What's Hairy and Toothy and Most Likely Benign?

Feb. 15, 2008 — -- The Hypochondriac Asks: Could it be a dermoid ovarian cyst?

The Angst: The Hypochondriac has been feeling pressure on the left side of her abdomen. It feels hard like a lump, and sometimes it migrates to her right. She complains that she feels it more "when I'm thin, in the summer, at my fighting weight. When there's no fat in the way when I press around my gut looking for it."

After mentioning it to her rushed and none-too-sympathetic gynecologist in Brooklyn, the doctor presses around, feels nothing and says it is probably "just bowel." More recently her primary physician schedules her for an ultrasound, which she ditches. Twice.

From The Hypochondriac's perspective the downside of actually having a medical test is that one misses out on the fun of speculation. So instead of rescheduling she's wondering if she has acquired the most horrifying noncancerous growth she could find on the Internet. The Dermoid Ovarian Cyst.

The Truth: Ovarian dermoids used to be called "homunculus" — little men — because they are capable of exhibiting many of the physical tissues one finds in a human. That would be long hair, bits of teeth, cartilage and skin with sweat glands.

Sean Dowdy, an OB/GYN at the Mayo Clinic, says dermoids are the most common benign growths in women in their 30s and 40s.

"It's also the most common benign growth in pregnancy, but that's just due to the age [that many women are when they get pregnant], not the state of being pregnant."

The more common medical term for dermoids is teratoma. That's Greek for monstrous tumor. They grow from the cells involved in reproduction, such as an egg, or the tissue surrounding an ovary. That's why some say they can develop such a ghoulish appearance — sometimes even eyeballs and hands.

Says Kevin Ault, a gynecologist at Emory University:

"Everyone who has been to med school has a great story about dermoids. They are the urban legend of medicine — that's how common and strange they are. But I've never run into anything more exotic than a tooth. That and hair."

In many cases, women don't feel anything at all. They just go in for a regular pelvic exam, and, if the tumor is large enough, the tumor is discovered then. Sometimes they are discovered when she undergoes a CT scan or ultrasound for some unrelated reason. The good news is they rarely affect fertility. "They just peel right out," said Ault. Cheerfully.

In case you're wondering, a dermoid is not a cousin to a fetus. "Not even close," said Karen Rosewater, a New York adolescent medicine physician who has diagnosed a couple of young patients with dermoids. In fact, men can develop them too, generally in their testes.

Dowdy, who says he's handled at least 50, says that like most benign tumors they grow very slowly, and rarely cause pain. Unless they twist around themselves or rupture. But what about psychological pain? Dowdy is a little puzzled. "Usually patients are just relieved they're benign," he said.

But all that hair and teeth! That would put The Hypochondriac right over the edge. According to Rosewater: "It can be scary, but that is not what would be emphasized to the patient when the diagnosis is made. It's not particularly relevant to their treatment."

Right. Dermoids are usually benign, and no matter how cringe-inducing, that's what matters most.

Postscript: The Hypochondriac finally went in for the ultrasound. The doctors found nothing. Not a lump, not a mass, not Rosemary's Baby, not a teratoma, not a homunculus. She said she was relieved, but was she, perhaps, just a tiny bit disappointed as well?