Dermoid cyst in an elderly man and its successful surgical treatment using robotic technologies: Clinical case

Introduction. Primary mature retroperitoneal dermoid cysts constitute a fairly rare pathology that is uncommon in men aged 50 years and older. In this article, we describe a case of a 68-year-old man with a large mature paravesical dermoid cyst extending into the rectovesical pouch and its successful surgical treatment using a da Vinci Xi robotic surgical system. Aim. To discuss the advantages of robotic access in the removal of large pelvic masses to achieve a speedy, successful outcome. Materials and methods. An oval-shaped mass in the right side of the lesser pelvis measuring 66×85×62 mm was detected during a pelvic MRI exam performed as a follow-up after an adenomectomy. The attempted ultrasoundguided puncture was unsuccessful. A diagnostic laparoscopy was indicated to collect biopsy samples of the mass, with its subsequent removal if possible. Histology results verified the presence of a retroperitoneal dermoid cyst. In order to ascertain its localization and relationship with surrounding tissues, as well as to determine the structural parameters, a PET CT scan was performed. The planned robot-assisted laparoscopic excision of the retroperitoneal pelvic mass was performed. Results and discussion. A general visual examination showed the removed specimen to be a cyst filled with a mushy mass of dirty white color, having an unpleasant odor and a large number of follicles. The histological study revealed an inflamed, ruptured retroperitoneal dermoid cyst. Conclusion. The clinical case shows that old age mature dermoid cysts are found in the elderly; however, with timely diagnosis, they can be fully treated.