Dermoid cyst
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Today I had a patient who was 27 weeks pregnant who presented to L&D on Sunday afternoon for suspicious tracing. She was placed on magnesium sulfate therapy and given betamethasone injections. This morning, as soon as the doctors turned over report at 8 am, they decided that they needed to do a c-section due to repetitive deep variables and late decelerations that had been occurring over the last several hours and did not appear to be getting any better. After delivery of the 1003 gm (2 lb 3 oz) baby boy who was intubated and sent to NICU, they found that the placenta had a 70% abruption. Then as they were beginning to tuck things in for the closure, they noticed a cyst on her right ovary (pt told me later that she knew she had a cyst there, but figured she would have to deal with it later...probably a few years). They decided to go ahead and remove it. It was a dermoid cyst, rather ugly one, about 4-5 cm round. (For those who don't remember this term from school and never dealt with it in practice, it is a bizarre tumor, usually benign, in the ovary that contains a diversity of tissue, teeth, bone, thyroid, etc. It develoops from a totipotential germ cell..a primary oocyte...that is retained within the egg sac which can give rise to all orders of cells necessary to form mature tissues and often recognizable structures such as sebaceous material, neural tissue and teeth.) Ours had a huge wad of hair on top of it (looked like a brillo pad on top) and you could see teeth underneath the outside layer of the cyst. It was so weird looking. Needless to say, we sent it off to pathology along with the placenta for studying.