, hair and hair follicles can be
found; these skin components are not found in epidermoid cysts. Yellow cystic fluid generally
contains desquamated epithelium and oil gland secretion products. 7
This is slow-growing tumor, so the signs and symptoms of these tumors are found in the
age of around twenty to thirties.3 and compress of nerve structures around the tumor. All

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Vol. 5 No. 1 February 2023

A Case Of Giant...
e-ISSN: 2442-5257

Case Report
symptoms of a large space-occupying-lesion in the spinal cord can be seen, but have different
intensities. In some literature, the number of male sufferers is slightly more than females.3,4
The risk of morbidity and mortality is associated with intact cystic walls. In the event of
rupture, the prognosis is not good, where there is spread of lipid droplets in the spinal cord.5
Although passive transport of lipid droplets through the cerebrospinal fluid pathway is still
unknown, dissemination of lipids to the spinal cord to the cystern and intracranial ventricles can
occur through the central canal.7
Spontaneous, traumatic, or intraoperative rupture can be asymptomatic or can cause
symptoms such as headaches, nausea, vomiting, meningism, or worsening neurological
symptoms that can cause coma. These symptoms are thought to be symptoms of chemical or
aseptic meningitis or secondary arachnoiditis caused by leakage of fatty and proteinous
components in the subarachnoid space. Excision is the main treatment that can reduce
symptoms.8,9
Although dermoid cysts are mostly benign tumors, there are several case reports that
describe the transformation of these tumors into malignant tumors in the form of squamous cell
carcinoma. If dermoid cysts are excised completely, recurrence is rarely found in these cases.
Previous study reported the dermoid cysts that turn into malignant tumors are generally
associated with ovarian and intracerebral lesions. 10-12 Ino et al reported a case of a tumor found
in the lumbar vertebra which then turned into squamous cell carcinoma 6 years after surgery. 13
The etiology of the transformation to a malignant tumor is still unclear. It is concluded that the
cyst was actually malignant, but spread slowly. 14-16 This case is unique because dermoid cyst
occurred in exstrapinal space. The aim of reported this case is to highlight the role of a
diagnostic and evaluate the surgical outcome

Case Report
This case report has received Ethical Clearance from Santosa Hospital Committee No
483a/KET/DIR/SHBK/XII/2020. Female, 47-year-old presented with the complaints of a mass
in the sacrococcygeal region for 27 years and gradually increased in size. No complaints of
lower limb weakness or bowel and bladder dysfunction. On physical examination, a giant mass
20 x 18 x 16 cm in size. It was of variable consistency. From the non-contrast lumbosacral
T2WI MRI sagittal and axial show hypointense mixed with hyperintense and well demarcated.
No bone defect. (Figure 1) The patient was performed excision with mass size mass size
20x18x16 cm solid and capsulated, patient was discharged on day 2 without complication.

(Figure 2)

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Journal of Medicine and Health
Vol. 5 No. 1 February 2023

A Case Of Giant...
e-ISSN: 2442-5257

Case Report

Figure 1 A. T2WI MRI Sagital Image; B. Axial Show Hypointense Mixed with
Hyperintense and Well-Demarcated Lesion

Figure 2 A. Lateral View; B. Superior View Before Surgery; C. Macroscopic Mass After
Surgery Size 20x18x16 cm Solid and Capsulated

Discussion
Spinal dermoid cysts are benign tumors located in the lumbar spine; the tumor cannot
spread. However, the presence of these tumors can cause compression of the spinal nerves and
at some point a cyst rupture can occur and the cyst will be resected. 1-4

Figure 3 Microscopic View Show Cyst Lineage by Stratified Squamous Epithelium (Small
Arrow) and Keratin Filled Lumen with Adnexa Structure (Large Arrow)

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A Case Of Giant...
e-ISSN: 2442-5257

Case Report
A cyst is defined as a thin encapsulated structure that contains liquid secretion. Dermoid
cysts contain components of the skin and are coated by a layer of skin that can remove dead skin
cells. However, dead skin cells are not released into the environment out of the body, but will be
collected in cysts. Therefore, the cyst will slowly enlarge. Dermoid cysts have skin cells, the
production of components from these skin cells, other skin components (such as hair follicles,
hair or sweat glands) and can even contain other components (such as components from teeth,
oil, or blood).3,7(Figure 3)
Previous studies revealed dermoid cyst intramedullary and intraspinal canal with a
progressive neurological deficit before surgery. 2,4-7 Dermoid cysts in the spine can be associated
with other spinal abnormalities, such as spinal dysraphism, dermal sinus tract, spina bifida,
spina bifida occulta, or myelomeningocele. 7 Dermoid cysts can be discovered accidentally
during treatment or diagnosis of one of these disorders.
This case is rare and unique because the dermoid cyst that occured in extraspinal space
causes compression of the surrounding soft tissue, no compression of neural structures. No
transformation into malignancy during

follow-up period. Spinal epidermoid cysts are

uncommon. They comprise between 0.5% and 1% of all spinal tumors but account for up to
10% of intraspinal tumors in children. 17-18 This makes it difficult to obtain data on case reports
and epidemiology from the last five years.

Conclusion
Extraspinal dermoid cyst is a rare case need to be considered as a differential diagnosis
for mass at sacrococcygeal. This condition requires special diagnostic and surgical modalities to
provide better clinical results. Long-term survival with no complications could be achieved with
complete resection. Early detection for cases like this is very important.

Acknowledgment
There is no potential conflict of interest relevant to this article reported. No specific
grant was provided for this article. All authors took part in the design of the study, literature
review, and writing the manuscript.

References
1.
2.

Najjar MW, Kusske JA, Hasso AN. Dorsal intramedullary dermoids. Neurosurg Rev. 2005;28(4):320-5
Shubha AM, Mohanty S, Das K, Garg I. Congenital inclusion tumors in the spinal dysraphism. Indian J Pediatr.
2010;77(2):167-70.

J Med Health.2023;5(1):74-9

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Journal of Medicine and Health
Vol. 5 No. 1 February 2023

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3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.

15.
16.

17.
18.

Cha JG, Paik SH, Park JS, Kim DH. Ruptured spinal dermoid cyst with disseminated intracranial fat droplets.
Br J Radiol. 2006;938(79):167-9.
Do-Dai DD, Brooks MK, Goldkamp A, Erbay S,Bhadelia RA. Magnetic Resonance imaging of intramedullary
spinal cord lesions:A pictorial review. Curr Probl Diagn Radiol.2010;4(39):160-85
Altay H, Kitiş O, Calli C, Yünten N. A spinal dermoid tumor that ruptured into the subarachnoidal space and
syrinx cavity. Diagn Interv Radiol. 2006;12(4):171-3.
Wojak HJ, Henker C, Erbersdobler A, Piek J. Unruptured Spinal Dermoid Cyst with Progressive Paraplegia.
Med Case Rep. 2017;3(59):1-4
Graham DV, Tampieri D, Villemure JG. Intramedullary dermoid Tumor diagnosed with the assistance of
magnetic resonance imaging. Neurosurgery.1988;23(6):765-7.
Van A alst J, Hoekstra F, Beuls EA, Cornips EM, Weber JW, etal. Intraspinal dermoid and epidermoid tumor
report of 18 cases and Reappraisal of the literature. Pediatr Neurosurg. 2009;45(4):281-90
Patankar AP, Sheth JH. DermoidCyst: A rare intramedullary inclusion cyst. Asian J Neurosurg.2012;2(7):81-3.
Selim MA, Razi A, Lankerani M. Squamous cell carcinoma arising from ovarian benign cystic teratoma.
Am J Obstet Gynecol.1984;6(150):790–2.
Bereston ES, Ney C. Squamous cell carcinoma arising in a chronic osteomyelitic sinus tract with metastasis.
Arch Surg.1941;43(2):257–68.
Krumerman MS, Chung A. Squamous Cell carcinoma arising benign cystic teratoma of the ovary:case report of
four cases and review of the literature. Cancer.1977;39(3):1237–42.
Ino M, Nagase M, Tsuge K, Kamata K, Udagawa E. Malignant squamous cell carcinoma arising in a lumbar
dermoid cyst. Int Orthop.1995;19(3):185–6.
Tangjitgamol S, Manusirivithaya S, Sheanakul C, Leelahakorn S, Thawaramara T, Jesadapatarakul S. Squamous
cell carcinoma arising from dermoid cyst: Case reports and review of literature. Int J Gynecol Cancer.
2003;13(4):558-563.
Sanghera P, El Modir A, Simon J. Malignant transformation within a dermoid cyst: a case report and literature
review. Arch Gynecol Obstet. 2006;274(3):178-180.
Gainford MC, Tinker A, Carter J, Petru E, Nicklin J, Quinn M, et al. Malignant transformation within ovarian
dermoid cysts: an audit of treatment received and patient outcomes. an Australia New Zealand gynaecological
oncology group (ANZGOG) and gynaecologic cancer intergroup (GCIG) study. Int J Gynecol Cancer. 2010
20(1):75-81
Wein S, Sharma R, Dembla S. Spinal epidermoid cyst. Reference article, Radiopaedia.org Accessed on 22 Jan
2023. Available from https://doi.org/10.53347/rID-19659
Van aalst J, Hoekstra F, Beuls EA. Intraspinal dermoid and epidermoid tumors: report of 18 cases and
reappraisal of the literature. Pediatr Neurosurg. 2009;45 (4): 281-90.

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